Prescription drug changes

Over the next couple of months, we’re implementing four pharmacy management initiatives to help manage per-capita health care costs.

1. With nearly all non-sedating antihistamine (NSAs) allergy medicines readily available over-the-counter at a low cost, many of our members will actually save money when they purchase over-the-counter NSAs. Effective May 1, 2011, both brand name and generic NSAs will no longer be covered. Commonly used NSAs include:
   • Claritin (loratadine)
   • Clarinex
   • Allegra (fexofenadine)
   • Claritin-D
   • Zyrtec (cetirizine)
   • Zyrtec-D
   • Xyzal
   • Allegra-D
2. Studies show that generic and over-the-counter proton pump inhibitors (PPIs), which combat stomach problems like heartburn and acid reflux, are just as effective as brand name versions. Plus, brand-name PPIs cost up to 10 times more than generic and over-the-counter PPIs. Effective May 1, 2011, Priority Health will only cover generic and over-the-counter versions of PPIs.
   
   We'll continue to cover the following generic and over-the-counter PPIs:
   • Prilosec OTC* (omeprazole)
   • Prevacid OTC* (lansoprazole)
   • Pantoprazole
     * Consumers Reports has named Prilosec OTC and Prevacid OTC as “Best Buy” PPIs.
   Brand-name PPIs (no longer covered) include:
   • Aciphex
   • Nexium
   • Dexilant
3. Members with contraceptive coverage will be encouraged to use Express Scripts home delivery, which provides a three-month supply for just 2 or 2.5 copays. Effective May 1, members will pay 1 copay per one-month supply of contraceptive medications at a retail pharmacy (3 copays for a three-month supply). This applies to both new and current members. (For more information about Express Scripts, go to priorityhealth.com and search “home delivery.”)
4. Generic equivalents are generally as effective as their brand-name counterparts, but cost much less. Effective immediately, we’ll be waiving the first copay when members switch from brands to generics for certain medications. This is part of our ongoing generic savings campaign. We're sending letters to your employees who take select brand-name drugs encouraging them to save by switching. The letters detail the projected savings and explain that generics are safe and effective.

If you have questions about any of these initiatives, please contact your agent or account representative.

Topics: Preventive care