Non-sedating antihistamines and brand-name PPIs no longer covered April 1, 2011
Effective April 1, 2011, non-sedating antihistamines (NSAs) and brand-name proton pump inhibitors (PPIs) will be excluded from coverage for commercial and Medicaid members. Generic and over-the-counter PPIs will continue to be covered. Priority Health will be informing members taking these drugs that coverage is ending. Affected members will receive a letter in early March. The letter encourages members taking brand-name PPIs to talk with their provider about covered alternatives.
| Covered PPIs | Not covered PPIs |
|---|
Prilosec OTC
omeprazole
Prevacid OTC
lansoprazole
lansoprazole disintegrating tab
pantoprazole
Zegerid OTC |
Aciphex
Dexilant
Nexium
Vimovo |
Why is Priority Health ending coverage of NSAs?
- Several non-sedating antihistamines are now available over the counter.
- Only a few NSAs remain as prescription only, Xyzal and Clarinex. Both of these products have very low utilization by Priority Health members.
- Members can often purchase NSAs over-the-counter for less than the cost of their copay.
Why is Priority Health ending coverage of brand-name PPIs? - Head-to-head studies show similar safety and efficacy among brand-name and generic PPIs.
- While drug metabolism and interactions vary among the products, all PPIs carry similar risks for adverse drug reactions.
- Brand-name PPIs cost 10 times as much, on average, as generic PPIs.
- Consumer Reports has named Prilosec OTC, omeprazole and Prevacid OTC as “Best Buy” drugs in the PPI class.
- To receive a copy of Priority Health’s clinical summary document for PPIs, contact your PAR.
Topics:
