FAQs For Nasal Steroid Step Therapy Program

  1. What are nasal steroid allergy medications?
  2. What are the most common prescribed nasal steroid allergy medications?
  3. Will a coverage review be required for the non-preferred nasal steroid allergy medications?
  4. How can I save money on my nasal steroid allergy medications?
  5. How can I obtain a coverage review?
  6. If I have further questions regarding this program, whom should I call?
  7. Why are you implementing this program?

1. What are nasal steroid allergy medications?
Nasal steroids are nasal sprays containing corticosteroids that are used to treat nasal symptoms such as congestion, sneezing and runny nose caused by seasonal or year-round allergies.

2. What are the most common prescribed nasal steroid allergy medications?
Fluticasone and Flunisolide are cost-effective generic nasal steroids. Nasonex® is the State Health Plan’s brand name preferred nasal steroid. Beconase AQ®, Rhinocort AQ®, Nasacort AQ®, Omnaris® and Veramyst® are brand name nasal steriods that members may see advertised. These medications are non-preferred and will result in higher out-of pocket costs than the generic or preferred nasal steroid options.

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3. Will a coverage review be required for the non-preferred nasal steroid allergy medications?
Yes. Starting October 1, 2009, Beconase AQ®, Rhinocort AQ®, Nasacort AQ®, Omnaris® and Veramyst® will require a coverage review. If you purchase any of these medications after October 1, 2009, you will be responsible for the entire cost of the prescription if prior approval is not obtained.

4. How can I save money on my nasal steroid allergy medications?
Speak with your doctor about trying a generic or preferred brand name nasal steroid. For example, the out of pocket cost for a generic is only $10 for a 30-day supply compared to a brand name which is $55 for a 30-day supply. See the chart below for additional information:

Tier Type

Nasal Steroid

Copay for 30-Day Supply

Annual Cost

Tier 1 - Generic

Fluticasone and flunisolide

$10

$120

Tier 2 - Preferred brand
(without a generic available)

Nasonex®

$35

$420

Tier 3 - Non-preferred brand
(without a generic available)

*Beconase AQ®, Rhinocort AQ®, Nasacort AQ®, Omnaris®and Veramyst®
*With approved coverage review.

$55

$660

5. How can I obtain a coverage review?
If your doctor recommends that you use a non-preferred nasal steroid allergy medication, you or your doctor can request a coverage review. He or she can call toll-free 1-800-417-1764, 8:00 a.m. to 9:00 p.m., Eastern Time, Monday through Friday. If the review is approved, you will pay the appropriate brand name copay for the prescription, which may be higher than what you would pay for the preferred alternatives.

6. If I have further questions regarding this program, whom should I call?
For further questions, you can call 1 800-336-5933 to speak to a Member Services representative.

7. Why are you implementing this program?
In order to maintain an affordable prescription drug benefit and to promote the use of generic and preferred medications.

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