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Letter to Members Taking NSA Medications
Letters explaining a new prior authorization program will be mailed from Medco to State Health Plan members currently taking a non-sedating antihistamine (NSA) for allergies. The letters will be received by members during the week of February 18. Members taking prescription Xyzal®, Clarinex®, Clarinex D®, Allegra® (fexofenadine), Allegra D®, cetirizine or Singulair® for allergies should click here for information on over-the-counter allergy treatment options and money saving coupons. Note: Members should check with their pharmacist or provider if they have questions about the OTC products.
Click here for the Member Letter. |
Allergy Prior Authorization Program (NSA Step Therapy Program)
Beginning April 1, 2008, all members, 6 years old and up, with a prescription for non-sedating antihistamines (NSA), as well as prescriptions for Singulair for allergies, will be required to use an over-the-counter (OTC) non-sedating antihistamine [Claritin® or Alavert® (loratadine) or Zyrtec® (cetirizine)] prior to approval of the prescription product. Exceptions, which must be documented by the provider, are:
- Intolerance (sensitivity, drug allergy or adverse effect) to treatment with an OTC NSA
- Verification that the OTC NSA has been ineffective after a 30-day trial
The Non-sedating Antihistamine (NSA) Step Therapy Program will ensure that the most cost-effective medications are used first by members in the treatment of seasonal allergies, whenever possible. OTC non-sedating antihistamine options are safe and effective allergy medications and, in most cases, may be used as a first choice in treating seasonal allergy symptoms.
Members taking a prescription allergy medication who have already tried the OTC alternatives will need to have their provider complete a coverage review with Medco. Providers should call Medco toll-free at 1-800-417-1764, from 8:00 am to 9:00 pm eastern time, Monday through Friday to request a review. Unless the doctor obtains approval during a review, members will be responsible for the full cost of the medication.
Click here for frequently asked questions, or call Medco customer service at 1-800-336-5933. |
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Member Education on OTC Allergy Medications
Over the past several months, the State Health Plan has been educating members on the potential cost savings when using over-the-counter (OTC) allergy treatment options.
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