Allergy Prior Authorization Program (NSA Step Therapy Program)
Members taking prescription Xyzal®, Clarinex®, Clarinex D®, Allegra® (fexofenadine), Allegra D®, cetirizine or Singulair® for allergies, please note the following:
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.
Singulair use for asthma (presence of asthma medication must be in the member’s pharmacy claims history in the past 12 months) is not subject to the prior authorization requirement.
Exceptions, which must be documented by the provider, are:
- Intolerance (sensitivity, drug allergy or adverse effect) to treatment with an OTC NSA, or
- 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 may click here for information on over-the-counter allergy treatment options and money saving coupons.
Members should also check with their pharmacist or provider if they have questions about the OTC products, or to see if an OTC allergy medication may be the right choice for them.
Click here (34 KB) for frequently asked questions, or call Medco customer service at 1-800-336-5933.
Click here (25 KB) to view the member letter.
Click here (74 KB) for the prior approval criteria.
