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Lexapro^®

As of October 1, 2008, the copay for  Lexapro^®  will be $50 for up to a 34-day supply.  If you refill your prescription on or after October 1, 2008, you will be subject to the new $50 copay.

Lexapro^® is being moved to the non-preferred tier of medications because there are several alternative generic medications available.  Generic medications are always State Health Plan-preferred medications. 

You can save money by using generic drugs instead of brand name drugs.  The copay for generic medications is only $10.  We encourage you to ask your provider whether one of the State Health Plan-preferred alternatives to Lexapro^® may be right for you. 

Click here  for more information and for frequently asked questions (FAQs), or call Medco customer service at 1-800-336-5933.

Coverage Review for new Lexapro^® and Luvox CR^®  Users

Also beginning October 1, 2008, all new users of Lexapro^® and Luvox CR^® will be subject to a formulary coverage review.  Coverage will only be provided if your provider documents that you have experienced failure or intolerance with at least two generic antidepressant medications.  Providers may 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.  Members will be responsible for the full cost of the Lexapro^® or Luvox CR^® prescription if the provider does not receive approval during the coverage review. 

Aciphex^® and Nexium^®

As of October 1, 2008, the copay for brand name heartburn medications Aciphex^® and Nexium^® will be $50 for up to a 34-day supply.  All brand name heartburn medications (Aciphex^®, Nexium^®, Prevacid^®, Prilosec^®, Protonix^®, and Zegerid^®) will now be covered at a $50 copay. 

Taking a brand name heartburn medication may cost you more than necessary.  By taking an over-the-counter (OTC) or generic heartburn medication you will save money.  Click here to learn more Ways to Save on heartburn medication and click here for money saving coupons.

Click here   for more information on Aciphex^® and click here for more information on Nexium^®. For a link to frequently asked questions (FAQs) click here, or call Medco customer service at 1-800-336-5933.

Aciphex^® Coverage Review

If you wish to remain on Aciphex^® you will be required to have your health care provider complete a coverage review with Medco, to determine whether Aciphex^® can continue to be covered.  If your doctor believes you should continue to take Aciphex^®, you or your doctor can request a coverage review as of October 1, 2008.  Providers may 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.  Members will be responsible for the full cost of the Aciphex^® prescription if the provider does not receive approval during the coverage review.

If you choose to continue taking Nexium^®, your health care provider will not be required to complete a coverage review.  Please note:  All prescription heartburn medications are subject to quantity limits.