Pharmacy Changes Effective May 1, 2009
In order to keep the pharmacy benefit affordable for members and provide access to high quality, effective medication options, several changes to the pharmacy benefit will be implemented beginning May 1, 2009. The changes include two new pharmacy prior authorization programs and several medication copay changes. These program changes apply to migraine and antiemetic medications.
Migraine Medication Copay Changes
Triptans are medications used to treat certain migraine and cluster headache conditions. The copay for triptans, Amerge®, Axert®, Frova®, Zomig®, and Zomig ZMT®, will be $50, for up to a 34-day supply (Note: All triptans are subject to quantity limits). These triptans are being moved to the highest copay tier of medications to encourage the use of Sumatriptan (generic for Imitrex®) and other preferred name brand products for migraine and cluster headaches.
Triptans |
|
Generic Medication ($10 copay) |
Sumatriptan (generic for Imitrex®) |
|
|
Preferred Brands ($30 copay) |
Maxalt®, Maxalt MLT®, Relpax® |
|
|
Non-Preferred Brands ($50 copay) |
Amerge®, Axert®, Frova®, Treximet®, Zomig®, and Zomig ZMT® |
Please talk to your provider about choosing preferred name brand medications or generics to see if they may be appropriate for you. You can save the most money by using generic medications, instead of name brand drugs.
Coverage Review for Migraine Medications
Also beginning May 1, 2009, all users of Amerge®, Axert®, Frova®, Treximet®, Zomig®, and Zomig ZMT® will be subject to a formulary coverage review. (Note: All triptans are subject to quantity limits). Coverage will only be granted if your provider documents that you have experienced failure or intolerance with a preferred migraine medication (Sumatriptan, Maxalt, Maxalt MLT or Relpax). Providers may call Medco toll-free at 1-800-417-1764, from 8:00 a.m. to 9:00 p.m., Eastern Time, Monday through Friday, to request a review.
Members will be responsible for the full cost of the prescription if the provider does not receive approval during the coverage review. Members currently taking generic Sumatriptan, Maxalt, Maxalt MLT or Relpax will not be subject to the coverage review.
Click here for frequently asked questions (FAQs), or call Medco Customer Service at 1-800-336-5933 for more information.
Antiemetic (anti-nausea medication) Quantity Limits
Antiemetics are medications used to prevent and treat chemotherapy-induced nausea and vomiting. Prescriptions for antiemetics (Anzemet®, Emend®, Kytril®(granisetron), Granisol®, Zofran®(ondansetron), Cesamet®, and Sancuso®) will have quantity limits. The quantities are based on FDA-approved prescribing and safety information, clinical guidelines, and uses that are considered safe, reasonable and effective.
Of course, if additional quantities are necessary, your provider may request a review for approval. Providers may call Medco toll-free at 1-800-417-1764, from 8:00 a.m. to 9:00 p.m., Eastern Time, Monday through Friday, to request a review. Please keep in mind that members will be responsible for the cost of the medication that exceeds the quantity allowed if the provider does not receive approval during the coverage review.
Click here for more information and for frequently asked questions (FAQs), or call Medco Customer Service at 1-800-336-5933 for more information.
