Over-the-Counter (OTC) Heartburn Medication Coverage
OTC Heartburn Medications Covered with a $5 Copay
In November 2009, Prevacid® (lansoprazole) 15mg capsules (called Prevacid® 24HR) became available as an over-the-counter (OTC) product. It is anticipated that an over-the-counter version of Zegerid® (omeprazole/sodium bicarbonate) 20mg will become available in early 2010.
Prilosec OTC® (omeprazole 20mg) and generic omeprazole OTC are currently available as one of your low cost OTC heartburn medication choices. In January 2010,
Prevacid® 24HR will also be covered by the pharmacy benefit. The OTC products contain the same active ingredients and are as strong, safe and effective as the prescription products.
Members can save money by using the pharmacy benefit to cover Prilosec OTC®, omeprazole OTC, Prevacid® 24HR and Zegerid OTC (when it is available) with a copay of only $5 for a 42-day supply. A prescription is required for members to purchase the OTC products for the $5 copay. The OTC products do not have the same prior authorization requirements and quantity limits as the more costly prescription-only alternatives in the same drug class.
Please see the attached flier if you would like to try an OTC product for your heartburn symptoms.
Prescription Products with OTC Equivalents No Longer Covered
As of February 1, 2010, Prevacid (lansoprazole) 15mg capsules will only be covered as the OTC Prevacid® 24HR product and brand name Prilosec (omeprazole) 20mg will only be covered as Prilosec OTC™ or omeprazole OTC. Prescription brand Prevacid 15mg capsules and generic lansoprazole capsules, as well as prescription brand Prilosec 20mg capsules, will no longer be covered under the pharmacy benefit because the same formulations are now available as OTC products. When OTC Zegerid becomes available, the equivalent prescription strength brand name and generic products will also no longer be covered.Your provider should write you a prescription for OTC Prevacid 24HR or Prilosec OTC (42-count), which will be covered with a $5 copay for a 42-day supply. The OTC equivalents are a more cost effective option for members.
Example of member savings: A member taking prescription brand Prevacid 15mg capsules paying $55 for a 30-day supply will save over $600 per year on copays by switching to the OTC product. Please note: A prescription will be required for the Prevacid 24HR.
Be sure to check with your provider or pharmacist if you have questions about the OTC products or to see if an OTC heartburn medication may be right for you. For a chart comparing the costs of alternate heartburn medications click here.
If you have questions about these medication coverage changes, please visit the FAQs or call the toll free Member Services number, 1-800-336-5933.
