Nasal Steroid Step Therapy Program

Beginning October 1, 2009, certain nasal steroid allergy medications will require a coverage review.   This step therapy program is being implemented to maintain an affordable prescription drug benefit and to promote the use of generic and preferred medications.

Nasal steroids are nasal sprays containing corticosteroids that are used to treat nasal allergy symptoms including congestion, sneezing and runny nose.

The State Health Plan’s preferred nasal steroids will continue to be covered without a coverage review.  They are:  fluticasone, flunisolide, and Nasonex®.

The following non-preferred nasal steroids will now require a coverage review:  Beconase AQ®, Rhinocort AQ®, Nasacort AQ®, Omnaris®and Veramyst®.  If you purchase any of these medications after October 1, 2009, you will be responsible for the entire cost if prior approval is not obtained.

The following chart compares the copays and annual cost for the generic, preferred and non-preferred nasal steroid medications:


Nasal Steroid Allergy Medication

Copay
(30-day supply)

Annual cost

Generic medications:  fluticasone and flunisolide

$10

$120

Preferred brand name medication:  Nasonex®

$35

$420

Non-preferred brand name medications:  *Beconase AQ®, Rhinocort AQ®, Nasacort AQ®, Omnaris®, and Veramyst®
*With approved coverage review.

$55

$660

Ask your doctor to consider prescribing fluticasone, flunisolide or Nasonex so you can pay less for your nasal steroid allergy medications.

  • Talk to your doctor and ask whether fluticasone, flunisolide or Nasonex would be right for you.
  • If your doctor agrees, ask for a new prescription.

If your doctor prescribes a non-preferred nasal steroid allergy medication, you or your doctor can request a coverage review by calling Medco toll-free at 1-800-417-1764, 8:00 a.m. to 9:00 p.m., Eastern Time, Monday through Friday. If coverage is approved, you will pay the appropriate copay for the brand name prescription.

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

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