Oregon Health Plan prescription benefit updates

Transcription

1 Oregon Health Plan prescription benefit updates EOCCO s prescription program is a pharmacy benefit that offers members a choice of safe and effective medication treatments. The program also helps you save money on prescription drugs. Periodically, medication coverage changes will occur. These changes allow us to maintain a comprehensive benefit and provide you with a formulary with choice that supports the program s ongoing stability. Please review the following expected pharmacy coverage updates. Please note, this information could change and does not represent every potential update to your benefits. Refer to your member handbook for specific tier and coverage information. Questions? Call our Pharmacy Customer Service team toll-free at Prescription coverage updates These expected EOCCO prescription tier and coverage updates go into effect for Product Name Medication Class Update Effective Date Additional Details Protonix Granule Packet Esomeprazole magnesium (Nexium) Lansoprazole (Prevacid) Rabeprazole (Aciphex) Dexilant/Kapidex (dexlansoprazole) Zegerid (omeprazole/sodium bicarbonate) as of as of as of as of as of as of Afrezza (insulin regular, human) inhalers Zafirlukast (Accolate) Leukotriene receptor antagonists Alternative(s) for asthma: montelukast. Asmanex (mometasone furoate) inhalers Alternative(s): Qvar (9/15/2015). For prior effective dates, please contact EOCCO 1

2 Alvesco (ciclesonide) inhalers Alternative(s): Qvar Foradil (formoterol fumarate) inhalers Perforomist ( formoterol fumarate) nebulizer solution Brovana (arformoterol tartrate) nebulizer solution Bydureon (exenatide microspheres) pens and vials Byetta (exenatide) pens Trulicity (dulaglutide) Namenda XR (memantine hcl XR) NMDA receptor antagonist Alternative(s): generic memantine hcl Onglyza (saxagliptan hcl) Alternative(s): Januvia, Janumet, Janumet XR, Tradjenta Doxycycline hyclate Tetracyclines Alternative: Doxycycline monohydrate Montelukast sodium (Singular) Leukotriene receptor antagonists Allergic rhinitis is not a covered condition on the OHP prioritized list of healthcare services. requirements added through inhalers indicated for Asthma diagnoses (E.G. Symbicort, Advair, Ventolin, etc..). Levalbuterol HCL (Xopenex) nebulizer solution Beta-Adrenergic agonists requirements added through Ventolin (formulary preferred albuterol inhaler), ProAir, Proventil, albuterol sulfate nebulizer solutions. Xopenex (levalbuterol HCL) HFA Beta-Adrenergic agonists requirements added through Ventolin (formulary preferred albuterol inhaler), ProAir, or Proventil (9/15/2015). For prior effective dates, please contact EOCCO 2

3 Apidra (insulin glulisine) required for insulins pens and Humalog (insulin lispro) required for insulins pens and Humalog Mix 50/50 (insulin lispro) cartridges and pens required for insulins pens and Humalog Mix 75/25 (insulin lispro) cartridges and pens required for insulins pens and Humulin 70/30 (insulin isophane [NPH] / insulin regular) pens required for insulins pens and Humulin N (insulin isophane [NPH]) pens required for insulins pens and Lantus (insulin glargine) required for insulins pens and Levemir (insulin detemir) pens required for insulins pens and Novolog (insulin aspart) required for insulins pens and Novolog Mix (insulin aspart protamine / insulin aspart) pens required for insulins pens and Noxafil (posaconoazole) Triazole antifungals required Xifaxin (rifaximin) Anti-infective agents (rifaximin) required added to ensure use meets the OHP prioritized list of healthcare services (covered diagnoses). Janumet (sitagliptin/metformin HCL) removed. Step therapy requirements will no longer apply. required (9/15/2015). For prior effective dates, please contact EOCCO 3

4 Janumet XR (sitagliptin/metformin HCL XR) removed. Step therapy requirements will no longer apply. required Januvia (sitagliptin) removed. Step therapy requirements will no longer apply. required Tradjenta (linagliptin) removed. Step therapy requirements will no longer apply. required Symlin (pramlintide acetate) Amylin analog removed. Step therapy requirements will no longer apply. required Tanzeum (albiglutide) removed. Step therapy requirements will no longer apply. required Victoza (liraglutide) removed. Step therapy requirements will no longer apply. required Chantix (varenicline) Smoking deterrents added to allow a member to receive two 90-day treatments per year. Diabetic test strips Diabetic supplies Removed all non-preferred test strips from Freestyle and Precision meters and test strips will become the preferred diabetic supply manufacturer. All other products will become non- Provider, Member and Pharmacy outreach will occur for this change. Advair Inhaled corticosteroid removed. 4/1/2015 Step therapy requirements will no longer apply. Protopic Topical immunosuppress ive agent 4/1/2015 methylphenidate CD (Metadate CD) ADHD treatment In alignment with FDA (Food & Drug Administration) dosing recommendations for safety, the following quantity limitations will be applied: 10mg, 20mg, 30mg, & 40mg allow 60 capsules per 30 days methylphenidate ER, methylphenidate SR, methylin ER (Ritalin SR, Metadate ER) 10mg & 20mg allow 90 tablets per 30 days (9/15/2015). For prior effective dates, please contact EOCCO 4

5 Methylpheidate LA (Ritalin LA) 20mg & 30mg allow 60 capsules per 30 days 40mg allow 30 capsules per 30 days methylphenidate solution (Methylin) 5mg/5mL allow 1800mL per 30 days 10mg/5mL allow 900mL per 30 days dextroamphetamine sulfate (Dexedrine) 5mg allow 60 capsules per 30 days 10mg & 15mg allow 120 capsules per 30 days Focalin XR 25mg & 35mg allow 30 capsules per 30 days clonidine ER (Kapvay) 0.1mg allow 120 tablets per 30 d ays dextroamphetamine sulfate solution (Procentra) 5mg/5mL allow 1200mL per 30 days Armour Thyroid, Nature-Throid, NP Thyroid, Westhroid, Westhroid-P Hypothyroidism treatment These medications will removed from the This document is provided for informational purposes only, and is intended as a quick reference. For cost and further details of the coverage, including exclusions, prior authorization requirements, any reduction or limitations and the terms under which the policy may be continued in force, contact your producer or Moda Health. Copyright 2015 Moda, Inc. All Rights Reserved. Health plans in provided by Moda Health Plan, Inc (9/15/2015). For prior effective dates, please contact EOCCO 5