PREVENTIVE DRUG BENEFIT PROGRAM

Transcription

1 PREVENTIVE DRUG BENEFIT PROGRAM FOR GROUPS USING THE BASIC OR ENHANCED Employee Guide Effective January 1, Blue Cross and Blue Shield of Texas, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association

2 PREVENTIVE DRUG BENEFIT PROGRAM FOR GROUPS USING THE BASIC OR ENHANCED INTRODUCTION Blue Cross and Blue Shield of Texas (BCBSTX) administers the preventive drug benefit for your group s high deductible health plan ( HDHP ), which has been designed for use with Health Savings Accounts ( HSAs ). The preventive drug benefit program includes categories of prescription drugs that are frequently used for preventive purposes. If your doctor has prescribed any of them to you for preventive purposes, then you and your HSA-eligible dependents may have coverage before satisfying your HDHP deductible. Below and on the following pages is a guide listing some examples of drugs that are commonly prescribed for preventive purposes. Coverage of all medications is still subject to your HDHP limitations, exclusions and out-of-pocket requirements (for example, your prescription drug payment levels). Coverage of some medications or drug products may be covered under your medical benefit. IMPORTANT REMINDER: These drugs could also at times be prescribed for treatment purposes. As a result, the listing of a drug in the Guide does not mean that it will be covered by your particular benefit plan before your HDHP deductible is satisfied. If your doctor has prescribed a listed drug for treatment purposes (and not preventive purposes) then your plan does not provide coverage for that drug before your HDHP deductible is satisfied. As each individual s medical circumstances are different, and because proper classification is necessary for you to ensure you are complying with your HDHP tax obligations, it is important for you to confirm the purpose of the prescription with your doctor. Please call the number on the back of your member ID card when your doctor confirms to you that he or she prescribed one of the listed drugs for treatment purposes so your claims can be processed correctly. Unless you provide us with this information, claims for the drugs listed in the Guide will be processed as preventive, and you or your doctor may be asked by us to provide medical records showing that the drug you re taking is being used for prevention. Remember, if you improperly classify the drug, it may result in adverse tax consequences so please be sure to take the confirming step to properly classify your claim. REMEMBER: Just because a drug is on the list, doesn t always mean it is covered. FOLLOW THESE STEPS: 1. Find your drug in the Guide. 2. Talk to your doctor about whether your drug is in fact being prescribed for preventive purposes (and not treatment purposes). 3. If prescribed for treatment purposes, call the number on the back of your ID card to let us know. 4. If prescribed for preventive purposes, there is no need to call Page 2 of 7

3 This Guide lists some, but not all, examples of drugs that are commonly prescribed for preventive purposes. It is being provided to you at your employer s request as a resource to help you in managing your prescription drug benefits under your employer s HDHP. This list does not include all drugs that may be prescribed as preventive. It will be reviewed periodically and is subject to change. Coverage of all medications is still subject to your HDHP limitations, exclusions and out-of pocket requirements (for example, your prescription drug payment levels). Coverage of some medications or drug products may be covered under your medical benefit. It is important to note, for the reasons described in the Introduction to this Guide, that the listing of a drug in the Guide does not mean that it will be covered by your particular benefit plan before your HDHP deductible is satisfied. Please follow the steps outlined in the Introduction to ensure you are properly directing the processing of your claims. The preventive drug program currently includes prescription drugs in the following categories: Anti-coagulants/anti-platelets High cholesterol Diabetes medications Osteoporosis Diabetic supplies Respiratory High blood pressure The drugs in each category are listed alphabetically on the following pages. Generic drugs are listed in bold. Brand drugs are listed in all CAPITAL letters. * Generic equivalent available Please be reminded that Health Savings Accounts (HSAs) have tax and legal ramifications. Blue Cross and Blue Shield of Texas does not provide legal or tax advice, and nothing herein should be construed as legal or tax advice. These materials, and any tax-related statements in them, are not intended or written to be used, and cannot be used or relied on, for the purpose of avoiding tax penalties. Tax-related statements, if any, may have been written in connection with the promotion or marketing of the transaction(s) or matter(s) addressed by these materials. You should seek advice based on your particular circumstances from an independent tax advisor regarding the tax consequences of specific health insurance plans or products Page 3 of 7

4 ANTI-COAGULANTS/ ANTI-PLATELETS AGGRENOX AGRYLIN* anagrelide ASPIRIN/DIPYRIDAMOLE BRILINTA cilostazol clopidogrel COUMADIN* dipyridamole EFFIENT ELIQUIS PERSANTINE* PLAVIX* PLETAL* PRADAXA SAVAYSA warfarin XARELTO ZONTIVITY DIABETES MEDICATIONS Hypoglycemic Agents GLUCAGEN HYPOKIT GLUCAGON EMERGENCY KIT Insulin Only AFREZZA APIDRA HUMALOG HUMULIN LANTUS LEVEMIR NOVOLIN RELION NOVOLOG RELION R TOUJEO SOLOSTAR Orals Only acarbose ACTOPLUS MET* ACTOPLUS MET XR ACTOS* ALOGLIPTIN ALOGLIPTIN/METFORMIN ALOGLIPTIN/PIOGLITAZONE AMARYL* CHLORPROPAMIDE CYCLOSET DIABETA DUETACT* FARXIGA FORTAMET* glimepiride glipizide glipizide ext-release glipizide/metformin GLUCOPHAGE* GLUCOPHAGE XR* GLUCOTROL* GLUCOTROL XL* GLUCOVANCE* GLUMETZA* GLYBURIDE, distributor of Diabeta glyburide, generics of Micronase glyburide/metformin glyburide micronized GLYNASE* GLYSET* GLYXAMBI INVOKAMET INVOKANA JANUMET JANUMET XR JANUVIA JARDIANCE JENTADUETO JENTADUETO XR KAZANO KOMBIGLYZE XR metformin metformin ext-release miglitol nateglinide NESINA NOVOLIN ONGLYZA OSENI pioglitazone pioglitazone/glimepiride pioglitazone/metformin PRANDIMET PRANDIN* PRECOSE* repaglinide REPAGLINIDE/METFORMIN RIOMET STARLIX* SYMLINPEN SYNJARDY TOLAZAMIDE TOLBUTAMIDE TRADJENTA TRESIBA XIGDUO XR Other Diabetic Injectables BYDUREON BYETTA TANZEUM TRULICITY VICTOZA DIABETIC SUPPLIES Alcohol prep pads, swabs Calibration liquid Insulin Infusion Pump Tubing, IV sets, reservoirs, and adapters Insulin syringes Lancets Lancet devices Pen needles Test strips (acetone, blood and urine glucose, blood and urine ketone) HIGH BLOOD PRESSURE ACCUPRIL* ACCURETIC* acebutolol ACEON* ADALAT CC* ALDACTAZIDE MG* ALDACTAZIDE MG ALDACTONE* ALTACE* amiloride amiloride/hydrochlorothiazide amlodipine amlodipine/atorvastatin amlodipine/benazepril amlodipine/valsartan amlodipine/valsartan/ hydrochlorothiazide Page 4 of 7

5 AMTURNIDE ATACAND* ATACAND HCT* atenolol atenolol/chlorthalidone AVALIDE* AVAPRO* AZOR benazepril benazepril/hydrochlorothiazide BENICAR BENICAR HCT betaxolol BIDIL bisoprolol bisoprolol/hydrochlorothiazide bumetanide BUMEX* BYSTOLIC CADUET* CALAN* CALAN SR* candesartan candesartan/hydrochlorothiazide captopril CAPTOPRIL/HYDROCHLOROTHIAZIDE CARDIZEM* CARDIZEM CD* CARDIZEM LA 120 MG CARDIZEM LA 180 MG, 240 MG, 300 MG, 360 MG, 420 MG* CARDURA* carvedilol CATAPRES* CATAPRES-TTS* CHLOROTHIAZIDE 250 MG chlorothiazide 500 mg CHLORTHALIDONE clonidine CLORPRES COREG* COREG CR CORGARD* CORZIDE* COZAAR* DEMADEX* DEMSER DIBENZYLINE* diltiazem diltiazem ext-release DIOVAN* DIOVAN HCT* DIURIL doxazosin DUTOPROL DYAZIDE* DYRENIUM EDARBI EDARBYCLOR enalapril enalapril/hydrochlorothiazide EPANED eplerenone EPROSARTAN EXFORGE* EXFORGE HCT* felodipine ext-release fosinopril fosinopril/hydrochlorothiazide FUROSEMIDE SOLN 8 MG/ML furosemide soln 10 mg/ml; tabs guanfacine hydralazine hydrochlorothiazide HYZAAR* indapamide INDERAL LA* INDERAL XL INNOPRAN XL INSPRA* irbesartan irbesartan/hydrochlorothiazide isradipine KERLONE* labetalol LASIX* LEVATOL lisinopril lisinopril/hydrochlorothiazide LOPRESSOR* LOPRESSOR HCT* losartan losartan/hydrochlorothiazide LOTENSIN* LOTENSIN HCT* LOTREL* MAVIK* MAXZIDE* MAXZIDE-25* METHYCLOTHIAZIDE methyldopa METHYLDOPA/ HYDROCHLOROTHIAZIDE metolazone metoprolol succinate ext-release metoprolol tartrate 25 mg, 50 mg, 100 mg METOPROLOL TARTRATE 37.5 MG, 75 MG metoprolol/hydrochlorothiazide MICARDIS* MICARDIS HCT* MICROZIDE* MINIPRESS* minoxidil moexipril moexipril/hydrochlorothiazide nadolol nadolol/bendroflumethiazide nicardipine nifedipine nifedipine ext-release nisoldipine ext-release 8.5 mg, 17 mg, 34 mg NISOLDIPINE EXT-RELEASE 20 MG, 25.5 MG, 30 MG, 40 MG NORVASC* perindopril phenoxybenzamine pindolol prazosin PRESTALIA PRINIVIL* PROCARDIA* PROCARDIA XL* PROPRANOLOL SOLN propranolol tabs propranolol ext-release PROPRANOLOL/ HYDROCHLOROTHIAZIDE quinapril quinapril/hydrochlorothiazide ramipril SECTRAL* spironolactone spironolactone/hydrochlorothiazide SULAR* Page 5 of 7

6 TARKA* TEKAMLO TEKTURNA TEKTURNA HCT telmisartan telmisartan/amlodipine telmisartan/hydrochlorothiazide TENEX* TENORETIC* TENORMIN* terazosin TEVETEN 600 MG TEVETEN HCT TIAZAC* TIMOLOL TABS TOPROL XL* torsemide trandolapril trandolapril/verapamil ext-release triamterene/hydrochlorothiazide caps, mg; tabs TRIAMTERENE/ HYDROCHLOROTHIAZIDE CAPS, MG TRIBENZOR TWYNSTA* valsartan valsartan/hydrochlorothiazide VASERETIC* VASOTEC* verapamil verapamil ext-release VERELAN* VERELAN PM* ZEBETA* ZESTORETIC* ZESTRIL* ZIAC* HIGH CHOLESTEROL ALTOPREV amlodipine/atorvastatin ANTARA atorvastatin CADUET* cholestyramine cholestyramine light COLESTID* colestipol CRESTOR* EQUAPAX/ATORVASTATIN/COQ10 FENOFIBRATE CAPS fenofibrate micronized fenofibrate tabs FENOFIBRIC ACID fenofibric acid delayed-release FENOGLIDE* FIBRICOR fluvastatin fluvastatin ext-release gemfibrozil LESCOL* LESCOL XL* LIPITOR* LIPOFEN LIVALO LOFIBRA* LOPID* lovastatin LOVAZA* MEVACOR* niacin ext-release NIACOR NIASPAN* omega-3-acid ethyl esters PRAVACHOL* pravastatin QUESTRAN* QUESTRAN LIGHT* rosuvastatin simvastatin TRICOR* TRIGLIDE TRILIPIX* VASCEPA VYTORIN WELCHOL ZETIA ZOCOR* OSTEOPOROSIS ACTONEL* alendronate 5 mg, 10 mg, 35 mg, 70 mg ALENDRONATE 40 MG ALENDRONATE SOLN ATELVIA* BINOSTO BONIVA* calcitonin-salmon EVISTA* FORTICAL FOSAMAX* FOSAMAX PLUS D ibandronate MIACALCIN NASAL* raloxifene risedronate risedronate delayed-release RESPIRATORY ACCOLATE* acetylcysteine ADVAIR DISKUS ADVAIR HFA AEROSPAN albuterol albuterol ext-release ALVESCO ANORO ELLIPTA ARCAPTA NEOHALER ARNUITY ELLIPTA ASMANEX HFA ASMANEX TWISTHALER ATROVENT HFA BEVESPI AEROSPHERE BREO ELLIPTA BROVANA budesonide inhal susp COMBIVENT RESPIMAT CROMOLYN SODIUM INHAL SOLN DALIRESP DULERA dyphylline/guaifenesin ELIXOPHYLLIN FLOVENT DISKUS FLOVENT HFA FORADIL AEROLIZER INCRUSE ELLIPTA ipratropium inhal soln ipratropium/albuterol inhal soln levalbuterol inhal soln LUFYLLIN METAPROTERENOL montelukast Page 6 of 7

7 PERFOROMIST PROAIR HFA PROAIR RESPICLICK PROVENTIL HFA PULMICORT FLEXHALER PULMICORT RESPULES QVAR SEREVENT DISKUS SINGULAIR* SPIRIVA HANDIHALER SPIRIVA RESPIMAT STIOLTO RESPIMAT STRIVERDI RESPIMAT SYMBICORT terbutaline THEO-24 theophylline theophylline ext-release TUDORZA PRESSAIR UTIBRON NEOHALER VENTOLIN HFA VOSPIRE ER* XOPENEX* XOPENEX CONCENTRATE* XOPENEX HFA zafirlukast Third-party brand names are the property of their respective owners. Page 7 of 7