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Prescription drug benefit changes affecting all anthem bcbs plans
Prescription Drug Benefit Changes Affecting All Anthem BlueCare & KeyCare
Plans in 2008
Effective April 1, 2008
, Anthem will begin excluding coverage for certain high-cost prescription drugs
currently on their prescription drug formulary where lower-cost, clinically equivalent medications in the
same therapeutic class are available. The generic options will continue to be covered. In certain
instances, lower-cost, clinically equivalent brand-name medications in the same therapeutic class also will
continue to be covered.
This change will include provisions for a health plan member to receive coverage for drugs not on
Anthem’s formulary in certain circumstances where it is determined that the formulary drugs are
inappropriate therapy for the member’s condition.
Anthem will continue to monitor and make changes to its prescription drug formulary based on
recommendations from the Anthem Pharmacy and Therapeutics committee, which is made up of
independent physicians and pharmacists from around the country.
The first three therapeutic classes of drugs to be impacted are:
1. Proton Pump Inhibitors (PPIs)
– PPIs are used to treat gastrointestinal conditions such as
heartburn and acid reflux. There are many choices available to consumers including generic and
over-the-counter options as well lower cost brand-name drugs. The lower cost brand-name PPIs,
Prevacid and Protonix, as well as the generic alternative, Omeprazole, will continue to be covered
under the Anthem formulary. The following higher cost brand-name PPIs will no longer be
2. Non-Sedating Anti-Histamines (NSAs)
– NSAs are used in the treatment of seasonal allergies,
hay fever, and other allergies. The generic fexofenadine will continue to be covered, while all
brand-name NSAs on Tier 3 of the Anthem prescription drug formulary will no longer be
covered. Brand names that will no longer be covered are:
• Allegra D
• Clarinex D
• Semprex D
• Zyrtec D
3. Ophthalmic Anti-Allergy Agents (OphAs)
– OphAs are eye drops used to treat itching,
redness, tearing, and eye lid swelling associated with allergies. The generic equivalents,
Ketotifen Fumarate and Cromolyn Sodium, will continue to be covered while all higher cost
brand-name OphAs currently on Tier 3 of the formulary will no longer be covered
names that will no longer be covered are:
Prescription Drug Benefit Changes in 2008
All of the latest clinical research (from references sources such as The Agency for Healthcare Research
and Quality, Consumer Reports Best Buy Drugs, and several other nationally known studies) supports the
changes that Anthem is making to its prescription drug formulary. These studies have found the
all brand-name drugs in the PPI category are equally effective;
generic and over-the-counter PPIs, NSAs, OphAs are just as safe and effective as their brand-name counterparts;
over-the-counter drugs in the PPI, NSA, and OphA categories are just as safe and effective as the brand-name and generic drugs available only by prescription.
Also, remember that generic drugs and over-the-counter medications are generally less expensive for you than brand-name drugs. Prior to April 1, Anthem will take the following steps:
notify those of you who are taking any of these excluded brand-name drugs and give you information to help you find a covered generic or over-the-counter drug;
alert doctors so they can talk with their patients about switching to generic or over-the-counter options;
alert network pharmacies so they can answer any questions.
If you or any of your covered family members are affected by any of these changes and you want to make a switch from non-covered brand names to covered generics or over-the-counter medications, you should talk with your doctors and get new prescriptions, if necessary.
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