Over-the-Counter (OTC) Heartburn Medication Coverage
OTC Heartburn Medications Covered with a $5 Copay
Prilosec OTC® (omeprazole 20mg), generic omeprazole OTC, and Prevacid® 24HR are covered by the pharmacy benefit as one of your low cost OTC heartburn medication choices. In April 2010, Zegerid® (omeprazole/sodium bicarbonate) 20mg capsules (called Zegerid OTC™) became available as an over-the-counter (OTC) product. Beginning June 1, 2010, Zegerid OTC™ 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™ 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 this flier if you would like to try an OTC product for your heartburn symptoms.
Prescription Zegerid® 20mg capsules with OTC Equivalent No Longer Covered
As of June 1, 2010, prescription Zegerid® (omeprazole/sodium bicarbonate) 20mg capsules will only be covered as the Zegerid OTC™ product. Prescription brand Zegerid 20mg capsules will no longer be covered under the pharmacy benefit because the same formulation is now available as an OTC product.
Your provider should write you a prescription for Zegerid OTC™ (42-count), which will be covered with a $5 copay for a 42-day supply. The OTC equivalent is a more cost effective option for members.
Example of member savings: A member taking prescription brand Zegerid® 20mg 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 is required for Zegerid OTC™.
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, 800-336-5933.