New Pharmacy Step Therapy Programs Begin January 3, 2012
On January 3, 2012, the State Health Plan will implement new step therapy programs for Travatan Z® (Travaprost) used to treat glaucoma, growth hormone specialty medications and medications used to treat multiple sclerosis.
Glaucoma Agents Step Therapy
Travatan Z (Travaprost) is a medication used to treat glaucoma. Travatan Z will require a coverage review for members who wish to remain on this medication. Glaucoma medications Latanoprost (generic for Xalatan®) and Lumigan® will continue to be covered without a review.
This step therapy program promotes generic and certain preferred brand medications as first line therapy. Benefit coverage for Travatan Z will be provided for patients who have exhibited intolerance (i.e. sensitivity, drug allergy, adverse effect) to treatment or treatment failure (medication didn't provide adequate clinical effect) with either Latanoprost or Lumigan. For those that meet these criteria, benefit coverage will be provided for 12 months.
Growth Hormone Step Therapy
As of January 3, 2012, the growth hormones, Nutropin®, Nutropin AQ®, Nutropin AQ NuSpin®, Saizen®, Valtropin®, Accretropin®, and Zorbtive®, will become non-preferred medications. In addition to ensuring that the clinical indication for use meets the State Health Plan's conditions for coverage, these medications will also be subject to step therapy.
The growth hormones Genotropin®, Genotropin® Miniquick, Humatrope®, Norditropin®, Norditropin Nordiflex®, Norditropin FlexPro® will continue to be preferred medications and will be covered at the appropriate specialty copay, as long as the clinical indication for use meets the Plan's conditions for coverage.
This step therapy program will ensure the use of Plan preferred products, prior to the use of other non-preferred agents. Members must have tried and been intolerant to or failed treatment with the preferred agents.
These specialty medications are available through Accredo Health Group, Medco's Specialty Pharmacy. You may contact Accredo at 877-988-0059 for more information.
Multiple Sclerosis Step Therapy
Beginning January 3, 2012 (and in addition to existing coverage criteria), new users of interferon beta-1a (Rebif®) and interferon beta-1b (Extavia®) must have tried and been intolerant to or failed treatment with either interferon beta-1b (Betaseron®), interferon beta-1a (Avonex®), or glatiramer acetate (Copaxone®).
This step therapy program will ensure the use of State Health Plan preferred products (Betaseron, Avonex or Copaxone) prior to the use of other non-preferred products (Rebif and Extavia).
Members currently using these medications will not be subject to the step therapy requirements. These specialty medications are available through Accredo Health Group, Medco's Specialty Pharmacy. You may contact Accredo at 877-988-0059 for more information.
Members or providers can request a coverage review by calling Medco toll-free at 800-417-1764, 8 a.m. to 9 p.m., Eastern Time, Monday through Friday. If the review is approved, you will pay the appropriate copay for the prescription. If approval is not obtained after January 3, 2012, you will be responsible for the entire cost of the prescription.
You may call Medco Member Services at 800-336-5933 for more information.
