Select Drug formulary update
Beginning April 1, 2010, AmeriHealth will make some updates to the Select Drug Program®. We would like to provide you with a list of our most recent changes to the drug formulary, including a change in our preferred insulin.
Updates to the formulary
Our formulary is the key to the Select Drug Program. The formulary includes all generic drugs and some brand drugs that have been selected for their medical effectiveness, safety, and value.
The FutureScripts® Pharmacy and Therapeutics Committee, whose members include practicing physicians and pharmacists from the area, regularly reviews the formulary and safe prescribing procedures to ensure their continued effectiveness. As a result of the committee’s recent reviews, we’re implementing the following changes:
- additions of generic drugs to the formulary;
- addition and deletion of brand drugs to or from the formulary;
- additions to our list of drugs that require the doctor to obtain prior authorization.
Click here to view a list of changes.
To view the complete formulary guide, please visit amerihealthexpress.com.
Note: Brand drugs removed from the formulary will now be covered at the highest non-formulary cost-sharing level.
Preferred brands of insulin change
Effective April 1,2010, Novolin® and Novolog® will be the only brand-name insulins on the Select Drug Program formulary and will be available at the brand formulary cost-sharing level. All Humulin®, Humalog®, and ReliOn® Novolin® insulin will be removed from the formulary on that date.
The FutureScripts Pharmacy and Therapeutics Committee, whose members include practicing physicians and pharmacists from the area, determined that Novolin and Novolog are clinically equal to Humulin, Humalog and ReliOn Novolin insulin in lowering blood sugar level, which is a key clinical marker in diabetes management. Since this formulary change does not take effect until April 1, 2010, members will be able to obtain Humulin, Humalog, and ReliOn Novolin at the brand formulary cost-sharing level through March 31, 2010.
New proir authorization requirement
Effective April 1, 2010, all newly prescribed non-preferred insulin will require prior authorization. Members who are currently taking non-preferred insulin do not have to receive prior authorization until July 1, 2010. Prior authorization requests will be reviewed in accordance with our established criteria, and if approved, non-preferred insulin will be covered at the appropriate cost-sharing level. If denied, non-preferred insulin will not be a covered benefit.
Communicating to members
All employer groups and members with Select Drug Program coverage will be notified of these changes in the spring issue of Update magazine. Comprehensive Major Medical members who do not receive Update will receive a letter notifying them of these changes. In addition, members who are directly affected by the changes detailed above will receive a letter with additional information and instructions. We will urge members who are affected by the removal of a drug to contact their doctor to discuss formulary alternatives, including the use of generic drugs. If a doctor decides that an alternative medication is appropriate, the member will need to ask for a new prescription for that medication.
If you have questions, please contact your AmeriHealth broker representative.
