P r e a u t h o r i z at i o n P r o g r a m
managing the treatment of gastrointestinal conditionsProton PumP inhiBitorS
Preauthorization programs target higher cost drugs that have lower cost alternatives. Typical y, these less expensive drugs provide the same or greater level of safety and effectiveness to treat a particular condition as their more costly counterparts. Your coverage includes a preauthorization program for proton pump inhibitors (PPIs).What are proton pump inhibitors? Proton pump inhibitors, also known as PPIs, are used to help reduce stomach acid and provide relief from the symptoms of heartburn, ulcers and gastroesophageal reflux disease (GERD).
The generic PPI medications omeprazole and pantoprazole, and the brand name drug Aciphex® are listed on the Blue Cross and Blue Shield of Nebraska formulary. Non-formulary drugs in this class include brand name Kapidex™, Nexium®, Prevacid®, Prilosec®, Protonix® and Zegerid®. Why are PPIs included in the preauthorization program? Clinical studies show that for most patients, all PPIs, regardless of their price, offer similar safety and effectiveness. The PPI drug class is one of the most costly for your employer and health plan. The medications listed on the formulary represent the lowest cost options. By using a lower cost formulary PPI, you play a key role in controlling the cost of your prescription drug benefit. How does the program work? The preauthorization program requires attempted use of all three formulary PPI products before benefits for a non-formulary PPI will be considered. Benefits for formulary PPIs do not need to be pre-authorized. Who will be automatically approved for benefits under this program? Benefits will be automatically approved for a non- formulary PPI for patients who have had at least one prescription filled for all three formulary PPIs within the last 12 months. If I am currently taking a non-formulary PPI, what do I need to do? How does this program affect my benefits? If you are currently taking a non-formulary PPI and it is not documented that you have tried all three formulary PPIs without success during the past 12 months, benefits for continued use of the non-formulary PPI will not be available.
Please contact your doctor to discuss your therapy requirements. If your medical history indicates that changing to a formulary PPI is not appropriate for you, your doctor must submit a preauthorization request form to Blue Cross and Blue Shield of Nebraska for approval. If the preauthorization request is approved, you will be able to continue to purchase the non-formulary PPI for your plan’s non-formulary brand name out-of-pocket amount. This benefit approval will be valid for 36 months.
The ultimate decision regarding your treatment rests with you and your doctor.
No. 5 – 2002 Research News 1 Using plastics to track down prions Are waste treatment plants really capable of reducing the risk of BSEinfection? A new polymer indicator developed by Fraunhofer scientists,allows plant operators to quickly evaluate the extent to which theharmful pathogens have been destroyed. 2 Neon signs: colorful, better, cheaper Fraunhofer Press: Many people tak
CHRONIC EPIDIDYMITIS What is the epididymis? Although the testis feels like a simple egg shape, there is, wrapped around the back of it, a ridge called the epididymis. The sperms which are made in the testis pass through the microscopic channels in the epididymis where they are stored and where their ability to swim is enhanced by chemicals produced within the epididymis. If you hold the tes