Brand Lipitor Drug Coverage Changes April 1, 2012
We're changing the prescription drug coverage benefit to help your employees save on drug
costs without giving up quality. How? By encouraging your employees to switch from a brand
name drug to a generic drug. Generic drugs are just as safe and effective as brand name drugs -
and generic drugs cost less.
Recently, a new generic drug called atorvastatin became available for the brand drug Lipitor.
Atorvastatin costs less and is just as safe and effective as Lipitor. Beginning April 1, 2012,
brand name Lipitor will no longer be covered by some group's prescription drug benefit
plan. Atorvastatin, the new, lower cost generic will continue to be covered.
This change impacts commercial and individual groups in CO, CT, GA, IN, KY, ME, MO, NH and
NV (for local groups that have the "clinically equivalent" benefit exclusion in place), OH, VA, and
WI. National Accounts and ASO groups that have chosen to participate in the overall "clinically
equivalent" coverage strategy are also included.
The benefit exclusion does not apply to CA, NY, and local group and national accounts that do
not have the "clinically equivalent" benefit exclusion in place. However, prior authorization will
apply for these groups. How will my employees learn about this benefit change?
A letter explaining this drug benefit change will be mailed to employees of groups with the
"clinically equivalent" benefit exclusion who have filled a prescription for Lipitor. The letter points
out that Lipitor benefit coverage will end on April 1, 2012. It also mentions that benefit coverage
for atorvastatin will continue and directs employees to talk to their doctor if they have any
questions about switching drugs.
Employee savings may vary depending on your group's prescription benefit plan design.
Blue Cross and Blue Shield of Georgia, Inc. and GGL are independent licenses of the Blue Cross and Blue Shield Association.
Life and Disability products underwritten by Greater Georgia Life Insurance Company (GGL).
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DME Restrictions and Guidelines PLEASE NOTE: This list is not all-inclusive, as updates may occur periodically. Refer to the Fee Schedule for pricing and individual code prior authorization information. Restriction ADHESIVE TAPE LTD TO 240 UNITS PER 30 DAYS BED, HOSPITAL, MANUAL; LTD 1 PER 8 YEARS BEDRAILS, HALF AND FULL; LTD TO 1 PAIR EACH PER 5 YEARSBEDSIDE URINARY DRAINA
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