Fall 2011 - FirstCarolinaCare Insurance Company

thepharmacyconnection
Pharmacy
Benefit
Newsletter
Fall 2011
Flu Vaccine, Flu Vaccine, Everyone Get
Your Flu Vaccine
Autumn is a nice change from the “dog days of summer.”
The lower temperatures and the changing of leaves
mean it is time to get your influenza (flu) vaccine and
be prepared for the 2011-2012 flu season. The Centers
for Disease Control and Prevention (CDC) recommends
that everyone 6 months of age and older get a yearly flu
vaccine. This helps protect you, your family, your friends,
your co-workers and others against the flu. You can get
the flu vaccine as soon as it is available in your area, and
it can be given throughout the flu season. It is important
to remember that it takes about two weeks for your body
to develop antibodies to the flu virus.
The vaccine is developed to protect against the
three main influenza viral strains that researchers
believe will be the most common during the
upcoming flu season. This year’s vaccine will
protect against influenza A (H1N1), influenza A
(H3N2) and an influenza B virus.
You may have heard that this year’s flu vaccine is the
same formulation as last year’s vaccine, and you would be
correct. So why get the vaccine again? The immunity or
protection from last year’s vaccination decreases over time
and may not be strong enough in your body to fight off
the flu virus, thereby leaving you vulnerable to the flu.
There are two options for getting the flu vaccine: injection
or the nasal spray. The injection contains inactivated
(“dead”) viruses and can be given to people 6 months of
age and older. The flu shot does not cause the flu. The
nasal spray contains weakened, live (attenuated) flu
viruses. According to experts, the nasal spray vaccine
is designed not to cause the flu. The nasal spray cannot
be given to everyone. If you are interested in the nasal
spray, you will need to check with your provider to find
out if you are eligible.
Where Can I Get My Flu Vaccine?
FCC offers the flu shot, free of charge, to all of its
members at their work site if the employer requests it.
This service is open to spouses and dependents who are
18 years old or older who come to the flu shot clinic. FCC
nurses may have already scheduled your employer’s flu
shot clinic. Please check with your employer for the date.
If you miss the opportunity to get your flu vaccine at
your place of employment, or if you are a spouse or a
dependent under the age of 18, your physician’s office
will administer the vaccine at no cost to you.
New for 2011-2012: You can also get your shot at no cost at
your local FCC-participating pharmacy. As long as you
use an FCC-participating pharmacy and show your FCC
ID card, you will not need to submit a reimbursement
form. Your pharmacy will submit the claim just like a
regular prescription.
FCC provides members with three different opportunities
to get vaccinated. Please take advantage of one of these
options to try and keep healthy by preventing the flu.
FCC offers the flu shot, free of charge, to all of its members at their work site if the employer
requests it. This service is also open to spouses and dependents who are 18 years old or older
who come to the flu shot clinic.
What Does “Prior Authorization” Mean?
Prior Authorization
(PA) is a way that
FCC ensures that
certain medications
are being prescribed
appropriately
according to FCC
clinical guidelines.
What Do I Do If
My Medication
Requires A PA?
The first step is to let
your physician know that
your medication requires a
prior authorization. Sometimes your pharmacist will
also contact your physician to let him/her know the
medication requires a PA. If your medication requires
a PA, your physician must submit a medication request
form (MRF) to MedImpact for review.
How Do I Know If My Medication Has Been
Approved?
A letter will be sent to you via mail and to your
physician via fax notifying you of the status of the PA.
You can also call MedImpact to check the status of
the PA.
How Do I Find Out If My Medication Requires
A PA?
You can go to the Pharmacy Corner on the FCC website
for a list of medications that require a PA. You also can
go to the MedImpact website and look up the specific
medication or call MedImpact customer service to find
out if a PA is required. Although not all inclusive, your
FCC formulary tri-fold identifies the more commonly
prescribed medications that require a PA. Remember
to take your tri-fold with you when you see your
physician.
How Long Does The PA Process Take?
Once all of the information is received from your
physician to make a decision, the process can take two
business days for standard requests and about one day
for urgent requests. Sometimes additional information
is requested from the physician, which may prolong the
review process.
Rx Emergency Preparedness Plan
In light of Hurricane Irene, which hit the North Carolina coast in August, FCC would like to
remind everyone of our Emergency Preparedness Plan (EPP) for pharmacy services. The EPP
provides coverage of replacement prescriptions during a state of emergency or disaster.
FCC implements the EPP after the Insurance Commissioner issues an advisory
notifying insurance carriers of a declared state of disaster or state of emergency. The
EPP removes the time restriction on filling or refilling a prescription for a member living in a
county affected by the emergency or disaster.
Members can get a one-time “early” refill of a prescription within 30 days of declaration of the state
of emergency or disaster. At the pharmacy, the member must identify him/herself as affected by the
emergency or disaster. The pharmacist will verify that the member resides in a county affected by the
emergency or disaster. The pharmacist will then enter a code to override the “refill too soon” edit and
provide the emergency refill. If the pharmacist has any issues processing the prescription, he/she should
contact the MedImpact help desk for assistance.
Zocor® (simvastatin 80mg) and Vytorin® 10/80mg Dosing Recommendation Changes
In June 2011, the FDA released a statement
recommending that physicians limit the use of
medications containing simvastatin 80mg due to the
increased risk of muscle damage. These medications
include brand and generic Zocor® and Vytorin®
10/80mg. The risk appears to be higher during the first
year of treatment and is often the result of interactions
with other medications.
❖ Simvastatin 80mg containing medications should be restricted to patients who have been taking this dose for 12 months or more without any issues
The FDA recommends the following for simvastatin
80mg containing medications:
If you are currently taking simvastatin 80mg (generic
Zocor®) or Vytorin® 10/80mg and have questions,
please contact your physician or pharmacist.
❖ New patients should not be started on simvastatin 80mg containing medications
❖ Review for potential drug interactions with other medications
New Generics
Brand Name
Generic Name
Common Indications
Activella
estradiol-norethindrone
Hormone replacement
Adoxa
doxycycline
Acne
Allegra ODT
fexofenadine ODT
Allergy
Allegra Suspension
fexofenadine suspension
Allergy
Amrix
cyclobenzaprine ER
Muscle relaxer
Antabuse
disulfiram
Alcohol cessation
Arixtra+
Fondaparinux
Blood clots
Aromasin
exemestane
Breast cancer
Carbatrol
carbamazepine ER
Seizure
Concerta*
methylphenidate ER
ADD/ADHD
Elestat
epinastine eye drops
Allergy
Entocort EC
budesonide EC
Crohn’s disease
Extina
ketoconazole 2% foam
Seborrheic dermatitis
Felbatol
felbamate tablets
Seizure
Femara
letrozole
Breast cancer
Fexmid
cyclobenzaprine
Muscle relaxer
Furadantin
nitrofurantoin suspension
Infection
Femcon FE^
zeosa (noreth-ethinyl estradiol/iron)
Contraception
Keppra XR
levetiracetam XR
Seizure
Levaquin
levofloxacin
Infection
Lybrel^
estradiol-norethindrone
Contraception
Nasacort AQ
triamcinolone nasal spray
Allergy
Prodrin
isometheptene/APAP/caffeine
Migraine
Seasonique+^
amethia (ethinyl estradiol-levonorgesterol)
Contraception
Ultram ER
tramadol ER
Pain
Uroxatral
alfuzosin
BPH
Xalatan
latanoprost eye drops
Glaucoma
* Age Edit
+Quantity limit applies
^Gender Edit
Formulary Updates:
Changes to the Formulary Medication List can occur at
any time throughout the year. When possible, FCC will
try to notify members of the changes in advance.
Change Tier 2 to Tier 3:
Nasacort AQ (brand only)
Penlac (brand only)
Paxil (brand only)
Zoloft (brand only)
Paxil CR (brand only)
Change Tier 3 to Tier 2:
Duac Gel
Viramune XR
Tekamlo (ST required)
Restrictions have been removed on the
following medications:
Step Therapy:
Losartan (generic Cozaar)
Losartan/HCTZ (generic Hyzaar)
Pantoprazole (generic protonix)
Exclusion:
The following medications have new
requirements for coverage:
Step Therapy:
Gender Edit:
Conzip
Staxyn
Gralise
Prior Authorization:
Horizant
Alsuma
Nucynta ER
Dificid
Vancocin
Firazyr
Quantity Limit:
Hizentra
Axiron
Incivek
Emsam
Orencia
Nucynta ER
Sprix
Oleptro ER
Sylatron
Omeprazole 40mg
Testosterone
Staxyn
Umecta Kit
Tamiflu
Victrelis
Xarelto
Viibryd
Omeprazole 40mg capsules
The following medications will not be covered by FCC:
Avage*
Renova*
Egrita*
Tri-luma*
Rosadan Kit (metronidazole 0.75% cream/skin cleanser)
Available as generic metronidazole 0.75% cream without cleanser
*Medications used for cosmetic purposes are not a covered benefit.
Important Prescription Drug Benefit Contact Information
FirstCarolinaCare Insurance Company
Office Hours: 8:30 a.m.-5 p.m. Monday-Friday
MedImpact HealthCare Systems Inc.
(Pharmacy Benefits Manager)
Customer Service:
24-hour service available
(910) 715-8100
Customer Service: (800) 788-2949
(800) 574-8556
E-mail: [email protected]
(910) 715-8101 (fax)
Website:www.medimpact.com
E-mail: [email protected]
Bioscrip Mail Service
Website: www.firstcarolinacare.com
Customer Service: (800) 677-4323
Website: https://pharmacy.bioscrip.com
1037-173-11