thepharmacyconnection - FirstCarolinaCare Insurance Company

thepharmacyconnection
Pharmacy
Benefit
Newsletter
Spring 2012
Important Changes in Your Pharmacy Benefits
Mail Order Pharmacy Provider
What You Need to Know About Shingles
On May 1, 2012,
FirstCarolinaCare
Insurance Company
(FCCI) changed mail
order prescription
vendors. Members will
no longer use Bioscrip
Pharmacy Services.
All mail orders will
be handled by Postal
Prescription Services
(PPS). The mail
order benefits will
remain the same.
The only change
is the vendor that
receives and fills your prescriptions.
With PPS, you will still be able to order a 90-day supply
of covered maintenance prescription medications by
telephone, online or by mail, and have the prescriptions
delivered directly to your home or work.
Shingles (herpes zoster) is a painful skin rash that
begins as a cluster of small red spots that often blister.
The rash usually affects one area of the body. Shingles
is caused by the same virus that causes chickenpox
(varicella zoster). While chickenpox heals and appears to
go away, the virus remains dormant in your body. For
reasons unknown, the virus can become active again and
reappear as shingles. While shingles can occur in people
under the age of 50, it is more common in people over the
age of 50.
www.ppsrx.c
om
To inquire about receiving your covered maintenance
prescriptions by mail, contact PPS:
• Visit www.ppsrx.com or
• Call PPS at (800) 552-6694, Monday-Friday, 9 a.m.
to 9 p.m. EST, and Saturday, noon to 5 p.m. EST.
With PPS, you will be able to
order a 90-day supply of covered
maintenance prescription
medications by telephone,
online or by mail, and have the
prescriptions delivered directly to
your home or work.
Zostavax is an FDA-approved vaccine for adults 50
years of age and older. It is a live vaccine that contains
a weakened chickenpox virus. The vaccine is given
once per lifetime. Zostavax is not 100 percent effective,
so some people who get the vaccine may still get
shingles. The vaccine may reduce pain in people who
get shingles despite receiving the vaccine. While the
vaccine is FDA-approved for people 50 and older, the
Advisory Committee on Immunization Practices (ACIP)
recommends that only people 60 and older receive the
vaccine. FCCI covers the vaccine for members 50 years
of age and older.
Currently, members can get the shingles vaccine at
their in-network provider’s office or have a prescription
filled at their local pharmacy and have it administered by
their provider.
Beginning July 1, 2012, members 50 and over will
have another option for getting the Zostavax vaccine.
You will be able to get the vaccine from your local FCCIparticipating pharmacy that administers the vaccine. As
long as you use an FCCI-participating pharmacy and
show your FCCI ID card, you will not need to submit a
reimbursement form. Your pharmacy will submit the
claim just like a regular prescription.
It is important to remember that not all people are
recommended to receive Zostavax. If you are 50 years of
age or older, talk with your health care provider to see if
you should receive the shingles vaccine.
Formulary Updates:
Changes to the Formulary Medication List can occur
any time throughout the year. When possible, FCCI
will try to notify members of the changes in advance.
Change Tier 3 to Tier 2:
Dutoprol
Janumet XR
Restrictions have been removed on the
following medications:
Oxcarbazepine (Trileptal)
The following medications have new
requirements for coverage:
Step Therapy:
Glumetza
Pristiq
Onfi
Picato
Relistor
Riomet
Subsys
The following medications will not be
covered by FCCI:
• Pedipirox-4 8% kit (ciclopirox topical solution, 8%, OTC nail lacquer removal pads, OTC
nail file)
o Available generic ciclopirox 8% solution without OTC lacquer removal pads and
nail file
• Rosadan Kit (metronidazole 0.75% gel/skin cleanser)
o Available as generic metronidazole 0.75% gel without cleanser
• Suprenza ODT*
Quantity Limit:
Advair diskus/HFA
Cymbalta
Daliresp
Dulera
Juvisync
Intermezzo
Jakafi
Kalydeco
Korlym
Lazanda
Omontys
• Duexis (Ibuprofen 800mg/famotidine 26.6mg)
o Available as generic ibuprofen and famotidine
Step Therapy:
Daliresp
Edarbyclor
Fortamet
Prior Authorization:
Lexapro
Nucynta
Pristiq
Spiriva
Symbicort
• Vasculera**
*Medications used for weight loss are not a covered
benefit.
**Medical Foods are not a covered benefit.
Important Prescription Drug Benefit Contact Information
FirstCarolinaCare Insurance Company
Office Hours: 8:30 a.m.-5 p.m. EST Monday-Friday
Customer Service:
(910) 715-8100
(800) 574-8556
(910) 715-8101 (fax)
E-mail: [email protected]
Website: www.firstcarolinacare.com
MedImpact HealthCare Systems Inc.
(Pharmacy Benefits Manager)
24-hour service available
Customer Service: (800) 788-2949
E-mail: [email protected]
Website:www.medimpact.com
www.firstcarolinacare.com
Postal Prescription Services (PPS)
(Mail Order)
Customer Service: (800) 552-6694
Hours: 9:00AM-9PM EST Monday-Friday
Saturday noon - 5 p.m. EST
Website: www.ppsrx.com
515-173-12
Reminders
2012 Formulary Tri-fold
Enclosed is your 2012 formulary guide, which contains a listing of the more commonly
prescribed classes of medication. Please take this with you when you visit your provider.
It is a helpful tool for you and your provider to understand your pharmacy benefits. If
a generic medication is not available or clinically appropriate, ideally, your provider
will prescribe a medication on the “preferred brand” (or 2nd tier) rather than a “nonpreferred” (or 3rd tier) medication to help save you money. The formulary guide will
also inform your provider if certain medications require special authorization such as
prior authorization, step therapy, quantity or age limits. The medications eligible for
the voluntary tablet-splitting program, “Split the Pill, Split your Bill,” are also noted on
the formulary guide. If you need additional formulary guides, you can go to www.
firstcarolinacare.com or call member services at (800) 574-8556.
This formulary guide is not all-inclusive, nor does it guarantee coverage. For a complete listing of the
FCC formulary, please visit www.medimpact.com.
Generic Policy
As a rule, your medication will be covered at the generic, preferred
or non-preferred brand copayment. One exception to this rule is if for
any reason you take a brand name medication when a direct generic
equivalent is available. In addition to the brand copayment, you will
be responsible for the cost difference between the brand and generic
medications. This cost difference is not applied to the deductible for
high-deductible health plans.
Only narrow therapeutic index (NTI) medications designated by the
N.C. Secretary of Health and Human Services are excluded from this
policy. The NTI medications will be covered at the preferred or nonpreferred copayment.
What Does “Quantity Limit” Mean?
Quantity limit (QL) is a utilization management tool to promote the use
of safe and cost-effective medications and to prevent the potential for abuse
or misuse of medications. QL refers to the maximum number of days supply
or quantity of medication that can be obtained at one time under your
prescription benefit coverage. QL is often based on criteria such as safety,
overdose potential, abuse potential and FDA-dosing recommendations.
What if my provider prescribes a higher quantity?
Your provider can submit a medication request form (MRF) to MedImpact
that will provide the necessary clinical information to review the request.
How do I find out if my medication has a QL?
You can go to the Pharmacy Corner on the FCCI website and click on the MedImpact icon. Once on the MedImpact
website, you can look up the specific drug. You can also call MedImpact customer service at (800) 788-2949 to find out
the quantity limit on a requested medication.
Valturna Voluntarily Withdrawn from Market
On July 20, 2012, Novartis Pharmaceuticals Corporation
will discontinue manufacturing the combination
high blood pressure medication, Valturna (aliskiren/
valsartan). This voluntary withdraw from the market
is the result of new safety data from the ALTITUDE
trial which showed increased risk of side effects in
certain patient populations.
Valturna will be available until July 20, 2012, to allow
adequate time for providers to transition patients over
to another medication.
If you are taking Valturna, you will need to contact
your provider to discuss this information. It is not
recommended to stop taking Valturna for treatment
of your high blood pressure without first talking with
your provider.
Patients and/or caregivers may contact Novartis
Customer Interaction Center at 1 (877) 263-6725 or visit
www.pharma.us.novartis.com for further information.
New Generics
Brand Name
Generic Name
Common Indications
Arava
leflunomide tablets
Rheumatoid Arthritis
Avalide#^
irbesartan/hctz tablets
High Blood Pressure
Avapro#
irbesartan tablets
High Blood Pressure
Boniva
ibandronate tablets
Osteoporosis
Caduet
atorvastatin/amlodipine tablets
High Cholesterol/blood pressure
Clobex 0.05%
clobetasol 0.05% shampoo and lotion
Dermatology
Combivir
lamivudine/zidovudine tablets
HIV
Epivir
lamivudine 150mg, 300mg tablets
HIV
Geodon
ziprasidone capsules
Bipolar/Schizophrenia
Lescol
fluvastatin capsules
High Cholesterol
Lexapro+~
escitalopram tablets
Depression
Lipitor~
atorvastatin tablets
High Cholesterol
Loseasonique
ethinyl estradiol/levonorgestrel
Contraception
Prometrium
progesterone capsules
Hormone replacement
Provigil**
modafinil capsules
Narcolepsy
Ritalin LA*
methylphenidate LA 20mg, 30mg, 40mg
ADHD/narcolepsy
Seroquel
quetiapine tablets
Bipolar/Schizophrenia
Vancocin#+
vancomycin capsules
Infection
Vectical
calcitriol ointment
Psoriasis
Xyzal
levocetirizine solution
Allergy
Zyprexa
olanzapine
Bipolar/Schizophrenia
*Age Edit
**Prior Authorization Required +Quantity limit applies
#Step Therapy Required
~Tablet Splitting Eligible
^Avalide 300mg/25mg, Clobex 0.05% spray, Epivir HBV 100mg and solution, Ritalin LA 10mg, not available generically