Anthem Blue Cross of California
August 4, 2015
NEXIUM® 24HR (esomeprazole 20 mg) became available as an over-the-counter (OTC) 14-day treatment for frequent heartburn in May 2014. As a result, our drug formulary (list of covered drugs) will change, effective October 1, 2015, as follows:
- Nexium 40 mg moves from Tier 2 to Tier 3 and has been added to the Clinically Equivalent Medications program
- Esomeprazole 40 mg moves from Tier 2 to Tier 3
- Lansoprazole moves from Tier 1 to Tier 3
How members will be notified
Members impacted by these changes will be notified of the formulary changes by mail in late August. Here’s an example of a letter they’ll receive.
Around the same time, a separate mailing also will go to fully-insured and self-insured group members who are currently taking one of several other proton pump inhibitors (PPIs ) by prescription. Here’s a sample of that letter.
Employers will get an email this week as notification of the changes.
$9 Nexium coupon included in both mailings
To help encourage our members to use the Nexium 24-hour OTC version, instead of by prescription, we’ll include a $9 coupon with the letters toward one, 42-count retail purchase of the drug. The OTC drug offers a more convenient, affordable alternative to prescription heartburn medicine.
Sample of letter being sent to members
A change to our Drug List affects one of the drugs you take.
Dear [Member First Name] [Member Last Name]:
We want to make sure you get the most out of your health plan and help you save the most money. We wanted to let you know about a change we made to our drug list.
Why we make changes to the drug list
To make sure you get access to safe, affordable drugs, we sometimes add or remove drugs from our drug list (also called a formulary). It’s a list of drugs covered by your plan. We make changes to it based on research from our clinical committee, which is made up of doctors and pharmacists. In some cases, a drug is moved to a higher tier (group) based on cost. The higher the tier, the higher the cost – which means you pay more out of pocket.
Our records show that you filled a prescription for <LABEL NAME>.
Starting October 1, 2015,<drug label name> will move to Tier 3. This means, when you refill your prescription, you’ll have to pay a higher copay/coinsurance.
Here are some drug choices to speak to your doctor about that could save you money:
• omeprazole
• pantoprazole
• NEXIUM 24HR: You can buy this over the counter without a prescription. Plus, we’re including a $9 coupon toward your first 42-count purchase.
Please don’t think we’re giving you any specific advice about which drugs you should take. We’re sharing this news with you but only you and your doctor can decide which drugs are right for you. So ask your doctor or pharmacist if switching to a lower cost drug is good for you. And check your plan benefits to see your specific drug coverage.
If you have questions about your drug plan, just call customer service at the number on your member ID card. If you have questions regarding your drugs, please talk to your doctor or pharmacist.
Wishing you the best of health,
The End.
