| |
 | * The following article was archived on 09/30/2010.
| |
| | |
|
Upcoming changes to self-injectable drug coverage
Posted: 10/09/2009 | |
| | |
| | |
 |  | |
| We are changing the way we cover self-injectable drugs in an effort to provide our commercial HMO, POS, Direct POS (PA only), HMO Plus (NJ only), and POS Plus (NJ only) members access to self-injectable drugs in the right setting at the right time for a good value. These changes are part of our evolving approach to managing specialty pharmaceutical benefits.
Upcoming changes for self-injectable drugs
Effective January 1, 2010, we will no longer provide benefits for most self-injectable drugs under our medical benefits program. However, HMO, POS, PPO, Direct POS (PA only), HMO Plus (NJ only), and POS Plus (NJ only) members who have AmeriHealth pharmacy coverage will continue have coverage for self-injectables under their pharmacy benefits. Members who have pharmacy coverage from another carrier should check their benefits to determine whether their prescription drug plan includes coverage for self-injectable drugs.
Self-injectables through our pharmacy benefits program
The self-injectable drugs that are available under our pharmacy benefits program are those that patients typically administer themselves and do not require physician monitoring. This list of drugs is available in the accompanying document, Self-Injectable Drug List.Please note that self-injectable growth hormones have been added to the pharmacy benefits program and require prior authorization.
We will continue to cover the following types of injectables under our medical benefits program at the appropriate levels of cost-sharing:
- injectables that cannot be administered without medical supervision;
- injectables that are mandated by law to be covered (e.g., insulin);
- injectables that are required for emergency treatment under the medical benefits program, such as selfinjectable drugs that effectively counteract allergic reactions (e.g., EpiPen®).
Direct ship option available
We coordinate with our pharmacy benefits manager, FutureScripts®, to offer the FutureScripts Direct Ship Specialty Pharmacy Program to members who have pharmacy* coverage through AmeriHealth. You can use the FutureScripts Direct Ship Specialty Pharmacy Program to order self-injectables, and through this program FutureScripts will facilitate shipment to your office or to your patient’s home. Your patients can benefit from key features of this program, including:
- free shipping;
- educational information and pharmacists available to answer questions about their therapies and possible side effects;
- proactive refill service, providing your patient with a phone call the week before the prescribed refill date to schedule the next delivery.
To enroll a patient in the FutureScripts Direct Ship Specialty Pharmacy Program, call FutureScripts at 1-888-678-7012, option 3, or go to www.futurescripts.com/priorauthorization and download the Direct Ship Injectable Form. FutureScripts will coordinate the shipment and delivery of the self-injectables.
If you have any questions about these changes, please call Customer Service at 1-800-275-2583. You can also refer to the notification for policy #08.00.78: Self-Injectable Drugs, in our Policy Notifications section.
*Please note that the FutureScripts Direct Ship Specialty Pharmacy Program is available for members who have either medical or pharmacy coverage through AmeriHealth. However, as of January 1, 2010, self-injectables through the FutureScripts Direct Ship Specialty Pharmacy Program will only be available for members who have pharmacy coverage through AmeriHealth. Accessing the FutureScripts Direct Ship Specialty Pharmacy Program under the medical benefit after January 1, 2010, is only for non-self-injectable specialty drugs that are typically
administered in a provider’s office.
Note: Some members are not affected by the change of coverage of self-injectable drugs to the pharmacy benefit. In addition, some self-funded groups may be transitioning at a later date. This is not a statement of benefits. Benefits may vary based on state requirements, Benefits Plan (HMO, PPO, etc.), and/or employer group. HMO and PPO member coverage may be verified by calling Customer Service.
* This article was featured in the November 2009 edition of Partners in Health Update.
| |
|