Coverage Change to Additional Drug Classes

WellPoint NextRx, the pharmacy benefits manager for UniCare health plans, is dedicated to helping our members make the most of their health care dollars. We strive to help ensure that they have access to the care they need. As we work with our health plan partners to investigate the various ways to make health care more affordable for everyone, we will exclude coverage for certain prescription drugs while continuing to cover less costly, clinically equivalent alternatives.

As you know, one of the most widely prescribed classes of medications are Non-Sedating Antihistamines (NSAs) and Opthalmic Allergy Agents. Clinical studies¹ and popular reference sources like Consumer Reports Best Buy Drugs² have reported that prescription, generic and OTC medications within the NSA and Ophthalmic Allergy drug classes are clinically equivalent medications and offer effective symptom relief.

For these reasons we are asking you to consider prescribing fexofenadine (a generic NSA) and cromolyn sodium (a generic Ophthalmic), when appropriate. These medications are available at a much lower cost for our members. Brand names* that will no longer be covered for some members include: Allegra/Allegra® D, Clarinex/Clarinex D®, Semprex D®, Xyral® and Zyrtec/Zyrtec D®. Ophthalmics that will no longer be covered for some members include Alamast®, Alocril®, Alomide®, Elestat®, Emadine®, Optivar®, Patanol®, and Pataday™.

Please consider recommending the OTC forms of these drugs that could cost our members less than the amount of their prescription drug copay. For NSAs* these are Claritin OTC®, Alavert OTC®, Zyrtec OTC® and loratadine. For opthalmics, these are Alaway™ and Zaditor®.

Listed below is an example of how much a member whose copay is $40 could potentially save using an OTC drug alternative:

Source: NextRxOTC.com

We know that you also want your patients to receive the care they need at a price that’s most affordable for them. That’s why we’ll continue to work on identifying alternative, lower-cost medications and keep you informed about our efforts to help protect our members—your patients—from rising health care costs.

Thank you for your dedication to UniCare members.

* The drug names listed here are the registered and/or unregistered service marks of third-party pharmaceutical companies unrelated to and unaffiliated with UniCare.

Sources:
1. Oregon Evidence-based Practice Center, Oregon Health & Science University, Drug Class Review on Newer Antihistamines.

Final Report Update 1. 2006. http://www.ohsu.edu/drugeffectiveness/reports/final.cfm

2. Consumer Reports Best Buy Drugs™, Treating Allergies, Hey Fever and Hives: The Antihistamines. Comparing Effectiveness,

Safety and Price. Consumers Union, 2005

Drug Class Reviews for NSAs:

Howarth PH, Stern MA, Roi L, Reynolds R, Bousquet J. Double-blind, placebo-controlled study comparing the efficacy and safety of fexofenadine hydrochloride (120 and 180 mg once daily) and cetirizine in seasonal allergic rhinitis. Journal of Allergy Clinical Immunology. 1999; 104 (5):927–933.

Hampel F, Ratner P, Mansfield L, Meeves S, Liao Y, Georges G. Fexofenadine hydrochloride, 180 mg, exhibits equivalent efficacy to cetirizine, 10 mg, with less drowsiness in patients with moderate-to-severe seasonal allergic rhinitis. Annals of Allergy, Asthma and Immunology. 2003 Oct; 91 (4):354-61.

Drug Class Reviews for Ophthalmic allergy agents:

Avunduk AM, et al. Mechanisms and comparison of anti-allergic efficacy of topical lodoxamide and cromolyn sodium treatment in vernal keratoconjunctivitis. Ophthalmology. 2000 Jul;107(7):1333-7.

Ganz M, et al. Ketotifen fumarate and olopatadine hydrochloride in the treatment of allergic conjunctivitis: a real-world comparison of efficacy and ocular comfort. Advances in Therapy. 2003 Mar-Apr;20(2):79-91.

Shulman DG. Two mast cell stabilizers, pemirolast potassium 0.1% and nedocromil sodium 2%, in the treatment of seasonal allergic conjunctivitis: a comparative study. Advances in Therapy. 2003 Jan-Feb;20(1):31-40.

Verin PH, et al. Nedocromil sodium eye drops are more effective than sodium cromoglycate eye drops for the long-term management of vernal keratoconjunctivitis. Clinical and Experimental Allergy. 1999 Apr;29(4):529-36.

If the health benefit plan is provided on a self-funded basis by the employer, claims are administered by UniCare Life and Health Insurance Company. If the member’s health plan is insured, insurance or HMO coverage is provided by one of the following companies: UniCare Life & Health Insurance Company, UniCare Health Insurance Company of the Midwest (IN & IL only), UniCare Health Plans of the Midwest, Inc. (HMO in IN & IL only), UniCare Health Insurance Company of Texas (TX only) or UniCare Health Plans of Texas, Inc. (HMO in Texas only). ® Registered mark and SM service mark of WellPoint, Inc. © 2008 WellPoint, Inc.

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