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0508DBT200247IDM.lay 11/9/05 12:34 PM Page 334
Issues in Drug Benefit
Evaluating OTC Coverage Options
Irecently had the opportunity to discuss whether plans makes this the only exception to the plans’ exclusion of
should cover OTC medications with several of my col-
leagues in managed care. Although coverage of OTC
In general, I applaud the efforts of pharmacy direc-
agents is common in managed Medicaid plans, most com-
tors to look for innovative ways of providing effective,
mercial plans do not provide such coverage. The new
cost-efficient therapy. But if plans are covering one OTC
Medicare Part D benefit, which will be implemented in
medication, why aren’t they covering others? Could pro-
January 2006, also does not cover OTC medications.
viding coverage for just one OTC product or a selected
The issue of OTC coverage has recently resurfaced
therapeutic category of OTC agents help establish a sys-
with the introduction of OTC Claritin and Prilosec OTC.
tem in which enrollees could claim “discrimination” be-
In the past, pharmacy directors at MCOs were happy
cause their OTC medication is not covered? In addition,
when prescription drugs were switched to OTC status
it is likely that other agents in the proton pump inhibitor
because plans could save money by dropping coverage
(PPI) class will become available OTC in the near future.
of OTC medications. Although it could be argued that
Will the plans that cover Prilosec OTC also need to
covering the OTC version in lieu of the more expensive
include the OTC versions of the other PPIs as they are in-
prescription drug can be cost-effective, most pharmacy
troduced, or will these plans decide to reverse their cov-
directors used the “it’s too hard to administer” excuse to
erage policy for Prilosec OTC and exclude coverage of all
avoid adding OTCs to the pharmacy benefit.
PPIs if the entire class switches to OTC status? If plans do
In my conversations with several pharmacy direc-
reverse their decision, how do they handle the enrollees
tors, I learned that many plans are now covering Prilosec
who are currently receiving coverage for an OTC agent
OTC under the generic (first) tier of their commercial
that they will then have to purchase out-of-pocket?
pharmacy benefit. Some of these directors also intend to
I think that there are only 2 available options to
cover Prilosec OTC for their Medicare Part D enrollees
when the prescription drug benefit takes effect next year.
• Option 1 is to add an OTC tier to the formulary: at least
These pharmacy directors report significant savings
one OTC agent from each therapeutic class for which
from providing coverage for the OTC product and, con-
OTCs are available could be covered at a lower co-
trary to previous policies, tout not only the ease of ad-
payment. This provides equal treatment of all drug
ministering the program but also the efficiency of their
classes and diseases with OTC options, thereby avoid-
step-edit protocols when OTC “prescriptions” are in-
ing a situation in which claims of discrimination are
cluded in the database. Interestingly, some of the plans
that cover Prilosec OTC do not cover the OTC versions
• Option 2 is to exclude OTC agents from the insured
of any other medications in the pharmacy benefit, which
“prescription drug benefit.” Unless pharmacy direc-tors want to start covering all OTCs, why open thedoor to exceptions that could lead to unwanted,
Dr Reissman is president of Rxperts, Inc, a managed care con-sulting firm in Irvine, Calif. You can visit the Rxperts Web site at
334 DRUG BENEFIT TRENDS
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