- Anastrozole (Arimidex) Gender Exclusion
- Erectile Dysfunction Drugs
- Lilly manufactured insulin (Covered insulin includes Novolin, Novolog, Lantus and Levemir)
- Nasal steroids (generics covered)
- Non-sedating antihistamines
- Proton Pump Inhibitors (PPIs)
- Statin Drugs with generic equivalents
- Tetracycline Antibiotics (doxycycline, minocycline)
- Topical antibiotics (generics and Finacea covered)
- Topical retinoids (generics and Tazorac covered)
Anastrozole (Arimidex) Gender Exclusion
Anastrozole (also available by the brand name Arimidex) is FDA approved for treatment of breast cancer in postmenopausal women. It has also been used in men to treat symptoms of testosterone deficiency, such as decreased libido. This is not an approved use for anastrozole. Claims for anastrozole and Arimidex are not covered for males.
Erectile Dysfunction Drugs
Excluded drugs include Caverject, Cialis 10mg and 20mg, Edex, Levitra, Muse, Staxyn, Stendra, and Viagra.
Nasal steroids (generics covered)
Excluded drugs include Beconase AQ, Flonase, Flunisolide, Nasacort AQ, Nasonex, Omnaris, Qnasl, Rhinocort Aqua, Veramyst, and Zetonna.
Non-sedating antihistamines (NSAs) are types of drugs used to treat hay fever or other allergies by relieving symptoms including nasal congestion, runny nose, sneezing, watery eyes and skin rashes.
Common drugs in this class, Allegra, Claritin and Zyrtec, previously required a prescription but are now available over-the-counter (OTC). The generics for each of these drugs, fexofenadine, loratadine, and cetirizine, are also OTC products. The NSA brand-name drugs currently available by prescription include Clarinex, and Xyzal. The generic of Clarinex, desloratadine, and Xyzal, levocetirizine, are also prescription drugs. There are older antihistamine drugs available OTC, such as Benadryl, Chlor-Trimeton, Dimetapp and Tavist.
None of the prescription NSA drugs have been proven to work better than the OTC antihistamine drugs. Therefore, your BCBSKS prescription drug benefit may no longer cover the following drugs: Clarinex, Clarinex-D, Semprex-D and Xyzal. Generics desloratadine and levocetirizine will continue to be covered at a generic copay.
Proton Pump Inhibitors (PPIs)
Proton Pump Inhibitors (PPIs) are a class of drugs used to treat acid reflux disease or ulcers. There are a number of generic and brand-name drugs in this class, with clinical research indicating they are all effective in treating these conditions. Your prescription drug benefit may only cover the generic PPIs, including omeprazole, lansoprazole and pantoprazole.
Omeprazole and lansoprazole are generic drugs available by prescription or they can be purchased over-the-counter (OTC). If purchased by prescription they are covered at your lowest copayment. While the OTC medication is not covered under your prescription benefit, it may be your lowest cost option.
Aciphex®, Dexilant®, Nexium®, Prevacid®, Prevacid Solutab®, Protonix®, Prilosec®, Vimovo® and Zegerid® are non-formulary PPIs and may not be covered under your prescription drug benefit. You always have the option to purchase the non-covered medication at your own expense.
Other exclusions may apply. Please refer to the Prescription Drug Program Exclusions section of your contract for a complete list of excluded drugs or call Customer Service toll-free at (800) 432-3990.
Statin Drugs with generic equivalents
Statin drugs are used to treat high blood cholesterol. There are a number of generic drugs in this class, which provide the same cholesterol lowering benefits as their brand name equivalents.
Your prescription drug benefit may only cover the generic statins atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin, and the brand name statins which do not have a generic available, Advicor, Altoprev, Crestor, Lescol XL, Livalo, Simcor, Vytorin. Your benefit may require use of a generic statin before a brand name statin will be approved.
The tetracycline antibiotics minocycline and doxycycline are commonly used to treat acne and other infections. These drugs have been available generically in multiple strengths for several years. Recently, these products have been remarketed in modified dosage forms and strengths with no additional clinical benefit, but with a significantly higher cost.
The following brand minocycline or doxycycline drugs may not be covered under your prescription drug benefit: Adoxa, Adoxa Pak, Alodox, Avidoxy, Avidoxy DK, Doryx, doxycycline hyclate ext. rel., Dynacin, Minocin, Minocin Kit, Monodox, Morgidox Kit, Nutridox, Ocudox Kit, Oracea, Oraxyl, Periostat, Solodyn, Vibramycin, Vibra-Tab.
Topical antibiotics (generics and Finacea covered)
Excluded drugs include Acanya, Aczone, Akne-Mycin, Azelex, Benzaclin, Benzamycin, Cleocin-T, Clindacin, Duac, Epiduo, Erygel, Klaron, Metrogel, Metrocream,Metrolotion, Noritate, and Ziana.
Topical retinoids (generics and Tazorac covered)
Excluded drugs include Atralin, Differin, Retin-A, and Tretin-X.
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