Non-covered non-sedating antihistamines
A Jan. 1, 2009, change to your Blue Cross and Blue Shield of Kansas prescription drug coverage involves non-sedating antihistamines (NSAs). These types of drugs are used to treat hay fever or other allergies by relieving symptoms including nasal congestion, runny nose, sneezing, watery eyes and skin rashes.
Two common drugs in this class, Claritin and Zyrtec, previously required a prescription but are now only available over-the-counter (OTC). The NSA brand-name drugs currently available by prescription include Allegra, Clarinex, and Xyzal. The generic of Allegra, fexofenadine, is also a prescription drug. 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, as of Jan. 1, 2009, BCBSKS will no longer cover the following drugs: Allegra, Allegra-D, Clarinex, Clarinex-D, Semprex-D and Xyzal. Generic fexofenadine 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 and formulary brand PPIs, including omeprazole, Aciphex®, and Protonix®.
Omeprazole is a generic drug available by prescription or it can be purchased over-the-counter (OTC). If purchased by prescription it will be covered at your lowest copayment. While the OTC medication is not covered under your prescription benefit, it may be your lowest cost option. Protonix and Aciphex will be covered at the higher, formulary brand copayment.
Nexium®, Prevacid®, Prevacid Solutab® (for persons over age 17), Prilosec®, Kapidex® 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.
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