Many generic drugs are available to treat depression. They are in drug classes called SSRI and SNRI. Medical guidelines support using one of the generic SSRI drugs before using a brand-name antidepressant drug. Formulary and non-formulary brand-name drugs will require a prior authorization unless one of the available generic drugs has been tried first. An electronic claims edit at the pharmacy will determine if a member has been receiving the brand-name medication or has tried a required generic. In either case, the requested brand-name drug will be approved. Members new to BCBSKS prescription drug coverage will not have a claim history to automatically approve the brand-name drugs. Therefore, a prior authorization process is in place to provide a manual review of claims that do not meet the electronic edit.
The table below shows the generic drugs available, as well as, the brand-name drugs that will require a prior authorization if a generic has not been used.
Generic Drugs |
citalopram (generic for Celexa®) |
paroxetine hydrochloride (generic for Paxil®) |
fluoxetine (generic for Prozac®) |
sertraline (generic for Zoloft®) |
fluvoxamine |
|
|
Drugs requiring generic SSRI first or Prior Authorization |
|
Celexa® |
Prozac® |
Lexapro® |
Zoloft® |
Paxil® |
Cymbalta® |
Paxil CR® |
Effexor® |
Pexeva® |
Effexor XR® |
venlafaxine |
Pristiq® |