Pharmacy Changes Effective January 1, 2015
Posted on November 26, 2014
There was a recent mailing that was sent to providers who currently have patients that are utilizing prescription NEXIUM®, Kapidex™, Dexilant, Prevacid® Solutab™, omeprazole sodium bicarbonate (generic Zegerid®), or rabeprazole. Effective January 1, 2015, HNE will no longer cover prescription NEXIUM®. HNE will instead cover the over-the-counter (OTC) version: Nexium® 24HR.
Below is an example of which Nexium selection you should choose when you electronically prescribe (E-prescribe) or write your Nexium 24HR prescription:
| Nexium 24HR 20mgCPDR Oral |
Nexium® 24HR is available in 14, 28, and 42 count packages. The new prescription will need to be written for one of these listed quantities, as Nexium® 24HR is not available in the standard 30 count package.
For ease of transition we are asking HNE providers to proactively apply the following changes when prescribing Nexium® 24HR:
- Change prescriptions for 30 NEXIUM® 20 mg to 28 Nexium® 24HR capsules per month.
- Change prescriptions for 30 NEXIUM® 40 mg to 56 Nexium® 24HR capsules per month.
Members and pharmacies have already been made aware of this change.
The reject messaging on the claim at point of service will reflect the bullets above. Pharmacies will be asked to contact the prescribing physician for verbal authorization to switch.
Additionally, since the cost of OTC Nexium ®24HR product is considerably lower than other brand name and some generic proton pump inhibitors (PPIs), HNE will now require Nexium ® 24HR (OTC) as a step therapy requirement for the following PPIs effective January 2015:
- Kapidex™
- Dexilant
- Prevacid® Solutab™
- Omeprazole sodium bicarbonate (generic Zegerid®)
- Rabeprazole
For HNE to cover the Step Therapy drugs listed above, the member must try all of the corresponding First Line drugs, which include omeprazole, pantoprazole, and Nexium ®24HR (OTC).
Should you have any questions, please feel free to contact our Provider Relations at 413.233.3313 or 800.842.4464, extension 5000.
