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State Health Plan Preferred Insulin Brand Program
As of July 1, 2014, the State Health Plan will only include Novo Nordisk brand insulins (rapid-acting, short-acting, intermediate-acting, and insulin mixtures) on Tier 2 of the Traditional pharmacy benefit preferred drug list. Lilly and Sanofi-Aventis brand insulins (rapid-acting, short-acting, intermediate-acting, and insulin mixtures) will be moved to Tier 3. This program applies to the State Health Plan's Traditional 70/30 Plan, the Enhanced 80/20 Plan, and the Consumer-Directed Health Plan. It does not apply to the Medicare Advantage plans with Humana or UnitedHealthcare.
For a detailed chart showing which insulins will be preferred or impacted, along with additional information, please click here.
Please consider whether or not Novolog or Novolin insulins will be approprite for your patients requiring therapy. This program does not impact the long-acting insulints Lantus or Levemir.
In addition, a step-theray program will require the use of the preferred brand first prior to allowing coverage of a nonpreferred brand. This step-therapy program will ensure the use of State Health Plan-preferred products prior to the use of other nonpreferred agents. Members must have previously tried therapy with the preferred brand insulin. Program information about the prior authorization policy can be found online at www.shpnc.org.
If there are special reasons the member should continue the nonpreferred insulin, providers may call Express Scripts at 1-800-417-1764, Monday through Friday from 8 a.m. to 9 p.m. EST., to request a review starting on July 1. Members will be responsible for the full cost of the prescription if the provider does not receive approval during the coverage review.