State Health Plan Fertility Medication Pharmacy Changes
Effective April 2, 2012, Gonal-F® (follitropin alfa injection) will become a non-preferred medication and will require a coverage review. If your patients are planning to use Gonal-F in the future, you will need to complete a coverage review with Medco.
The fertility medication Follistim® (follitropin beta injection) will continue to be a preferred fertility medication and will be covered at the appropriate specialty copay, as long as the clinical indication for use meets the Plan’s conditions for coverage. Please consider using the preferred fertility medication Follistim for your State Health Plan patients.
To request a coverage review, providers may call Medco toll-free at 1-800-417-1764 from 8:00 a.m. to 9:00 p.m., Eastern Time, Monday through Friday, or log on to www.medco.com/coverage to request a review. Members will be responsible for the full cost of the prescription if the provider does not receive approval during the coverage review.
In addition, effective April 2, 2012, out-of-state specialty fertility pharmacies will no longer be in-network.
If your patients are receiving their fertility medications from an out-of-state specialty fertility pharmacy, they will need to change to an in-network pharmacy or pay out of pocket and file a paper claim with Medco for reimbursement.
Accredo Health Group, Inc., Medco’s specialty pharmacy, can provide delivery of these specialty medications, or members may visit www.medco.com to find another in-network pharmacy. You or your patient may contact Accredo at 1-877-988-0059 or visit www.shpnc.org for more information.
Accredo Health Group, Inc., is a wholly owned subsidiary of Medco Health Solutions, Inc.