New Pharmacy Step Therapy Program for the State Health Plan for Teachers and State Employees
Angiotensin Receptor Blocker (ARB) Step Therapy Program
On April 6, 2010, Cozaar® and Hyzaar® will become available as generics. In order for the State Health Plan to maintain an affordable prescription drug benefit and to promote the use of generics and preferred medications, several brand angiotensin receptor blockers (ARBs) will be moved to a higher copay tier and be subject to a step therapy program.
Beginning April 1, 2010, the copay for Atacand®, Atacand HCT®, Benicar® and Benicar HCT® will be $55. Diovan® and Diovan HCT® will now have a $35 copay instead of $55 copay.
Please consider if generic Losartan, Losartan HCTZ or one of the preferred ARBs would be appropriate for your patients requiring ARB therapy.
|Angiotensin II Receptor Blockers (ARBs)|
Tier One ($10 copay)
Losartan (generic for Cozaar®)
Losartan HCTZ (generic for Hyzaar®)
Tier Two ($35 copay)
Preferred Brand Name Medications
|Diovan®, Diovan HCT®, Micardis®, and Micardis HCT®|
Tier Three ($55 copay)
Non-Preferred Brands without a
Requires a coverage review
Atacand®, Atacand HCT®, Avapro®, Avalide®, Benicar®,
Benicar HCT®, Teveten®, and Teveten HCT®
Brand with Generic Equivalent
($10 plus the difference in the Plan's
cost for the brand and generic)
|Brand Cozaar® and Hyzaar®|
Also as of April 1, 2010, Atacand®, Atacand HCT®, Avapro®, Avalide®, Benicar®, Benicar HCT®, Teveten®, and Teveten HCT® will require a formulary coverage review. Coverage will only be approved if providers document either that the member is taking Atacand or Atacand HCT for heart failure, or that the member has experienced therapeutic failure with two different preferred ARBs. 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, 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.
Detailed program information is located on the SHP web site at http://www.shpnc.org/drugs-requiring-st.html.