Life Sciences

Employer adds universal step restrictions in September, more drug classes to be hit

Medicare & Reimbursement Advisor Weekly, August 26, 2009

To continue providing what it says is affordable access to prescription drugs, Principal Life Insurance Company will implement a national formulary and step therapy policy change in all states except Texas, starting September 15. Most branded drugs move from tier 2 to tier 3 and add a step and/or prior authorization (PA).

Generic “alternatives,” according to the company, will be available on tier 1.

For prescriptions filled on or after September 15, an additional 10 drug classes will be added to the step therapy program. At that time, both current and first-time users of third-tier drugs will need to try an alternative generic drug if they do not have a history of a generic drug within the past 24 months.

When a member wants to fill a prescription for a third-tier drug, the pharmacy system will check whether the member has received an alternative generic drug within the last 24 months.

CVS Caremark sent communications to members and physicians August 15, which included a list of impacted scripts.

Below are the primary changes (see chart). Tier changes apply to all drugs listed.