TO:
Kenneth Brynien, President
FROM:
Lorraine Simpkins,
Health Benefits
Specialist
DATE:
11/20/06
RE:
2007 Empire Plan Preferred Drug
List (PDL)
In
consultation with the state, Empire Blue Cross Blue Shield (BCBS), the insurer
for the Empire Plan Prescription Drug Program, has finalized the 2007 Empire
Plan Preferred Drug List (PDL). The
Empire Plan PDL includes all generic drugs and preferred brand name drugs.
Preferred brand name drugs are selected on the basis of therapeutic
effectiveness, safety, market share, and cost relative to other brand name drugs
used to treat the same conditions.
W
ith one exception, brand name drugs can only be
moved from the preferred (Tier 2) to the non-preferred (Tier 3) category on
January 1st of each year. The
exception is, when a generic equiva
len
t for a preferred brand name drug becomes available, Empire BCBS
immediately moves the drug to the non-preferred (Tier 3) category.
For year 2007, Empire BCBS is moving ten (10) brand name drugs from the
preferred (Tier 2) category to the non-preferred (Tier 3) category.
These ten (10) brand name drugs do not have generic equiva
len
ts.
There
are, however, therapeutic alternatives available for each of these drugs.
The alternatives, which may be either generic or brand name drugs or
both, are considered equally effective in treating the same condition. According
to Empire BCBS, only one (1) of the drugs being moved, Crestor (used to treat
high cholesterol), is in the list of Top 25 drugs dispensed to Empire Plan
enrollees. The brand name drugs
moving from Tier 2 to Tier 3 effective
1/1/07
are:
|
Non-Preferred
Brand Name Drug |
Therapeutic
Category
|
|
Androderm
and Testim |
Used
to treat testoste
ron
e deficiency
|
|
Betimol |
Used
to treat glaucoma |
|
Cipro
HC and Cortisporin TC |
Used
to treat external ear infections |
|
Crestor |
Used
to treat high cholesterol |
|
Famvir |
Used
to treat shingles and genital herpes
|
|
Ortho
Evra |
Used
for contraception |
|
Ritalin
LA |
Used
to treat Attention Deficit Hyperactivity Disorder (ADHD)
|
|
Synarel |
Used
to decrease the levels of testoste
ron
e in males and estrogen in females |
Last
week, Empire Plan BCBS mailed letters to all enrollees who had one or more
claims for any of these brand name drugs during the period
7/1/06
through
10/31/06
. The
letter advises them that these drugs are being removed from the PDL and will
become Tier 3 non-preferred brand name drugs effective
1/1/07
(sample attached).
GOER estimates the changes to the PDL will affect approximately 1,400
members and/or their dependents, which is approximately 1.7% of PEF members and
their dependents enrolled in the Empire Plan.
The removal of Ritalin LA is likely to generate the most concern.
ADHD affects both adults and children.
The
disorder affects everyone uniquely, and different treatments work for different
people. As such, patients may have
tried several different medications before finding the one that works.
If that medication is Ritalin LA, these patients may not be willing or
able to change to one of the alternatives identified by Empire BCBS.
Parents of a child with ADHD will be particularly sensitive to making
changes that may disrupt their child’s life.
Ritalin LA is formulated to control ADHD symptoms for 6-8 hours compared
to Ritalin, which only controls symptoms for approximately 3-4 hours.
In
addition to the ten (10) brand name drugs moving from preferred (Tier 2) to
non-preferred (Tier 3), Empire BCBS is also moving eight (8) brand name drugs in
the other direction – from
non-preferred
(Tier 3) to preferred (Tier 2). The
brand name drugs being moved to the preferred (Tier 2) category effective 1/1/07
are indicated below:
|
Preferred Brand Name Drug
|
Therapeutic Category |
|
Actonel
and Actonel with calcium |
Used
to treat osteoporosis |
|
Estring
|
Used
to treat estrogen deficiency |
|
Geodon
|
Used
to treat schizophrenia |
|
Proventil
HFA |
Used
to treat asthma |
|
Tamiflu
|
Used
to treat infections caused by the flu virus |
|
Travatan
|
Used
to treat glaucoma |
|
Tricor
|
Used
to treat high cholesterol |
Since
the changes to the Empire Plan PDL may affect enrollees out-of-pocket expenses
for their prescription drugs, members who enrolled in the Health Care Spending
Account (HCSAccount) may be concerned that their election amount will now be too
low or too high. Fortunately, the
state allows employees who enrolled in the HCSAccount by the deadline to change
their election amount in December. In
early December, the HCSAccount administrator, FBMC, will send participants a
letter confirming the amount set aside for 2007.
Participants who wish to change their election amount, either increase or
decrease it, must notify FBMC by 12/13/06.
Members
who have questions regarding the procedure for changing their election amount
should contact FBMC at 1-800-342-8017.
If you have any questions regarding the changes to the 2007 Empire Plan PDL,
please contact me.
Memo: