Spring 2009

Responsible Rx programs expand April 1

Effective April 1, 2009, Blue Cross and Blue Shield of Florida (BCBSF) and Health Options expanded the Responsible Step and Responsible Quantity components of the Responsible Rx program for BlueChoice, BlueOptions, BlueSelect and BlueCare members. Responsible Rx refers to an umbrella of pharmacy programs that also includes the Responsible Dose program.

Responsible Step

The step therapy program was implemented on medications known as Proton Pump Inhibitors (PPIs), including:

• Aciphex

• Kapidex

• Nexium

• pantoprazole

• Prevacid

• Prilosec (Rx only)

• Protonix

• Zegerid

The step therapy program requires the use of omeprazole, a cost-effective generic PPI prior to the coverage of more costly agents. Members switching to omeprazole may also benefit from the lower generic copay.

As of April 1, new users of the PPI medications included in Responsible Step are required to have a trial of omeprazole before any of the above medications will be covered.

Coverage for Nexium will continue for members already using Nexium prior to April 1, as long as they fill their prescriptions regularly. Current users of other PPI medications will be subject to the step therapy program effective May 1, 2009.

If omeprazole is not clinically indicated, physicians may submit a prior authorization request by filling out the PPI Step Therapy Prior Authorization Form at www.bcbsfl.com, under Physicians & Providers, Pharmacy.

A prescription for one of the PPIs in the program will be covered if a member has already tried omeprazole and we have a previous pharmacy claim for omeprazole in the system. Prior authorization is not required for continued coverage.

Responsible Quantity

This program ensures coverage of certain prescription drugs that reflects drug manufacturers’ and Food and Drug Administration (FDA) dosing guidelines.

The table below lists all medications and limits added to the Responsible Quantity Program effective April 1. If additional quantities are required, the Quantity Limit Prior Authorization Form is available on our website at www.bcbsfl.com under Physicians & Providers, Pharmacy, Responsible Quantity.