September 21, 2017
We know that you want to be sure your patients are getting the best care, while helping them manage the cost of that care. In an effort to reduce overall healthcare costs, we're changing the way some medications and/or medical devices are covered.
Starting November 1, 2017, your patient's Premera pharmacy benefit won't cover the following:
- office-administered medications
- medications with an FDA-approved label stating that they are to be administered by a medical professional
This may change your patient's out-of-pocket costs. We encourage you to review your patient's medications to determine if a change could be made.
Your patient's Premera pharmacy benefit also won't cover the following drugs that require pre-approval:
- Nucala®
- Stelara®
- Eylea®
- Entyvio®
- Xiaflex®
- Nplate®
Products that are approved as devices, such as topically applied skin barriers or protectants, will not be covered by the patient's pharmacy benefit. This restriction doesn't apply to products used to manage a patient's diabetes, such as test strips or insulin syringes.
In addition, we'll no longer cover products that aren't FDA-approved.
To see if a product or medication falls into the medical coverage category or is an unapproved product, check the National Library of Medicine's website DailyMed.