Late February 2015, generic Nexium® (Esomeprazole) will become available to the market. Esomeprazole will remain Non-Formulary for Medicare Part D Covered Persons and reject at point of sale (POS). The innovator product Nexium® will continue to be covered without prior approval* from the plan.

Action Required

If Participating Pharmacies receive a prescription for Esomeprazole for a Medicare Part D Covered Person, they will need to submit brand name Nexium® in order to receive a paid claim. If a prescription for Esomeprazole is submitted instead of brand name Nexium®, the claim will reject at POS with the following reject message:

• NCPDP Reject Code MR: “Drug Not on Formulary”

• NCPDP Reject Code 569: “NOTICE-MED D COV&RIGHTS”

• Secondary Message: “PROVIDE NOTICE: MEDICARE PRESCRIPTION DR UG COVERAGE AND YOUR RIGHTS NON-FORMULARY DRUG, CONTACT PRESCRIBER ESOMEPRAZOLE IS NON-FORMULARY; NEXIUM IS FORMULARY”

For questions regarding coverage of Nexium® or the new product, please refer Covered Persons to the Customer Service number on the back of their insurance card.

* Coverage of Nexium® is dependent on the Covered Person’s benefit plan.