Dear Pharmacy,
In an effort to support
continued access to affordable prescription drug benefits, PEEHIP has elected –
on a temporary basis - to preferentially cover the brand version of NEXIUM over generic ESOMEPRAZOLE
MAGNESIUM for PEEHIP’s
non-Medicare eligible members. Per
PEEHIP’s direction, we request pharmacies to dispense brand name NEXIUM for all new and refill ESOMEPRAZOLE MAGNESIUM prescriptions
from 04/01/15 to at least 08/18/15 for Alabama non-Medicare eligible PEEHIP members.
Pharmacies will continue to receive brand reimbursement for these fills.
The NDCs for the generic ESOMEPRAZOLE MAGNESIUM will be blocked from adjudicating on claims for those
members. The claim rejection response will contain a message reminding the
pharmacist that they should dispense brand NEXIUM to the member.
Because PEEHIP has elected to
not cover ESOMEPRAZOLE MAGNESIUM under its plan during the specified time
period (04/01/15 through 08/18/15 or a later date, if designated by PEEHIP),
ESOMEPRAZOLE MAGNESIUM will not be deemed “available” to PEEHIP members or
dependents as a covered benefit during that time for purposes of Ala. Code
(1975) §16-25A-18 (requiring pharmacists to “dispense a generic equivalent
medication to fill a prescription . . . when one is available . . . .”). Therefore, be assured that PEEHIP will not
consider a pharmacy or pharmacist dispensing NEXIUM over ESOMEPRAZOLE MAGNESIUM
to be in violation of Ala. Code (1975) §16-25A-18 and will not remove any
pharmacies or pharmacists from participating in PEEHIP as a result of
dispensing NEXIUM rather than
ESOMEPRAZOLE MAGNESIUM during the specified time period.. PEEHIP will,
however, consider ESOMEPRAZOLE MAGNESIUM to be “available” as a generic
equivalent for NEXIUM after this specified time period ends.
If pharmacies need a DAW code
to bypass internal edits, DAW code value 9 can be used:
DAW 9 means Substitution Allowed by Prescriber but Plan
Requests Brand - Patient's Plan Requested Brand Product to Be Dispensed.
If
you have any questions concerning this letter, please contact a MedImpact
representative at 1-800-788-2949.