Wellmark Drug List Changes Effective January 1, 2007

A primary goal of Pharmacy Insights is to deliver a clinically effective pharmacy program that achieves lowest total net spend. Several months of evaluation of clinical, safety, utilization, and drug alternative data has resulted in some changes to the Wellmark Drug List in January 2007. The changes fall into three categories:

• Drugs moving from Tier 2 to Tier 3 because AB-rated generics are now available
• Drugs moving from Tier 2 to Tier 3 because therapeutically similar options are available on Tier 1 and/or Tier 2 and/or over-the-counter
• Drugs requiring prior authorization

TIER CHANGES

Drugs moving from Tier 2 to Tier 3 because AB-rated generics are now available do not require a new prescription; members can simply ask their pharmacist to start filling their prescription with the generic option.

Generic Drug List Letter

Drugs moving from Tier 2 to Tier 3 because no AB-rated generic is available will require members to obtain a new prescription for the preferred alternative to prevent a possible increase in out-of-pocket costs at the pharmacy.

Wellmark Drug List Letter

PRIOR AUTHORIZATION CHANGES

Three new drugs require prior authorization — Differin, Penlac, and Daytrana:

• Differin is similar to Retin-A, an acne drug that also can reduce wrinkles and currently requires prior authorization for members 35 years of age and older
• Penlac is a topical anti-fungal drug similar to Sporanex and Lamisil, which currently require prior authorization
• Daytrana is a patch used to treat ADHD; added because of safety, clinical effectiveness, and cost concerns; approximately 30 percent of drug remains in patch after removal and the cost is about $5 per patch, which is more expensive than other ADHD drugs that are clinically the same

ONE TOUCH AND ACCU-CHEK: BLOOD GLUCOSE TEST STRIPS ON TIER 2

Effective January 1, your employees can take steps to lower their out of pocket costs by choosing One Touch or Accu-Chek blood glucose test strips. All other blood glucose test strips will move to Tier 3. Because changing test strips will require using a new blood glucose monitor, those affected by the change will receive a letter with instructions on how to receive a new monitor at no charge.

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