Prilosec OTC Program

Wellmark Blue Cross and Blue Shield now covers the over-the-counter drug Prilosec OTC^® as a generic drug. Drug card members will be responsible for the cost of their generic copayment or coinsurance. For members with drugs covered under their comprehensive major medical health benefits, Prilosec OTC will be applied toward their contracted benefits. This program is available to most members who have drug coverage through Wellmark.

Prilosec OTC is a proton pump inhibitor (PPI), a class of drugs that is often used to treat heartburn.

Here’s How The Program Works

• Members must have a prescription for Prilosec OTC in order for it to be covered.
• Members already taking a prescription PPI can simply call their doctor and ask to have their prescription changed; an office visit is not required. Their pharmacist can also call their physician to have their prescription changed.
• Take the prescription to a Catalyst Rx network pharmacy
• The pharmacy will file the claim electronically; the member is responsible for paying their cost share.

Why Cover Prilosec OTC?

The Prilosec OTC program gives physicians and members a cost effective option to clinically equivalent and higher priced brand-name PPIs. Prilosec OTC costs about 71 cents a pill. Brand-name PPIs cost six times as much.

Prilosec OTC contains the same active ingredient at the same strength as the most commonly prescribed version of prescription Prilosec (20mg).

Brand-name PPIs are on Tier 2 or Tier 3 on the Wellmark Drug List. Average out-of-pocket costs for brand-name PPIs range from $25-$50. Most generic copayments are around $10.

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