Prescription medications are necessary to effectively treat certain medical conditions. However, prescription medications have the potential to be unsafe when not used properly. IBC has taken several actions, referred to as a Safe Prescribing Procedures, to make sure that you and your family members are using prescription drugs safely and to reduce costs.
Two of these safe prescribing measures are prior authorization and quantity limits. Prior authorization is required before certain drugs are available for coverage. Quantity limits are designed to allow a sufficient supply of medication based on FDA approved maximum daily doses and length of therapy of a particular drug.
HOW DOES THIS AFFECT YOU AS AN EMPLOYEE?
IBC is making the following changes to their Safe Prescribing Procedures for narcotic drugs effective May 1, 2009:
- Expiration of Prior Authorizations. IBC is implementing a time limit of six to twelve months on prior authorization approvals for narcotic drugs. If your doctor wants you to continue the drug therapy after the expiration date, a new request will be required. If you currently have an approved prior authorization for a narcotic drug, it will expire May 1, 2009. Your doctor will have to submit a new prior authorization request if he or she recommends that you continue with your current drug therapy.
- New Quantity Limits. IBC is adding quantity limits to certain narcotics. If you attempt to fill a prescription that exceeds the set quantity limit, your pharmacist will fill the prescription only for the allowed supply. If your medical provider determines that your therapy requires a larger dose of medication than the set quantity limit for your drug, he or she may request a quantity limit exception. Your medical provider must receive an approval for the exception for you to continue to receive coverage for your therapy at a larger dose.
- Therapeutic Drug Class Quantity Limit. IBC is applying a 30-day total quantity limit to each class of narcotic drugs. If you use more than one narcotic within the same class, or if the same drug is taken in more than one strength, you may be unsafely duplicating medications. Effective May 1, 2009, you will only be able to obtain a 30-day total supply of any combination of drugs in the same class each month.
- Expiration of Quantity Limit Exceptions. If a quantity limit exception is approved, it will be limited to six to twelve months. For example, if a narcotic drug receives a quantity limit exception approval for six months on January 1, 2009, that approval will expire on June 30, 2009. If you doctor wants you to continue the drug therapy after the expiration date, a new request will be required.
WHAT SHOULD I DO NEXT?
Please contact your doctor to discuss your current treatment and the possible impact of the above changes on your drug therapy. That discussion may result in your doctor making the following recommendations:
- Alternatives to current therapy
- Prescribing approved generic medications
- Continuation of your current therapy
If you or a family member has questions about this notice please feel free to reach out to your BenefitsVIP team for assistance. As your employer’s broker, Corporate Synergies closely monitors carrier issues and will keep participants informed of any additional changes as they occur.
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