• Government
• Profession
• Business
• Opinion
• Health

• Health reform
• H1N1
• P4P
• EMRs
• Medicare
• Liability
• AMA House
• » More

• Book Excerpt
• Business Pitch
• Meetings
• » More

• Contract Language
• Ethics Forum
• In the Courts
• Practice Management
• Technically Speaking
• » More

• Issue dates
• Regions
• Health plans
• Sections
• News briefs
• Columns
• Editorials
• Letters
• Writers
• Other years

• Search tips
• E-mail alert
• Radio
• RSS
• Mobile
• Subscribe
• Institutions
• Staff directory
• Advertising
• Permissions
• Reprints
• News media
• Site guide
• Useful links
• About
• Premium
• Contact

Physicians wary of insurers covering OTC medications

Two Minnesota insurers are entering rare territory in an attempt to save money. Physicians are concerned about whether patients will get the drugs they need.

By Jonathan G. Bethely, amednews staff. Aug. 21, 2006.

• PRINT|
• E-MAIL|
• RESPOND|
• REPRINTS|
• SHARE

Four years ago, WellPoint Health Networks successfully petitioned the Food and Drug Administration to make Claritin available without a prescription. A year later, the FDA approved a nonprescription version of Prilosec. Insurers expected to save big money thanks to those approvals.

Not only did they no longer have to cover two of the biggest sellers in the two biggest-selling drug categories -- antihistamines and proton pump inhibitors -- but they could also steer patients toward the OTC medications by increasing co-pays and requiring prior authorization for the prescription counterparts.

Despite the FDA approvals and other plan strategies, such as using the rate of prescribing generics as part of a physician's pay-for-performance package, health plans are still seeing their annual drug costs go up by double-digit percentages. So a few plans are doing something that was unforeseen when WellPoint pressed its case to the FDA. Blue Cross Blue Shield of Minnesota and Medica, another Minnesota plan, are paying the full cost for over-the-counter Claritin and Prilosec.

The plans decided it would be cheaper to pay for the nonprescription medicine than even for the generic version of a prescription drug.

"We started the program because we saw an opportunity for savings," Minnesota Blues spokeswoman Jan Hennings said.

And savings there are. The Minnesota Blues says it's saved $400,000 in the first three months of its program, which began with the plan mailing notices to members taking allergy and heartburn drugs, informing them they could get over-the-counter versions at no cost if they got a prescription. The plan says it expects to save another $600,000 in the next three months of its nascent program.