Prescription plan shift puts all non-sedating antihistamines in most expensive tier

UNT HealthSelect members who are chronic allergy sufferers may have noticed a marked increase in the cost of their prescription antihistamines.

That is because of a change to the HealthSelect preferred prescriptions plan last fall that moved all non-sedating antihistamines (such as Allegra, Clarinex and Zyrtec) into the third, and most expensive, prescription tier. The change became effective Sept. 1. Prior to September, some non-sedating antihistamines were classified as tier 2 drugs.

David Roberson, human resources representative, says the change was made because the popular non-sedating antihistamines were costing the insurance company too much money. A law passed during the 78th session of the Texas Legislature allowed the drugs to be shifted to a higher tier, resulting in a greater percentage of the drugs' costs being passed to consumers.

HealthSelect members have two options for purchasing prescriptions that are taken every day (called maintenance drugs) such as prescription antihistamines. The first option is to purchase the maintenance drugs from a retail pharmacy. The second is to purchase these drugs from Medco Health Solutions, HealthSelect's contracted prescription management firm, using Medco's mail-order program.

If HealthSelect members choose to purchase non-sedating antihistamines from a retail pharmacy, they will pay $55 for a 30-day supply and will have to return to the pharmacy every 30 days for a refill, regardless of whether the prescription was written for a 30-, 60- or 90-day supply. That means that a 90-day supply will cost $165.

If, however, HealthSelect members choose to purchase the antihistamine using Medco's mail-order program, they can purchase the whole 90-day supply in one order for $120 — if the prescription is written for a 90-day supply.

Roberson suggests that members make sure their doctor writes a prescription for a 90-day supply, unless the drug is being used on a trial basis and won't be taken for that length of time.

All HealthSelect members are required to meet a $50 per plan year deductible for each family member covered by Health-Select. That means that each HealthSelect participant (employee and dependents) must spend $50 on prescriptions before the insurance plan begins to cover any prescription costs.

If HealthSelect members want to save money on prescription drugs, the Employees Retirement System recommends that they ask their doctor to consider prescribing generic or preferred brand-name medications rather than those on the non-preferred brand-name list.

But above all, Roberson recommends that HealthSelect members follow their doctor's advice regarding prescription purchases.

For more about HealthSelect's prescription plan, visit www.ers.state.tx.us.

BY MICHELLE HALE mhale@unt.edu

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