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Microsoft word - draft9-smhp fap prescriber letter 5.17.11.docxNEW STEP THERAPY REQUIREMENTS
FOR SELECT MEDICATION CATEGORIES
Effective July 15, 2011
<<Date>> <<Prescriber First Name>> <<Prescriber Last Name>> <<Prescriber Address>> <<Prescriber City>>, <<State>> <<Zip>> Dear Prescriber: On July 15, 2011, the Saint Mary’s Health Plans’ prescription drug plan, administered by Catalyst Rx, will add new Step Therapy requirements on select medications. Step Therapy is designed to encourage the use of safe and cost-effective prescription drugs. This letter is to provide you with advance notice so you can help your patients make this transition as smooth as possible. Step Therapy requires a member to try a preferred alternative before a non-preferred brand-name
medication will be covered by their prescription drug plan. If the member is currently taking a
medication that will require Step Therapy (see chart below), they will need to obtain a new
prescription for a preferred alternative to ensure continued coverage of the medication.
Requiring Step Therapy1
Invega2, Latuda2, Saphris2
Lexapro2, Luvox CR2, Pexeva2
1Does not apply to members under age 18 and other exceptions may apply. 2Applies to new starts only. Patients who start treatment on a non-preferred SSRI or Atypical Antipsychotic medication prior to July 15, 2011 will not be affected. 3Must try two preferred alternatives. On July 15, 2011, medications requiring Step Therapy will no longer be routinely covered and the member will be required to pay the full cost of the drug at the pharmacy. Affected members will be informed of this new process and will be encouraged to either obtain a new prescription for a preferred alternative or have a Prior Authorization request submitted to Catalyst Rx for continued coverage of their non-preferred medication. According to our records, you have prescribed medications requiring Step Therapy to Saint Mary’s Health Plans members. A list of these members and their prescribed medications is enclosed. Please attempt to transition your patient to a preferred alternative listed in the chart on the reverse side of this letter. If this is not possible, or all preferred alternatives have been tried and were not successful, please request a Prior Authorization for a non-preferred medication. You may fax your request to 1-888-852-1832 along with supporting documentation. Copies of the Catalyst Rx Prior Authorization Form are available online at www.catalystrx.com under the “Providers” tab. Thank you for your assistance in increasing patient awareness about the safety, efficacy and cost-savings associated with generic drugs and other preferred alternatives. Your support of the Saint Mary’s Health Plan Preferred Drug List is appreciated. If you have any questions, please call the Catalyst Rx Member Services Department at
1-866-358-9534. Representatives are available 24 hours a day, seven days a week to assist you.
Steven L. Phillips, MD
Saint Mary’s Health Plans
This communication is intended for the use of the person or entity to whom it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this information is STRICTLY PROHIBITED. If you have received this message in error, please notify the sender immediately. Prescriber: <<Prescriber First Name>> <<Prescriber Last Name>>
Table 1: PATIENTS POTENTIALLY TAKING MEDICATIONS REQUIRING STEP THERAPY
Drug Requiring Step Therapy
This communication is intended for the use of the person or entity to whom it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering it to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this information is STRICTLY PROHIBITED. If you have received this message in error, please notify the sender immediately.
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