Drug Protocol Management:
Drug Protocol Management:
Drug Protocol Management:
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� Frequently Asked Questions<br />
Q. Why should use of second-line<br />
drugs be limited?<br />
A. Second-line drugs may have more<br />
side effects, be more difficult to<br />
take, and/or be more expensive<br />
than their first-line alternatives.<br />
Q. Can I get coverage for a secondline<br />
drug even if I have not tried a<br />
first-line drug?<br />
A. In some cases, yes. Exception<br />
processes are available for the rare<br />
cases in which no first-line drug is<br />
appropriate. If you meet certain<br />
medical criteria, you may be able to<br />
get coverage through your plan’s<br />
usual prior authorization process.<br />
Q. Does a change to a first-line drug<br />
have to be approved by my doctor?<br />
A. Yes, because it involves a change<br />
in the drug being dispensed. No<br />
prescriptions will be changed<br />
automatically based on the Step<br />
Therapy program.<br />
Q. If my prescription is changed, will<br />
my copay also change?<br />
A. Your copay may be lower. In many<br />
cases, the first-line drugs are<br />
generic and therefore have a lower<br />
copay than the second-line drugs,<br />
which are typically brand-name<br />
products. Copayments for first line<br />
drugs are never higher than copays<br />
for their second-line alternatives.<br />
Q. What medications and conditions<br />
are included in the Step Therapy<br />
Program?<br />
A. In general, Step Therapy programs<br />
include drugs used for conditions<br />
with many drug therapy choices.<br />
Express Scripts has developed<br />
Step Therapy protocols to improve<br />
the use of medications for the<br />
following conditions (the specific<br />
drugs are listed in parentheses):<br />
� Pain/arthritis (non-steroidal antiinflammatory<br />
drugs)<br />
� High blood pressure<br />
(angiotensin II receptor<br />
antagonists, ACE inhibitors)<br />
� Depression (SSRI’s)<br />
� Gastrointestinal disorders<br />
(Proton Pump Inhibitors)<br />
Q. How are the first- and second-line<br />
drugs chosen?<br />
A. Selection of the first- and secondline<br />
drugs takes place after careful<br />
review of medical literature,<br />
manufacturer product information,<br />
and consultation with medical<br />
professionals. These steps are<br />
taken to make sure that the<br />
protocols reflect the most current<br />
and appropriate drug therapy<br />
recommendations.<br />
© 2002 Express Scripts, Inc.<br />
All Rights Reserved<br />
Rev. 5-2004
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