Important pharmacy benefit announcement for medical center employees and dependents on an employee group health plan

Pharmacy pdfEffective Sept. 1, 2016, the AU Medical Center Employee Group Health Plan, with pharmacy benefit managed by Navitus, will no longer cover nasal corticosteroids and proton pump inhibitors/H2RA (acid reflux) medications as part of the group health plan. These items will now have to be purchased over the counter. You can still have your prescription filled at the Employee Pharmacy, but it will not be covered under the group health insurance benefit.

If you utilize a flexible spending (FSA) or health savings (HSA) account to currently help with your out-of-pocket medical and/or pharmacy costs, you can continue doing so at the Employee Pharmacy.

For proton pump inhibitors/H2RA (acid reflux) medications, there may be exceptions based on certain medical conditions, which would allow a plan member to continue coverage under the group health plan. If you or your dependent on the group health plan meet the following criteria, please request your treating physician to submit a Prior Authorization to UMR to ensure continued coverage via the plan. Prior authorization will not be required for members under age 12.

  • Diagnosis of Barret’s esophagus
  • Hypersecretory condition such as Zollinger-Ellison syndrome
  • Chronic NSAID
  • Peptic ulcer disease (duodenal or gastric)
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