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Regence/Asuris formulary change for asthma/COPD medicine

Effective May 1, 2015, Regence/Asuris is shifting three Asthma/COPD medications that currently carry a $15 or $20 copay to non-formulary status. The impacted medications are Advair, Flovent, and Alvesco.

Letter to members

Regence/Asuris sent a letter explaining the details of the transition, including a list of alternatives, to each person currently using one of these medications.

Pre-authorization now needed for these medications

Employees who are currently using one of these medications will need to get a pre-authorization before the medications are covered at the Tier 3 (non-formulary) level. Until the pre-authorization is in place, the employee will be responsible for 100% of the cost of the medication.

If someone has “tried and failed” one of the alternative medications in the past six months, they will receive an automatic authorization. They will pay the higher non-formulary out-of-pocket costs listed below.

If the member and their physician feel that Advair, Flovent or Alvesco are the correct medication for their condition, then with the pre-authorization in effect, prescription out-of-pocket costs are still impacted. The AWC Regence/Asuris plans cover non-formulary medications in a variety of ways:

  • HealthFirst and HealthFirst 250 Plans
    Non-formulary medications have a $35 copay instead of the $15 copay for name brand formulary medications.
  • HealthFirst 500
    Non-Formulary medications have a 50% coinsurance instead of the $20 copay for name brand formulary medications.
  • High Deductible Health Plan (HDHP)
    The formulary/non-formulary status of a medication does not change the benefit level on the HDHP. Once the deductible has been met, the coinsurance remains 20% of the allowed amount.

    Advair and Flovent are currently on the Value Added List for the HDHP. This means that the plan pays 80% of the cost of the medication before the deductible has been met. Shifting these two medications to non-formulary status removes them from the HDHP Value Added List, so the deductible will apply beginning May 1, 2015 (once a pre-authorization is in place).

Impacts for children

Members under the age of 12 do not require a pre-authorization for Advair.