IMPORTANT CHANGES TO YOUR PRESCRIPTION BENEFITS EFFECTIVE MARCH 8, 2016

Jan 7, 2019 | News

SUMMARY OF MATERIAL MODIFICATION (“SMM”)

The information contained in this SMM reflects changes to the Rheumatoid Arthritis Step Therapy and changes to the Limits on FDA “CLASS II” Pain Medications information set forth  in the SMM mailed to all participants on October 30, 2015, and in the December 2015 Guardian Newsletter. 

SUMMARY OF MATERIAL MODIFICATION (“SMM”)

The information contained in this SMM reflects changes to the Rheumatoid Arthritis Step Therapy and changes to the Limits on FDA “CLASS II” Pain Medications information set forth  in the SMM mailed to all participants on October 30, 2015, and in the December 2015 Guardian Newsletter.

At the March 8, 2016 meeting, the Trustees of the Central Pennsylvania Teamsters Health & Welfare Fund (“Fund”) adopted the following changes:

Rheumatoid Arthritis Step Therapy

The following generic drugs are now added to the Step I Rheumatoid Arthritis Step Therapy category:

High dose ibuprofen and naproxen (i.e. requiring an RX), celecoxib, nabumetone, piroxicam, diclofenac, diflunisal, indomethacin, ketoprofen, etodolac, prednisone, cyclophosphamide, cyclosporine, azathioprine and methotrexate.

Limits on FDA “Class II” Pain Medications

The following changes apply to the Limits on FDA “Class II” Pain Medications:

In cases where patients are taking one or more Class II Pain Medications on an extended basis (i.e. more than 15 days) as part of a physician-monitored pain management program, the Fund Office will require a letter from the treating physician that:

  1. Explains the condition for which the patient is being treated; and
  2. Addresses the length of time that the patient has been under their care for said condition; and
  3. Lists the Class II Pain Medications which are being prescribed to the patient on an on-going basis; and
  4. Includes a certification by the physician that the treatment plan for the patient is being monitored on a regular basis.

If these four conditions are documented by the treating physician in writing, the Fund can relax the 15 day script requirement and allow the patient to go to a regular 30 day script co-pay schedule for their Class II Pain Medications.