While we usually think of generics as being low-cost alternatives to brand drugs, new-to-market generics are not always the most cost-effective option. When a generic is first available, the price may be nearly as high as the brand cost. There may also be shortages of generics when they are first available because only one or a few manufacturers are making the drug.
BlueChoice® has carefully considered both the cost of generic Nexium and its availability. To offer our employer groups and our members the best value for their health care dollars, as well as to continue to provide a range of options for reflux medications, we have made these coverage decisions:
- Brand Nexium: The PA will require members to have tried a generic reflux medication other than Nexium and also to have tried OTC Nexium.
- Generic Nexium: Due to potential availability issues and demand, we will reconsider coverage of generic Nexium when we know there is ample supply in the market and when the cost comes down to align better with other available generic reflux medications.
- Other covered reflux medications: We currently cover several generic reflux medications that do not require PA including prescription lansoprazole, omeprazole, pantoprazole, and rabeprazole. This is a good opportunity for Nexium users to discuss these options with their doctors.