Effective January 1,
2013, for coverage under the terms of our commercial health plans*, prior
authorization will not be issued for Humatrope? in the absence of a documented trial and failure of therapy with, or
contraindication to, Norditropin?.
As of January 1, 2013, a new prior
authorization will be required in order for members to receive Humatrope?. In addition, any existing authorizations for
Humatrope? will no longer be valid as of
January 1, 2013. Members who are currently taking Humatrope?, but who have a documented history of trial and
failure of Norditropin?, will not be
considered an exception. For members who have previously tried and failed
Norditropin?, the documentation of such
failure should be submitted along with your prior authorization request for
coverage of Humatrope?. All coverage requests
and prescription drug claims for Humatrope?
for commercial members will be denied in the absence of a new prior
authorization. This requirement for Humatrope?
prior authorization applies to members starting, as well as those currently
taking, Humatrope?.
Please note that even in circumstances
where prior authorization is obtained for Humatrope?, members will be responsible for the highest non-formulary level of
cost-sharing available under the terms of their plan.
Effects on existing Humatrope? prescriptions
Prescriptions now on file for
commercial members on Humatrope? will require
prior authorization effective January 1, 2013.
Recent approvals for Humatrope?
We recognize that certain members may
have recently had a prior authorization issued for Humatrope?. Those prior authorizations are valid for one
year. To reduce the administrative burden on you and your patients and to avoid
disruption in therapy, Norditropin? will not
require authorization for the period of coverage prior to January 1, 2013, that
Humatrope? was authorized. However, patients
will require a new prescription for Norditropin? in order for Norditropin? to be
dispensed by the pharmacy. Submission of additional clinical information will
not be necessary. Your AmeriHealth commercial patients will not experience a
change to their cost-sharing obligation for Norditropin? (i.e., copayment, coinsurance, or deductible) as a
result of this change.
If you have any questions related to
this change, please call FutureScripts at 1-888-678-7012.