April 05, 2011
On January 1, 2011, Humana Pharmacy Solutions implemented a prior authorization requirement for the popular blood pressure medication, Benicar. The edit was put in place to optimize the cost of therapy for the entire ARB class, which includes generic forms of Cozaar and Hyzaar.
The edit requires members to have tried and failed on the generic form of Cozaar or Hyzaar and Avapro, Avalide, Diovan, or Diovan HCT—our preferred ARBs—before authorization for Benicar is approved.
Although we notified affected members by mail and automated phone calls, some members are being caught unaware of the authorization requirement at the pharmacy counter.
To mitigate the access to care issues these members may experience, we updated our claims system to allow a transitional fill for any Benicar user who has not yet attempted to fill Benicar. The transitional authorization will expire on April 1, 2011.
A letter was sent to members who had filled Benicar in November and December 2010 and January 2011. These members are encouraged to work with their doctors to get the necessary approval before April 1, 2011.