PLAN STRs INSTI PI PREFERRED NRTI HEP C

Transcription

1 2018 ILLINOIS MEDICAID COVERAGE OF HIV AND HEPATITIS C MEDICATIONS APRIL 2018 PLAN s NRTI HEP C FFS BCBS Meridian Molina Illini Care Harmony WellCare Next Level County Care 2 of 6 3 of 6 3 of 6 4 of 6 5 of 6 6 of 10 9 of 10 9 of of 10 8 of of of 10 7 of 10 3 of 7 6 of 7 1 of 7 5 of 7 2 of 7 1 of 7 3 of 7 3 of 7

2 FEE FOR SERVICE S : 2 OF 6 : 2 OF 2 : 3 OF 6 NRTI/: 6 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT NON- NON- IBILD NON- NON- NON- NON- NON- NON- EVIR NON- NON- NON- NON- NON- NON- NON- NON- SOURCE: DATE ACCESSED FOR ALL: 3/20/2018 EFFECTIVE DATES: 4/1/2018

3 MERIDIAN S : 3 OF 6 : 2 OF 2 : 4 OF 6 NRTI/: 9 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT NON NON IBILD NON NON NON NON EVIR NON NON NON NON NON NON NON SOURCE: EFFECTIVE DATES: 2/17/2018

4 BCBS S : 6 OF 6 : 2 OF 2 : 6 OF 6 NRTI/: 9 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT (30P/30D) (30P/30D) (30P/30D) (30P/30D) IBILD (30P/30D) (30P/30D) (VARIOUS) (VARIOUS) (30P/30D) (VARIOUS) (VARIOUS) (30P/30D) (VARIOUS) (VARIOUS) (30P/30D) (VARIOUS) EVIR NON (30P/30D) (VARIOUS) (VARIOUS) (30P/30D) (30P/30D) (VARIOUS) (VARIOUS) (VARIOUS) NON SOURCE: EFFECTIVE DATES: 1/2018

5 MOLINA S : 6 OF 6 : 2 OF 2 : 6 OF 6 NRTI/: 10 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT (30P/MONTH) (30P/MONTH) (30P/MONTH) (30P/MONTH) IBILD (30P/MONTH) (30P/MONTH) (VARIOUS) (60P/MONTH) (30P/MONTH) (VARIOUS) (VARIOUS) (30P/MONTH) (VARIOUS) (VARIOUS) NON (30P/MONTH) (VARIOUS) EVIR (VARIOUS) (30P/MONTH) (30P/MONTH) (VARIOUS) (VARIOUS) (30P/MONTH) (30P/MONTH) (VARIOUS) (VARIOUS) (60P/MONTH) NON NON SOURCE: EFFECTIVE DATES: 4/2018

6 ILLINICARE S : 6 OF 6 : 2 OF 2 : 6 OF 6 NRTI/: 8 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT NOTES (1/DAY) (1/DAY) (1/DAY) (1/DAY) IBILD (1/DAY) (VARIOUS) (1/DAY) (VARIOUS) (VARIOUS) (1/DAY) (VARIOUS) (VARIOUS) (1/DAY) AT LEAST 18 YR (VARIOUS) EVIR NON NON (1/DAY) (VARIOUS) (VARIOUS) (1/DAY) (1/DAY) (VARIOUS) (VARIOUS) (VARIOUS) NON (1/DAY) (1/DAY) NON NON NON NON SOURCE: EFFECTIVE DATES: 9/2017

7 HARMONY WELLCARE S : 6 OF 6 : 2 OF 2 : 5 OF 6 NRTI/: 10 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT NOTES (31P/31D) (31P/31D) IBILD (31P/31D) (31P/31D) 3 ALTERNATIVE GENERICS (62P/31D) NON (62P/31D) (31P/31D) (VARIOUS) EVIR (31P/31D) (VARIOUS) (31P/31D) (31P/31D) NON NON NON NON NON NON SOURCE: EFFECTIVE DATES: 3/2018

8 NEXTLEVEL S : 6 OF 6 : 2 OF 2 : 6 OF 6 NRTI/: 10 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT (1/DAY) (1/DAY) (1/DAY) IBILD (1/DAY) (6/DAY) (1/DAY) (10.67 ML/DAY) (12/DAY) (1/DAY) (12 ML/DAY) (VARIOUS) (1/DAY) (VARIOUS) EVIR (VARIOUS) (1/DAY) (1/DAY) (VARIOUS) (VARIOUS) (1/DAY) (1/DAY) (VARIOUS) (VARIOUS) (VARIOUS) NON (1/DAY) (1/DAY) NON NON NON (3/DAY) SOURCE: EFFECTIVE DATES: 3/1/2018 *COOK COUNTY ONLY

9 COUNTY CARE S : 5 OF 6 : 2 OF 2 : 6 OF 6 NRTI/: 7 OF 10 DRUG NAME CATEGORY /NON-, REQUIRES PA SPECIALTY PHARMACY QUANTITY LIMIT NON IBILD NON EVIR NON NON NON NON NON NON NON SOURCE: EFFECTIVE DATES: NOT STATED *COOK COUNTY ONLY Information collected by AIDS Foundation of Chicago, March Contact Daniel Frey, dfrey@aidschicago.org. DISCLAIMER: To help people with HIV choose Medicaid health insurance plans, the AIDS Foundation of Chicago (AFC) has collected information on HIV and Hepatitis C medications. Keep in mind: Do not rely solely on the information in this document to choose a plan it is only a guide. Consult a trained enrollment assister for help in selecting a plan. You can reach AFC s navigators at Always verify medication coverage directly with a plan before enrolling. Insurance companies can change their coverage without notifying consumers.