Rx Benefits

When you’re paying for a medication, you want to be sure it’s both clinically appropriate and financially responsible. At RxBenefits, our team of licensed pharmacists is regularly reviewing available drugs to make sure there’s not a better option for your members.
 
Our clinical team is adding 14 additional medications to the Clinical Advantage Program - Low Clinical Value Program Drug List. Some examples are:

  • DermacinRx (All Product Extensions) has a cost of $3,000/pack, with an OTC alternative available at $5 per 80g
  • Folika-V has a cost of $1,800 per 30-day supply, with an OTC alternative available for less than $20 per 30-day supply
  • Vivlodex has a cost of $840 per 30-day supply, with a generic NSAID alternative available for $25 per 30-day supply

 

 
What Does This Mean for You?
Starting July 1, 2020, your plan will no longer cover the additional low clinical value medications, even if they are listed on your formulary. The updated Low Clinical Value Drug List with preferred alternatives is available here:

Low Clinical Value Drug List Alternatives 07-2020

What Does This Mean for Your Members?
Members who are prescribed or are currently taking a low clinical value medication will be unable to receive the drug without paying for it out of pocket. Their pharmacist will direct them to a more affordable, effective alternative.
 
How Will This Be Communicated?
Members who are currently taking a low clinical value medication will be mailed a notification letter with alternative drug options before July 1, 2020.
 
We appreciate the opportunity to service your prescription benefit needs. If you have any questions regarding these changes, please do not hesitate to contact your account team.