MEDICARE PART D STEP THERAPY CRITERIA risedronate sodium
Transcription
MEDICARE PART D STEP THERAPY CRITERIA risedronate sodium
MEDICARE PART D STEP THERAPY CRITERIA risedronate sodium Plan Limitations: Does not apply to the following Blue Shield of California Medicare Part D plans: o Blue Shield Medicare Basic Plan (PDP) o Blue Shield 65 Plus Riverside (MAPD) o Blue Shield 65 Plus San Bernardino (MAPD) o Blue Shield 65 Plus Sacramento (MAPD) o Blue Shield 65 Plus San Diego (MAPD) o Blue Shield 65 Plus Ventura (MAPD) o Blue Shield 65 Plus Contra Costa (MAPD) o Blue Shield 65 Plus Fresno (MAPD) o Blue Shield 65 Plus Santa Clara (MAPD) o Blue Shield 65 Plus Kern (MAPD) o Blue Shield 65 Plus San Luis Obispo (MAPD) o Blue Shield Medicare Enhanced Plan (PDP) o Blue Shield of California Medicare Rx Plan (PDP) o Blue Shield of California Medicare Rx Plan (MADP) Step Therapy Criteria: 1) Step One: Alendronate sodium tablets or oral solution 2) Step Two: Ibandronate sodium tablets 3) Step Three: If any claims history for a step one drug (alendronate) AND a step two drug (ibandronate), OR if any claims history for a step two drug (ibandronate) within the past 180 days, then risedronate sodium is approved for coverage. Coverage Duration: Annual Effective: 03/2016