Understanding Your Health Care Plan

Sunday, March 1, 2009

How Insurance Coverage May Affect Your Prescription Drugs (NAPS)—How well do you the Tier 2 level, which is a lower to remember that each patient is plan? For many people, the different options, confusing terms and endless forms can be a major headache. But in today’s economic name drugs that are considered nonpreferred are covered at the Tier 3 level. ing on their specific cholesterol levels, a generic statin may be an understand your health insurance environment, it’s more important than ever to understand how your co-pay than Tier 3. Other brand- In today’s economic environment, it’s more important than ever to understand how your prescrip- prescription drug coverage can tion drug coverage affects you and your family. questions: How can I tell if my prescription drugs are covered by my insurance? Most plans have a formulary, or a “preferred drug list,” which typically includes both brand-name and generic drugs. It is important affect you and your family. Here are answers to some common Whatare the major types of health insurance plans? Most people enroll in a health insurance plan—also known as a managed care plan—through their employers. These plans are contracts between health care providers and medical facilities called the plan’s “network”to offer care at reduced costs. Health Maintenance Organizations (HMO) usually only pay for in-network care. This means you choose a primary care doctor within the network who will coordinate your care. Preferred Provider Organiza- tions (PPO) usually cover some of your care if you go outside the network. Point of Service (POS) plans let you choose between an HMO or PPO each time you needcare. Other types of health insurance include Medicare and Medicaid, which are government-funded plans for retirees and low-income individuals. Whatis a prescription drug co-pay? You usually pay a fee, called a co-pay, each time you pick up a prescription. Generic drugs are usually covered at the Tier 1 copay level, which is a lower co-pay than Tier 2 or Tier 3. Preferred brand-name drugs are covered at to talk to your doctor about what treatment option is most appropri- ate for your medical condition and to find out which prescription drugs are covered by your insurance. However, some plans may not immediately cover a brandnamedrugif a generic in the same class is available. For example, cholesterol-lowering drugs called statins are widely prescribed, and both brand-name and generic statins are available. One of the commonly prescribed branded statins is CRESTOR (rosuvastatin calcium)—and there is no generic different. For some people, depend- appropriate treatment. However for other patients, such as those with two or more risk factors for heart disease, including high blood pressure, obesity, smoking, or fam- ily history, a more effective branded statin like CRESTOR may be more appropriate. In the end,it is critical that patients work closely with their doctors, and ask questions about what therapy is best for both their medical and insurance needs. Once your doctor has determined the best medication for you, remember to make sure the drug recommended by your physician matches what you get at the pharmacy counter. Is my insurance likely to cover CRESTOR if my doctor recommendsit? CRESTOR is reimbursed for 91.5% of memberlives for com- mercial plans. Further, nearly 90.3% of Medicare Part D plans reimburse CRESTOR, and 38 out of version of CRESTOR, which has proven to be highly effective at 51 state Medicaid formularies have CRESTOR on their preferred drug lists, so it is unlikely that your insurance will not cover CRESTOR if your doctor thinks it is the right medication for you. simvastatin (CRESTOR 10 mg vs. CRESTOR, also offers a program where CRESTOR costs no more than $25 per monthfor eligible patients with commercial prescription drug coverage. For more information about lowering bad cholesterol, and has also been proven to raise good cholesterol. In fact, one study showed CRESTOR reduced bad cholesterol and raised good cholesterol significantly more than the generic statin simvastatin 10 mg, 20 mg and 40 mg). CRESTOR is also the only statin indicated to slow the progression of atherosclerosis—the buildup of plaque within the arteries—atall stages of the disease.It’s important AstraZeneca, the maker of CRESTOR, visit Www.CRESTOR.com. If you have additional questions about your health insurance plan, contact your human resources department or health plan administrator. References 1. Managed Care; Medicaid; Medicare. MedLine Plus. www.nlm.nih.gov /medlineplus/managedcare.html ; www.nlm.nth.gov [| medlineplus /medicaid.html ; www.nlm.nih.gov | medline plus /medicare.html  . Aecessed 02/25/09. 2. Jones PH, Davidson MH, Stein EA, et al, for the STELLAR Study Group. Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simva- statin, and pravastatin across doses (STELLAR Trial). Am J Cardiol. 20038;92:152-160. 3. Prescribing Information for CRESTOR. AstraZeneca Pharmaceuticals LP, Wilmington, DE. 4. “Risk factors and coronary heart disease.” American Heart Association.  . Accessed 01/20/09. www.americanheart.org /presenter.jhtml ?identifier=235 5. Fingertip Formulary. Data accessed: Percentage of covered lives—Commercial Plans. Accessed March 1, 2009. *Defined as Tier 1 through Tier 7 on Commer- cial, Commercial (BCBS), Commercial (Medicaid), Employer, PBM, and Union by Fingertip Formulary as of January 2009. Data include covered lives whose prescriptions may be subject to step-therapy requirements. 6. Fingertip Formulary. Data accessed: Percentage of covered lives—Medicare Part D. Accessed March 1, 2009. **Defined as Tier 1 through Tier 7 on Medicare MA, Medicare PDP, and Medicare SN by Fingertip Formulary as of January 2009. Data include covered lives whose prescriptions may be subject to step-therapy requirements. 7. Fingertip Formulary. Data accessed: State Medicaid Plans. Accessed March 1, 2009. IMPORTANT SAFETY INFORMATION: CRESTORis indicated as an adjunct to diet to reduce elevated Total-C, LDL-C, ApoB, non-HDL-C, and TG levels and to increase HDL-C in patients with pri- mary hyperlipidemia and mixed dyslipidemia. CRESTORis also indicated as an adjunct to diet to slow the progression of atherosclerosis in adult patients as part of a treatment strategy to lower Total-C and LDL-C to target levels. CRESTORis not approved to reduce cardiovascular morbidity and mortality. CRESTORis contraindicated in patients with a known hypersensitivity to any component of this product, in patients with active liver disease, which may include unexplained persistent elevations of hepatic transaminase levels, in women who are pregnant or may become pregnant, and in nursing mothers. Cases of myopathy and rhabdomyolysis with acute renal failure secondary to myoglobinuria have been reported with HMG-CoA reductase inhibitors, including CRESTOR.These risks can occur at any dose level, but are increased at the highest dose (40 mg). CRESTOR should be prescribed with caution in patients with predisposing factors for myopathy (e.g., age = 65 years, inadequately treated hypothyroidism, renal impairment). The risk of myopathy during treatment with CRESTOR may be increased with concurrent administration of some other lipid-lowering therapies (fibrates or niacin), gemfibrozil, cyclosporine, or lopinavir / ritonavir. Therapy with CRESTORshould be discontinued if markedly elevated CK levels occur or myopathy is diagnosed or suspected. All patients should be advised to promptly report unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever. It is recommendedthat liver enzyme tests be per- formed before and at 12 weeks following both the initiation of therapy and any elevation of dose, and periodically (e.g., semiannually) thereafter. Should an increase in ALT or AST of >3 times ULN persist, reduction of dose or withdrawal of CRESTORis recommended. CRESTOR should be used with caution in patients who consume substantial quantities of alcohol. CRESTOR 40 mg should be used only for those patients not achieving their LDL-C goal with 20 mg. Patients initiating CRESTOR therapy or switching from anotherstatin should begin treatment with CRESTORat the appropriate starting dose. In the controlled clinical trials database, the most common adverse reactions were headache (3.7%), myalgia (8.1%), abdominal pain (2.6%), asthenia (2.5%), and nausea (2.2%). Please see accompanying full Prescribing Information. If you have any questions concerning CRESTOR, please contact AstraZeneca at 1-800-237-8898. CRESTORis a registered trademark of the AstraZeneca group of companies. About AstraZeneca: AstraZeneca is engaged in the research, development, manufacturing and marketing of meaningful prescription medicines and in the supply of health care services. AstraZenecais one of the world’s leading pharmaceutical companies with global health care sales of $31.6 billion andis a leader in gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infectious disease medicines. In the United States, AstraZeneca is a $13.5 billion dollar health care business. For more information about AstraZeneca in the U.S. or our AZ&Me™Prescription Savings programs, visit: www.astrazeneca-us.com.

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