member education Dose Optimization

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1 member education Dose Optimization Do you take a prescription drug more than once each day? For some drugs, your doctor can prescribe a higher amount that you only have to take once a day. We call this dose optimization. We want you to know about the advantages of dose optimization.

2 member education What is dose optimization? Dose optimization usually means increasing the amount of a medication so that you only have to take it once a day, instead of taking a lower dose two times each day. For example, a 10mg dose taken twice per day would be changed to a 20mg dose taken only once per day. Sometimes, doctors prescribe drugs at a lower dose when people start taking them and then gradually increase the dose. The goal of dose optimization in these cases is to help make sure you take a single dosage at the higher strength as soon as your doctor thinks it s appropriate. There are important reasons to take your drug once per day Forgetting to take your medication can cause health problems. And research shows it s easier for people to remember to take their medication if they only have to take it once per day. You may be able to save money if you take fewer doses each day. For example, a 20mg dose of a drug taken once per day may cost less than a 10mg dose taken twice per day. You would pay for fewer tablets or capsules. But, because each tablet would be a higher strength, you would still get the same amount of medication your doctor prescribed. Your pharmacist will tell you if the medication you take requires dose optimization The pharmacy will receive an electronic message if your drug requires dose optimization. Then, your pharmacist will: call your doctor to see if the dosage can be changed so you only have to take the drug once each day talk to you and your doctor about other ways to meet the requirement, if needed Fill your prescription at the new dose if your doctor approves. There may be medical reasons why your doctor believes the original dosage is better for you. Your doctor will contact us to request prior authorization review to determine if your prescription plan can cover your medication dosage. What is prior authorization? Prior authorization means we need to know a little more about your health before we can cover your prescription. Your doctor or pharmacist will provide this information to us if it is needed. If we find your health needs require the dosage your doctor prescribed, we ll contact your doctor or your pharmacist and your prescription will be filled. We may do additional medical review if your prescription claim is not approved. If this medical review finds that your prescription claim is still not approved, we ll send a letter to you and your doctor describing how you can start the Anthem appeals and/or grievance process.

3 Medications with dose optimization: Category Type Medication Recommended Dosing Brain Aneurysm Management Nimotop 30mg Diabetes Onglyza 2.5mg Heart Attack Prevention Effient 5mg Heart Failure Treatment/High Blood Atacand 16mg 2 per day Heart Failure Treatment/High Blood Atacand 4mg, 8mg 3 per day High Blood Adalat CC 30mg High Blood Avalide 150/12.5mg High Blood Avapro 75mg, 150mg High Blood Azor 5/20mg High Blood Benicar 20mg High Blood Benicar 5mg 3 per day High Blood Benicar HCT 20/12.5mg High Blood Cardene SR 30mg, 45mg, 60mg High Blood Cardizem CD 120mg, 180mg, 240mg, 300mg High Blood Cardizem LA 120mg, 180mg, 240mg, 300mg, 360mg, 420mg High Blood Covera-HS 180mg, 240mg Dose Optimization 3

4 Category Type Medication Recommended Dosing High Blood Dilacor XR 120mg High Blood Diltiazem ER High Blood Dynacirc CR 5mg, 10mg High Blood Exforge 5/160mg High Blood Exforge HCT 5/160/12.5mg High Blood Hyzaar 50/12.5mg High Blood Micardis 20mg, 40mg High Blood Micardis HCT 40/12.5mg High Blood Norvasc 2.5mg, 5mg High Blood Plendil (all strengths except 10mg) High Blood Procardia XL 30mg High Blood Sular 8.5mg, 10mg, 17mg, 20mg, 25.5mg, 30mg, 34mg High Blood Tekturna 150mg High Blood Tekturna HCT 150/12.5mg, 150/25mg High Blood Tiazac 120mg, 180mg, 240mg, 300mg, 360mg, 420mg High Blood Twynsta 40/5mg 4 Dose Optimization

5 Category Type Medication Recommended Dosing High Blood Valturna 150/160mg High Blood Verelan PM 100mg, 200mg, 300mg High Blood /Heart Failure Cozaar 25mg 3 per day High Blood /Heart Failure Diovan 40mg, 80mg 3 per day High Blood /Heart Failure Diovan HCT 80/12.5mg, 160/12.5mg High Cholesterol Advicor mg High Cholesterol Altoprev 10mg, 20mg, 40mg High Cholesterol Crestor 5mg, 10mg, 20mg High Cholesterol Lescol 20mg, 40mg High Cholesterol Lipitor 10mg, 20mg, 40mg High Cholesterol Livalo 1mg, 2mg High Cholesterol Mevacor 10mg, 20mg High Cholesterol Pravachol 10mg, 20mg, 40mg High Cholesterol Zocor 5mg, 10mg, 20mg, 40mg High Cholesterol/High Blood Caduet mg, mg, mg, 5-10mg, 5-20mg, 5-40mg Mental Health Antidepressant Citalopram (Celexa) 10mg, 20mg 45 per 30 days Dose Optimization 5

6 Category Type Medication Recommended Dosing Mental Health Antidepressant Citalopram (Celexa) 10mg/5ml 600ml per 30 days Mental Health Antidepressant Citalopram (Celexa) 40mg Mental Health Antidepressant Cymbalta 30mg Mental Health Antidepressant Effexor XR 37.5mg, 75mg Mental Health Antidepressant Fluoxetine (Prozac) 20mg/5ml 600ml per 30 days Mental Health Antidepressant Fluoxetine (Prozac) 40mg 60 per 30 days Mental Health Antidepressant Fluoxetine (Prozac, Sarafem) 10mg 45 per 30 days Mental Health Antidepressant Fluoxetine (Prozac, Sarafem) 20mg 120 per 30 days Mental Health Antidepressant Fluvoxamine 100mg 90 per 30 days Mental Health Antidepressant Fluvoxamine 25mg, 50mg Mental Health Antidepressant Lexapro 20mg Mental Health Antidepressant Lexapro 5mg, 10mg 45 per 30 days Mental Health Antidepressant Lexapro 5mg/5ml 600ml per 30 days Mental Health Antidepressant Paroxetine (Paxil, Pexeva) 10mg 45 per 30 days Mental Health Antidepressant Paroxetine (Paxil, Pexeva) 20mg Mental Health Antidepressant Paroxetine (Paxil, Pexeva) 30mg, 40mg 60 per 30 days 6 Dose Optimization

7 Category Type Medication Recommended Dosing Mental Health Antidepressant Paxil 10mg/5ml 1,250 ml per 30 days Mental Health Antidepressant Paxil CR 12.5mg Mental Health Antidepressant Paxil CR 25mg, 37.5mg 60 per 30 days Mental Health Antidepressant Pristiq 50mg Mental Health Antidepressant Prozac weekly 90mg 4 per 28 days Mental Health Antidepressant Venlafaxine Extended Release Tablets 37.5mg, 75mg Mental Health Antidepressant Wellbutrin XL 150mg Mental Health Antidepressant Zoloft 100mg 60 per 30 days Mental Health Antidepressant Zoloft 20mg/ml 300ml per 30 days Mental Health Antidepressant Zoloft 25mg, 50mg 45 per 30 days Drugs on this list may not be covered by your prescription plan because health benefit plans vary. Your prescription drug benefit description of coverage will tell you the limitations and exclusions of your coverage. We make changes to this list from time to time. Check empireblue.com or call the number on your member ID card to check a specific drug. Dose Optimization 7

8 Services provided by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Si necesita ayuda en español para entender este documento, puede solicitarla sin costo adicional, llamando al número de servicio al cliente que aparece al dorso de su tarjeta de identificación o en el folleto de inscripción NYMENEBS

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