Why Keep Covering PPIs?

I’m not a clinician so I’m sure there are some clinical exceptions to this general comment.  [For example, look at Aetna’s PPI Medicare information.]

But, with Prilosec available OTC (Over The Counter) both as a brand product and as a generic (omeprazole) and now Prevacid will also be available OTC, I wonder why PBMs and plan sponsors don’t stop covering this class of drugs.  [See here for CVS Caremark’s overview on this.]

BTW – PPIs (or Proton Pump Inhibitors) are generally used for acid reflux and some people can simply use other OTCs such as H2 Antagonists (e.g., Tagamet, Pepcid, Zantac).  [Consumers might also read Consumer Reports Best Buy Drugs report on PPIs.]

Traditionally, PPIs represented one of the higher cost drug categories (and also one of the most highly rebated).  In CVS Caremark’s BOB (book-of-business), it represented 7.3% of their spend according to their TrendsRx 2009 publication.

Plans have stopped covering NSA (non-sedating antihistamines) once Claritin went OTC.  This seems like the next natural category with perhaps some formulary override option for certain medical exceptions.

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