The attached explains a notice of formulary changes that was recently mailed to providers on 5/20/2014. This mailing was sent to providers who currently have patients that are utilizing fluoxetine 40mg capsules and fluoxetine 20mg tablets. HNE will no longer cover fluoxetine 40mg capsules and fluoxetine 20mg tablets. The fluoxetine changes are effective 7/1/14.
*We will still cover all other strengths and all quantity limits remain in place at this time. Members and pharmacies have already been made aware of this change.
• In place of the 20mg tablets pharmacies will be asked to switch to 20 mg capsules.
• In place of the 40mg capsules pharmacies will be asked to switch to two 20 mg capsules.
For ease of transition we are asking HNE providers to proactively apply the above changes when prescribing fluoxetine.
The reject messaging on the claim at POS will reflect the bullets above. Pharmacies will be asked to contact the prescribing physician for verbal authorization to switch.
The reason for this change is the current net pricing for the 40mg capsules and the 20mg tablets, after all discounting, is much more expensive than the net pricing for the 20mg capsules. If you have any questions, please contact Provider Relations at 413.233.3313 or 800.842.4464, extension 5000.