If FDA Moves Some Meds Behind the Counter, Some Health Plans Say They Are Unlikely to Cover Any Patient Medication Costs

Nice to have some over the counter availability, but what about the cost, will the drugs no longer be covered by insurance plans? Some may pay if you consult with the pharmacist according to the article, but still too soon to know...it sounds like Dr. Google for the diagnosis information and then off to the pharmacy. Employer provided insurance will also enter the picture, depending on the contract on whether or not any coverage will be allowed. Aetna doesn't cover any over the counter and Well Point has given out coupons for a discount...BD

Although none have made a final decision, some health insurers say they likely will not cover any patient medication costs should the Food and Drug Administration (FDA) proceed with a proposal to move some medications to behind-the-counter (BTC) from prescription status. Other insurers say they may pay for such expenses, and add that they have covered members' expenses for other over-the-counter drugs in the past. Among the items they'll consider are whether the medication is included on the formulary or benefit plan, and whether the drug provides significant clinical benefit in comparison to other medications used to treat the same conditions.

But most say they stopped covering other medications, such as the antihistamine Claritin, when the drugs were made available over the counter (OTC). They say they may do the same with BTC medications, depending on the drug and its intended use. And all say that if coverage changes must be made, they will give members as much advance notice as possible.