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Select Health covers several products for a limited 90-day period of time to help your patients stop smoking. Preferred products include Zyban, Chantix, nicotine gum and nicotine patches.
- Zyban and Chantix will fill at the pharmacy with no prior authorization for up to 90 days. Quantity limits of two tabs daily apply.
- Patches and gum require prior authorization. If the patches are prescribed, Select Health requires a monthly step down from the 21mg patch to the 14mg patch to the 7mg patch. Quantity limits of 1 patch daily apply. If the gum is prescribed, quantity limits of 330 pieces per month apply. The pharmacy or the physician can obtain prior authorization for the patches or gum.
Please keep in mind that approval length for smoking cessation products is limited to 90 days per rolling 12-month period of time. For example, a member cannot use the patch for 1 month, discontinue use for 4 months and then resume prescription coverage again. The 90-day benefit is consecutive. Also, members are limited to one product at a time. Multiple products can be tried over the 90 days, but each product will count toward the 90-day maximum. When the first prescription is filled, the the 90-day benefit period starts. Once the 90 days benefit is exhausted, the member will need to wait 9 months before becoming eligible again for plan covered smoking cessation products.
Please contact Pharmacy Services at 866.610.2773 if you have questions or if you would like to obtain authorization.
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