OTC Claritin Could Lead to Higher Out-Of-Pocket Costs for Other Allergy Drugs

Although the allergy medicine Claritin's shift to over-the-counter status this week will eventually drive down the cost of the drug, the move also could affect the cost of "whole variety of other allergy drugs" as many health plans raise copayments for such medicines, the Wall Street Journal reports. The over-the-counter version of Claritin is expected to cost consumers about $30 for a month's supply, and most health plans will no longer cover the medication. Since the FDA's approval of over-the-counter Claritin two weeks ago, several health plans have "already taken steps" to increase members' out-of-pocket costs for allergy medicines Allegra, Zyrtec and Clarinex, by raising copays to as much as $50 (Saranow/Docker Marcus, Wall Street Journal, 12/10). In addition, Aetna U.S. Healthcare has said it will no longer cover Allegra, Zyrtec and Clarinex without a "special request" from a physician, the Pittsburgh Post-Gazette reports. Highmark Blue Cross Blue Shield in Pennsylvania has said it may offer employers the chance to eliminate coverage for all non-sedating antihistamines, Highmark spokesperson Phil Neubauer said. He added that the number of employers who will choose that option is unknown, but the health plan already has "received several inquiries from workplaces," according to the Post-Gazette (Linn, Pittsburgh Post-Gazette, 12/10).

The Journal reports that the effect of Claritin's status change might "extend well beyond the $4.6 billion prescription allergy drug market," as other blockbuster prescription drugs are expected to switch to over-the-counter status or lose patent protection. Further, some health plans see the change in Claritin's status as a "key step in an ongoing effort to revamp the way drugs are paid for," the Journal reports. Some HMOs, which generally have a three-tier copay system in place for prescription drugs, are "experimenting" with a fourth tier that would have beneficiaries pay up to 50% of the cost of the drug, generally much higher than a standard copay. The fourth tier would include "lifestyle" drugs, which do not "treat a life-threatening condition" but improve quality of life, such as the impotency treatment Viagra. With Claritin's status change, prescription allergy drugs also could be considered a lifestyle medication, the Journal reports (Wall Street Journal, 12/10).