April 21, 2022

Commercial plans: Coverage change for Dexilant

Effective May 1, 2022, Dexilant®, a proton pump inhibitor (PPI), will be excluded from coverage for UnitedHealthcare commercial pharmacy plans.  

Alternatives, such as pantoprazole (generic Protonix®) and omeprazole (generic Prilosec®) will remain covered in Tier 1, and rabeprazole (generic Aciphex®) will remain covered in Tier 2. Over-the-counter (OTC) options, including Nexium® 24 HR, Prevacid® 24, Prilosec OTC, and Zegerid® OTC, are available without a prescription.

PPIs Current coverage New coverage as of May 1, 2022
Dexilant Tier 3 Excluded
omeprazole Tier 1 No change
pantoprazole Tier 1 No change
rabeprazole Tier 2 No change

What this means for you
Dexilant cannot be automatically substituted at the pharmacy, so if you have a patient taking Dexilant, you’ll need to provide them with a new prescription for a covered alternative or suggest an OTC option if you choose to continue PPI therapy. If a member continues taking medications that are no longer covered, they may be responsible for the full prescription cost.

Use of PPIs
It may be beneficial for members who have been taking PPIs for longer than the recommended duration of 4 weeks to be assessed for appropriateness of continued use. To help with your assessment, we’ve created guidance around the use of PPIs based on recommendations from the College of Family Physicians of Canada and the American Gastroenterology Association.

Questions?
Email us at pharmacy_news@uhc.com.

PCA-1-22-01053-E&I News