BY PERRY DORGAN | Senior Vice President and Innovation Lead , Aon Hewitt

1 . Therapeutic Alternative Reference Based Pricing ( TARP )

• For four classes of drugs :

▪ stomach hyperacidity / acid reflux

▪ high blood pressure ( single ingredient and combination products )

▪ anti-inflammatories ; and

▪ triptans ( treatment of migraines ).

• TARP establishes a maximum price covered within a grouping of non-specialty drugs with different active ingredients for the four classes of drugs listed above .

• There will be no grandfathering of existing medications in these classes .

2 . Maintenance Medications

• A maximum of five dispensing fees per script will be paid each calendar year for the following nine therapeutic categories :

▪ high blood pressure

▪ anti-depressants

▪ anti-lipidemic agents

▪ anti-diabetic agents

▪ oral contraceptives

▪ thyroid agents

▪ anti-asthmatics / COPD

▪ hormone replacement therapy

▪ overactive bladder agents

3 . Enhanced Special Authorization

• For five health states :

▪ rheumatoid arthritis

▪ multiple sclerosis

▪ Crohn ’ s disease / colitis

▪ psoriasis

▪ hepatitis C

• Enhanced special authorization applies only to new diagnoses for these health states as of January 1 , 2017 , or later .

• If you are currently taking a medication that is effective at treating one of the health states above , your medication will be grandfathered ; however , renewal of your existing ( pre-January 1 , 2017 ) medications will need to be submitted on the new request forms .

4 . Over-the-Counter Medications

• Non life-sustaining over-the-counter ( OTC ) medications will no longer be covered .

• Coverage will continue for the following life-sustaining OTC medications :

▪ insulin and the supplies needed to measure blood sugar and administer insulin

▪ glucagon and products related to enhancing blood sugar in a crisis

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