Managing Your Medications
When it comes to managing prescription medications — whether they’re your own or you’re helping a loved one — things can get complicated. At ARTA, we understand that medication needs are as unique as each person. From making sure new medications are added for coverage at the right time, to ensuring every member has fair and equal access to the coverage they need — it’s important work that we’re proud to offer to ARTA plan members. While we have implemented a number of medication management programs to help make sure that your ARTA benefits provide the best possible coverage now, and well into the future, the two benefits we receive the most questions about are Least Cost Alternatives (LCA) and Therapeutic Alternative Reference Pricing (TARP).
Least Cost Alternatives
Our LCA program, in which your ARTA benefits pay for prescriptions up to the price of the lowest cost medication for a specific drug, helps us mitigate the risk posed by the wide range of prices for similar medications. For example, brand name Lipitor 80 mg costs $2.45 per pill while Atorvastatin, a generic version of the same medication, costs 23¢ per pill. So, while you are still able to take Lipitor if that’s what you and your physician prefer, your benefits will only cover the cost of 23¢ per pill. As noted in the following, all the medications identified as LCA have the same active ingredients as their brand name counterparts and are proven equally safe and effective.
Therapeutic Alternative Reference Pricing
ARTA’s TARP program encourages cost-effective prescribing for common medical conditions, identifying ‘preferred’ medications to treat high blood pressure, migraines, pain and inflammation management (non-narcotic), and stomach hyperacidity. All the medications identified as preferred alternatives have similar active ingredients to their higher cost counterparts and are proven equally safe and effective.
If the medication you have been prescribed falls into one of the program’s four categories and has preferred alternatives, you have two options:
- You can choose to start taking the preferred drug instead of the one you were prescribed, and you will be covered as you usually would under your plan,
- You can choose to take the medication you were originally prescribed and pay for the cost difference between the prescribed and the preferred drug either out-of-pocket or through your benefits with another health-care provider.
Just like with the LCA program, you decide what medication to take.
We understand that sometimes taking an alternative medication to what your physician has prescribed is not always possible. Whether it’s because of medical reasons such as allergies or medication shortages, if you’re unable to take or access the preferred or reference medication used in our medication management programs, you have options.
If you’re allergic to any of the ingredients found in the preferred medications used in our TARP program or another medical reason prevents you from taking it, your physician can complete a special authorization form to request coverage for the medication they have prescribed — your physician has access to this form, so you do not need to provide it to them. Please note that there must be medical documentation to support this exception and simply requesting it does not guarantee approval.
If you are unable to access the LCA or preferred medication due to a known medication shortage — which can and does happen — ARTA will assess the situation and may temporarily suspend LCA and TARP programs for the affected medication category. During medication shortages, especially those that result in a need to change your regular medication, we encourage you to work directly with your physician or pharmacist to manage how the shortage affects you and the best course of action for your health. Please do not try to obtain medications through online sources or by travelling to other countries who may have supply — your ARTA benefits may not cover associated costs.
While these programs are in place to benefit our members, we understand there may be some hesitation when it comes to ‘generic’ medication. When people hear LCA, TARP, or generic medications, they sometimes believe these drugs aren’t as effective as their higher cost counterparts. Rest assured that all of the generic and preferred medications ARTA references in its programs have the same level of quality, safety, and performance as the higher cost medications.
At the end of the day, our main goal is to ensure that you and your dependants have access to the medications you need when you need them — now and in the future. Our medication management programs allow us to reduce the risk medication costs pose to the plan without compromising fair and equitable access to prescription coverage for all ARTA plan members.
If you have questions about the medication you’ve been prescribed or the one your pharmacist is recommending based on our programs, please speak with your health-care provider.