New  Outpatient Laboratory Services

As a reminder, Laboratory Corporation of America (LabCorp) is the exclusive Coventry Health Care of Delaware, Inc. provider for outpatient laboratory services. 

When a doctor orders laboratory work, we encourage our members to use one of the many LabCorp locations in Delaware, Maryland, New Jersey and Pennsylvania. Use of LabCorp will help to reduce out-of-pocket expenses. 

Please note that Quest Diagnostics is not a participating provider for Coventry members, except Coventry members with a benefit plan that utilizes the First Health PPO Network.  Coventry Health Care of Delaware members requiring laboratory services should be referred to participating laboratory providers.  Tests that are referred to a non-participating laboratory provider will be denied.

For a current listing of participating providers, please log on to our website, www.chcde.com, or contact a customer service representative at (800) 833-7423, Monday through Friday, 8a.m. to 5:00 p.m.     

New  Lipitor® Will Stay on Formulary as Second Tier Drug

Coventry Health Care of Delaware has decided to keep Lipitor® on our drug formulary as a second tier drug.  That said, we will still make simvastatin available for coverage at a tier one (lowest) company level on our drug formulary.  Crestor® and Lesol® will remain (as they have been all along) as tier three drugs on Coventry’s commercial formulary.  In addition, we will honor our previously communicated intent to waive the co-payment for members changing from selected branded agents to simvastatin during July and August, 2006.

New  On June 23, 2006, a generic version of the cholesterol-lowering drug Zocor®, called simvastatin, will become available from multiple manufacturers. Brand name prescription drugs such as Zocor®, Lipitor®, Crestor®, Lescol®, Mevacor®, Pravachol® and Vytorin® are cholesterol lowering drugs that belong to a class of medications known as “statins.”

Statins are some of the most widely used prescription drugs in the country. Drugs belonging to the “statin” class are highly effective at reducing bad cholesterol (LDL cholesterol) and decreasing the risk of major cardiovascular events by approximately 30%.

Effective July 1, 2006, Coventry Health Care of Delaware and the health plans of Coventry Health Care will be instituting several actions with respect to statins, including:

• Coventry will make simvastatin available for coverage at a Tier One (lowest) copayment level on their Drug Formulary.
• To help encourage members to use simvastatin, Coventry Health Care of Delaware will waive the generic copayment for members changing from Lipitor®, Lescol® or Crestor® to simvastatin during July and August 2006.
• Effective July 1, 2006, Coventry will also move Lipitor® to Tier Three of their commercial Formulary (with the copayment for Lipitor® increasing to the Tier Three level), and make low dose Vytorin® increasing to the Tier Three level), and make low dose Vytorin® (10/10 & 10/20), a Tier Two statin, subject to step therapy.
• For any members enrolled through a group customer that has elected a managed Drug Formulary product (i.e. “closed formulary” or “Two Tier Formulary”), Lipitor® 10mg & 20mg will no longer be covered and current members on Lipitor® 40mg & 80mg will be granted an exception to continue therapy.

The introduction of simvastatin presents a significant opportunity to recognize savings with no change in clinical quality.

Approximately 1 out of every 10 enrolled members can be expected to take a cholesterol-lowering medication, at an average total annual cost of $1,400 per member for a 12 month supply. Therefore, the magnitude of this opportunity starts the day Zocor® loses its patent protection, on June 23, 2006. Multiple manufacturers will begin shipping simvastatin on that day.

The cost of this generic is expected to be 75% to 90% less than the average cost of the branded product, or approximately $12.00 per prescription for simvastatin.