Progesterone in oil, a standard injectable medication, is currently covered for our members under their pharmacy benefit. Effective January 1, 2012, progesterone in oil will no longer be covered under the pharmacy benefit and will only be covered under the medical benefit. This change is being made because this medication is not considered a self-injectable and therefore should not be covered under the pharmacy benefit.
Our Pharmacy Services department will work with providers who have prescribed this injectable to a member to obtain a new prescription and start the member in the Direct Ship Injectables Program.
For more information about this change or the Direct Ship Injectables Program, please refer to the December edition of Partners in Health UpdateSM.