BCBSAZ adjusts tier status for albuterol sulfate HFA inhalers
BCBSAZ adjusts tier status for albuterol sulfate HFA inhalers
 

BCBSAZ adjusts tier status for albuterol sulfate HFA inhalers

For prescriptions filled on or after January 28, 2021, albuterol sulfate HFA is available at the lowest cost-share level (tier 1/generic) for Blue Cross® Blue Shield® of Arizona (BCBSAZ) members with fully insured and self-funded group plans. We now consider generic albuterol to be preferred for these benefit plans. It does not require prior authorization or step therapy using other medications.

If your patient is using an albuterol inhaler more than twice a week, it might be time to consider adding a controller medication or intensifying therapy.

Albuterol is a bronchodilator that is often used for:

  • Opening the airways in lung diseases where spasm may cause breathing problems
  • Preventing breathing problems that happen with exercise

Generic helps reduce member cost share

BCBSAZ’s shift to the generic albuterol as preferred enables members to pay less at the pharmacy for a medication that helps them stay healthy. To further support this positive change over the next six to nine months, we’ll be moving the higher-cost branded products (ProAir® HFA, ProAir Digihaler®, ProAir RespiClick®, Ventolin HFA, and Proventil HFA) to the highest retail member cost-share level or tier. In addition, this drug will become a mandatory generic in applicable benefit plans. Approval for the branded albuterol products may require trial/failure of the preferred generic or prior authorization for an exception.

What about members with other types of benefit plans?

Here is the coverage and tier-level status of albuterol sulfate HFA for members with the following types of plans:

  • Federal Employee Program® (FEP®) plans – Generic albuterol is currently $5.00 for a 30-day supply (see Rx costs at fepblue.org/pilot/rx-cost-tool/search)
  • Medicare Advantage plans – Generic albuterol is currently tier 2; coverage and tier level varies for brand-name products
  • Out-of-area BlueCard® plans – Coverage and tier level varies according to the member’s BCBS Plan requirements
  • Corporate Health Services (CHS) group plans – Coverage and tier level varies according to third-party administrator (TPA) requirements
  • BCBSAZ-TPA co-administered group plans – Coverage and tier level varies according to TPA requirements

Please help us lower treatment costs for our members by prescribing generic albuterol when appropriate. For asthma/allergy patient education materials, visit the Asthma and Allergy Foundation of America programs page.

If you have questions about this medication tier-status change, you can contact your provider liaison or call Provider Partnerships at 602-864-4231 or 1-800-232-2345, ext. 4231.


ProAir HFA, ProAir Digihaler, and ProAir RespiClick are registered trademarks of Teva Respiratory, LLC.

Ventolin HFA is a registered trademark of GlaxoSmithKline.

Proventil is a registered trademark of Merck, Sharpe, & Dohme Corp.


Print Friendly and PDF
Our members can take a digital ID card with them wherever they go with the MyBlue AZSM mobile app.