Multiple Copay
We consider using Multiple Copay* when a medication’s packaging is large enough to contain two or more month’s worth of product. The number of copayments will reflect the amount of product contained in its packaging. Members who fill a prescription for the select medication will be charged an additional copayment.
The following medication will be added to the Multiple Copay program:
| Medications | Size / Dosage | Therapeutic Use | Tier as of January 1, 2010 | Alternatives |
| Vusion® | Ointment | Diaper Rash / Dermatitis | 3 | OTC products |
Rationale for change:
Vusion is comprised of miconazole and zinc oxide and is over six times more expensive than readily available over-the-counter (OTC) options. It is typically a one-time use product with only 13% of members refilling and the average refill occurring after 72 days. Members who fill a prescription for Vusion will be charged two copayments.
Medications currently included in the Multiple Copay Program
| Medications | Size / Dosage | Therapeutic Use | Alternatives |
| Xolegel® | 15 g & 45 g | Dermatitis | ketoconazole cream (generic Nizoral® 2%) |
| Atralin™ | 45 gm | Acne | tretinoin 0.05% gel, tretinoin 0.05% cream |
| Cutivate® Lotion | 60 & 120 mL | Dermatitis | fluticasone propionate 0.05 cream%, desonide 0.05% lotion, hydrocortisone butyrate 0.1% solution |
| Loprox® Shampoo | 120 mL | Dermatitis of Scalp | ketoconazole shampoo |
| Metrogel 1%® (gel and kit) | 60 gm | Rosacea | metronidazole 0.75% gel |
| Noritate™ | 60 gm | Rosacea | metronidazole 0.75% cream |
* Not all benefit plans allow the Multiple Copay plan. Call the phone number on the back of your ID card for more information about your benefit plan design.