OptumRx and UnitedHealthcare are now accepting the Brand Tamiflu for reimbursement due to the shortage of the generic product in the market.
OptumRx and UnitedHealthcare are taking action to address current shortages in the supply of the generic anti-flu medicine oseltamivir by allowing the brand version, Tamiflu, to process as a single source brand effective immediately. Accordingly, if clients have penalties or an ancillary charge associated with the brand product when there is a generic available, the penalties or an ancillary charge will not apply for most clients.
OptumRx and UnitedHealthcare are taking these proactive measures to address the severity of the 2017/2018 influenza season. In addition to reports of influenza related mortality, recently published research indicates that this year’s flu vaccine is estimated to be only 10% effective against the predominant influenza virus strain, which can result in increased utilization of antiviral agents such as Tamiflu.2
For UnitedHealthcare benefits which excluded brand Tamiflu, brand coverage has been reinstated and brand Tamiflu will be covered at Tier 2 until the shortage abates or the flu season ends, which is through end of May 2018.