CurrentUnitedHealthcarePolicy N/A
Proton Pump Inhibitors - Nexium® for suspension (esomeprazole), Prevacid® SoluTab™ (lansoprazole), Zegerid® for suspension (omeprazole and sodium bicarbonate) - Step Therapy - UnitedHealthcare Commerc
UnitedHealthcare step therapy program that requires trial of specified lower-cost PPIs before coverage of Nexium suspension (esomeprazole), Prevacid SoluTab (lansoprazole ODT) and Zegerid suspension (omeprazole + sodium bicarbonate). Applies to commercial members; claims for Nexium suspension and lansoprazole ODT will process automatically for patients under age 6. Authorization issued for 12 months.
Policy Summary
PayerUnitedHealthcare
PolicyProton Pump Inhibitors - Nexium® for suspension (esomeprazole), Prevacid® SoluTab™ (lansoprazole), Zegerid® for suspension (omeprazole and sodium bicarbonate) - Step Therapy - UnitedHealthcare Commerc
Policy CodePolicy N/A
Change TypeAnnual review; exclusions updated
Effective DateAug 1, 2025
Next Review Date
Key ActionProvider must document history of failure, contraindication, or intolerance to required step agents (omeprazole prescription formulation, pantoprazole, rabeprazole) for Nexium suspension/Prevacid SoluTabs; for Zegerid suspension document failure/contraindication/intolerance to both Nexium suspension and lansoprazole ODT. Include reason for therapeutic failure, contraindication, or intolerance.
SourceLink
POLICY UPDATE CHANGES
Annual review with update noting additional clinical rules may apply.
Updated to note brand Prevacid SoluTab and brand/generic Zegerid suspension are typically excluded from coverage.
Added Zegerid suspension to criteria and allowed coverage when patient has a feeding tube.
3Referenced PPI products