Insurers limit coverage of nonsedating antihistamines. (Increasing Copays, Restricting Access).

Treating patients with nonsedating antihistamines is becoming tricky as insurers start to limit coverage for these commonly used medications.

Managed care and state Medicaid programs are doing so by increasing copays; restricting access to newer drugs; and, in some cases, requiring prior authorization for their use--even for asthma episodes requiring emergency care, the American College of Allergy, Asthma, and Immunology contends.

Insurers aren't using these tactics for medical reasons, Dr. William Berger, president-elect of ACAAI, told this newspaper. "They're trying to find ways to alleviate the cost of taking care of patients."

For primary care physicians "who prescribe even more nonsedating antihistamines than do allergists," this is of concern, said Dr. James C. Martin, president of the American Academy of Family Physicians.

At the end of 2002, it's expected that loratadine will be available over the counter--both branded as Claritin and in generic formulations.

This comes more than a year after a Food and Drug Administration advisory panel recommended switching Claritin, Zyrtec (cetirizine), and Allegra (fexofenadine) from prescription to OTC status. The recommendation supports a 1998 citizens' petition to the FDA from Well-point Health Networks Inc.

Mohit Ghose, spokesman for the American Association of Health Plans, said it's possible that health plans "are going to take a hard look at what their copay structure is for other similar classes of drugs within their formularies" once Claritin goes OTC.