NRECA Employee Benefits Weekly

Prescription Drug Coverage Updates Taking Effect July 1, 2020

Posted on Posted in Group Benefits

CVS Caremark™, NRECA’s pharmacy benefit manager, has announced changes to NRECA’s Medical Plan prescription drug coverage that will take effect July 1, 2020.

CVS Caremark continually reviews and updates drugs covered under the plan to help ensure NRECA participants have access to safe, reliable and affordable prescription drugs.

Note: Of the following changes, brand products are in all caps, branded generics in upper and lowercase Italics, and generic products in lowercase italics.

CVS Caremark will mail a letter before June 1 to participants affected by the following updates:

  • Removed from the formulary and added to the Medications Requiring Prior Authorization list: bimatoprost/bimatoprost LM sol 0.03% op, bupropion tab 450mg xl, chlorzoxazone tab 375MG and 750MG, clindamycin gel 1% (NDC 68682046275 only), CONSENSI tab, CoreMino tab, cyclobenzaprine er cap, doxycycline mono cap 75MG and 150MG, doxycycline hyc tab (50MG, 75MG, 150MG), doxycycline hyc tab delayed-rel tab 200MG, ergot/caffeine tab 1-100mg, flucytosine 500MG cap, fluoxetine tab 60MG, flurandrenolide lotion (NDC 24470092112 only), hydrocortisone butyrate lipophilic cream, ketoprofen cap 25mg, Lorzone tab 375MG, minocycline ER TAB, NL CAP 75MG, naprox-esomeprazole tab, NOREGESIC TAB FORTE, Okebo CAP, orph cit/asp tab caffeine, Orphengesic Forte, posaconazole del-rel tab, REPATHA, sumatriptan-naproxen tab, tramadol hcl tab 100MG (NDC 52817019610 only), TREXIMET TAB, triamcinolone aer spray
  • Moved from tier 2 (preferred) to tier 3 (nonpreferred): APRISO CAP, HALOG OIN 0.1%, NUVARING VAG RING, SENSIPAR TAB, SERNIVO SPRAY, ULORIC TAB, VERZENIO TAB
  • Removed from the Preventive Drug List: CALAN, DEPAKENE, FAZACLO, isosorbide dinitrate ext-rel, KYNAMRO, PRANDIN, repaglinide/metformin, TOFRANIL

Additional updates include:

  • Added to the Performance Drug List (commonly prescribed drugs): BAQSIMI, EMGALITY, LO LOESTRIN FE, NURTEC ODT, ONEXTON GEL, PRALUENT, REYVOW TAB, RYBELUS TAB, STELARA VIAL 5MG/ML, SYMJEPI, SYMTUZA TAB, TAKHZYRO, UBRELVY TAB, VUMERITY, YUPELRI
  • Added to the Preventive Drug List: CAPLYTA, COAGADEX, DESCOVY, ESPEROCT, everolimus, RIOMET EXT-REL, simvastatin susp, TERIPARATIDE, TRIJARDY XR,XCOPRI
  • A quantity limit will be required on the following specialty drugs: ACTERMRA PEN, BIKTARVY, CIMDUO, CINQAIR, DAURISMO, ERLEADA, FIRDAPSE, ILUMYA, LORBRENA, MUPLETA, NUCALA, RADICAVA, SYMDEKO, SYMFI, SYMFI LO, SYMTUZA, TALZENNA, TEGSEDI, TIBSOVO, UDENYCA, VITRAKVI, XERMELO, XOSPATA

Updated drug lists available
The current Performance Drug List, which contains the most commonly prescribed brand and generic drugs, is available on the Prescription Drug page of the NRECA Employee Benefits website. Note that the Performance Drug List will not reflect the updates described in this article until July 1. Participants can visit the Manage Your Prescriptions page to check on coverage and costs for drugs that are not on the Performance Drug List.

No later than July 1, benefits administrators will receive a Message Center notification directing them to a supplemental medical plan summary of material modifications (SMM) describing the changes listed in this article. The notification will also contain a link to distribution instructions and deadlines. If you or your employees have questions about prescription drug coverage or about these updates, call CVS Caremark Customer Care at 888.796.7322.

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