NRECA Employee Benefits Weekly

Prescription Drug Coverage Updates Taking Effect April 1, 2021

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 April 1, 2021.

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.

Below is a list of updates. Note: Brand products are in all caps, branded generics in upper and lowercase Italics, and generic products in lowercase italics.

CVS Caremark recently mailed a letter to participants affected by the following updates:

  • Removed from the formulary and added to the Medications Requiring Prior Authorization list: ADDERALL TAB, ADVAIR HFA (NDCs 00173071522, 00173071622, and 00173071722), ANDROGEL 1.62%, AZOR TAB, BANZEL SUS, BREO ELLIPTA INH (NDCs 00173085914 and 00173088214), clocortolone topical cream, clocortolone topical pump, COREG CR CAP, COZAAR TAB, CYTOMEL TAB, desoximetasone ointment 0.05%, doxycycline hyclate tab 50mg dr, ELIDEL CREAM 1%, fenofibrate cap 50mg & 130mg, fenofibrate tab 40mg & 120mg, FOCALIN XR, GUARDIAN RT SYSTEM/SUPPLIES, hydrocortisone lotion 0.1%, hyoscyamine er, HYOSCYAMINE SR TAB, HYZAAR TAB, LYRICA CAP, MAXALT TAB, MAXALT-MLT ODT, MICARDIS HCTZ TAB, MICARDIS TAB, nitrofurantoin sus (NDC 70408023932), Oscimin SR TAB, pantoprazole pak, paroxetine cap, REMODULIN INJ, SILENOR TAB, Symax-SR TAB, topiramate er cap, TRAVATAN Z, triamcinolone ointment, TRIANEX OINTMENT, ULORIC TAB, YASMIN (28) TAB, ZESTORETIC TAB, zileuton-er, ZOLOFT CON, ZOLOFT TAB
  • Moved from tier 2 (preferred) to tier 3 (nonpreferred): APTIOM TAB 200MG, ATRIPLA TAB, BRIVIACT INJ 50MG/5ML, SYMFI, SYMFI LO, TYKERB TAB
  • Removed from the Preventive Drug List: AGGRENOX, ANTABUSE, DYAZIDE, GLYSET, LOPRESSOR HCT, PEGANONE, PROFILNINE SD, tolbutamide, TRIGLIDE

Additional updates:

  • Added to the Performance Drug List (commonly prescribed drugs): ASACOL HD TAB, MITIGARE CAP, VAGIFEM VAG
  • Added to the Preventive Drug List: asenapine, emtricitabine/tenofovir disoproxil fumarate 200/300 mg, PRALUENT, PROFILNINE, REPATHA, rufinamide, SUTAB, TRELEGY ELLIPTA
  • A quantity limit will be required on the following specialty drugs: EPCLUSA, FARYDAK, GAVRETO, Nyvepria, ONUREG, REDITREX

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 listed in this article until April 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 April 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 these updates, call CVS Caremark Customer Care at 888.796.7322.

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