NRECA Employee Benefits Weekly

Prescription Drug Coverage Updates Planned, Effective April 1

Posted on Posted in Group Benefits

CVS Caremark, NRECA’s pharmacy benefit manager, has announced changes to the NRECA Medical Plan’s prescription drug formulary, effective April 1, 2019.

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

Here is a list of all coverage updates going into effect April 1. Note: Brand products are in all caps, branded generics in upper and lowercase Italics, and generic products in lowercase italics.

The following medication(s) will be:

  • Added to the formulary because it offers enhanced effectiveness and/or more convenient dosages compared to available options: Retacrit
  • Moved from tier 3 (nonpreferred) to tier 2 (preferred) within the formulary, which may lower the copay and coinsurance cost: MULPLETA, SENSIPAR, ARISTADA INITIO, DUPIXENT
  • Added to the Performance Drug List (of commonly prescribed drugs): abiraterone, AJOVY, budesoinide ext-rel, carvedilol phosphate ext-rel, EMGALITY, fludrocortisone, liothronine, LOKELMA luliconazole, ORILISSA
  • Added to the high-deductible health plan (HDHP) Preventive Drug List: Arakoda, clobazam, FORTEO, PLENVU, TAKHZYRO, TYMLOS, ZORTRESS
  • Removed from the HDHP Preventive Drug List: afeditab CR, BEBULIN, D-CARE DM2 KIT, IPRIVASK, MICROZIDE
  • Subject to quantity limits under the plan:  These specialty drugs have quantity limits and must be managed by CVS Caremark: COPIKTRA, DELSTRIGO, DUPLIXENT, EPIDIOLEX, FULPHILA, GALAFOLD, ONPATTRO, PIFELTRO, VIZIMPRO

CVS Caremark will mail a letter on or before March 1 to participants affected by the following changes. These medications will be:

  • Moved from tier 2 (preferred) to tier 3 (nonpreferred) within the formulary, which may affect a participant’s copay or coinsurance amount: ATRALIN Gel, COREG CR, ESTRACE Vaginal Cream, LUZU Cream, UCERIS, NEORAL, ADCIRCA
  • Removed from the formulary (and added to the Medications Requiring Prior Authorization list) because they may have less convenient dosage forms, more side effects or cost more compared to alternative options on the CVS Caremark Drug List: benzonatate 150 mg capsules, butal/apap 50-300 mg capsules, chlorzoxazone 250 mg tablets, diclofenac 1% gel, hydrocortisone absorbase ointment, ZYTIGA, PROCRIT, EPOGEN

Updated drug lists available
Participants can visit the Prescription Drug page on the NRECA Employee Benefits website to view the most current version of the Performance Drug List. This list contains the most commonly prescribed brand and generic drugs covered by NRECA’s prescription drug benefit. Note: This list will not reflect the changes listed in this article until April 1.

For drugs not on the Performance Drug List, participants can visit the Manage Your Prescriptions page to check on drug coverage, as well as the drug cost.

A Message Center notification will be sent in March instructing benefits administrators to download and distribute the supplemental medical plan summary of material modifications to plan participants outlining the changes listed in this article.

If you or your cooperative’s employees have questions about prescription drug coverage or these changes, call CVS Caremark Customer Care at 888.796.7322.

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