NRECA Employee Benefits Weekly

Prescription Drug Coverage Updates Taking Effect April 1, 2023

Posted on Posted in Group Benefits

CVS Caremark™, NRECA’s pharmacy benefit manager, has announced changes to the NRECA Medical Plan’s prescription drug coverage that will take effect April 1, 2023.

CVS Caremark and NRECA continually review and update 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. Brand products are printed in ALL CAPS and generic products in lowercase italics.

CVS Caremark will mail a letter by March 1 to participants affected by the following changes:

  • Removed from the formulary and added to the Medications Requiring Prior Authorization list: ACZONE, BYSTOLIC, CARBAGLU, CLIMARA, COMBIGAN, CYSTADANE, DALIRESP, DEPAKOTE, DEPAKOTE SPRINKLE, DEPAKOTE ER, DILANTIN, fenofibrate micronized cap 30mg & 90mg, LOVAZA, mifepristone 200mg, SELZENTRY, TARGRETIN, TEGRETOL XR, TEGRETOL, TRILEPTAL, TYVASO DPI, VASCEPA
  • Moved from tier 2 (preferred) to tier 3 (nonpreferred): PERFOROMIST, ZOMIG NASAL SPRAY
  • Removed from the Preventive Drug List: aspirin/omeprazole delayed release, CHANTIX, DUTOPROL, NIASPAN, PRECOSE          

Additional updates:

  • Added to the Preventive Drug List: AUVELITY, BRIUMVI, ezetimibe/atorvastatin, ZONISADE
  • A quantity limit will be required on the following specialty drugs: AMJEVITA, KRAZATI, LYTGOBI, RELYVRIO, ROLVEDON, SOTYKTU, SPEVIGO, STIMUFEND, TASCENSO ODT

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 about these updates, call CVS Caremark Customer Care at 888.796.7322.

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