Prescription Drug Coverage Updates Taking Effect January 1, 2021

CVS Caremark™, NRECA’s pharmacy benefit manager, has announced changes to NRECA’s Medical Plan prescription drug coverage that will take effect January 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 has mailed a letter recently to participants affected by the following updates:

Removed from the formulary and added to the Medications Requiring Prior Authorization list: ACCU-CHEK TEST STRIPS/SUPPLIES (applies to new starts only) ,ADZENYS XR ODT, AMITIZA, APOKYN, APTENSIO XR, ARALAST, AZELEX, AZESCO, BEPREVE, BEVESPI, BORTEZOMIB, calcipotriene/betamethasone suspension, calcipotriene/betamethasone ointment, CIPRO HC SUS OTIC, CIPRODEX SUS OTIC, DARAPRIM, DAYTRANA, DIFFERIN, ESTRING, FABIOR, FEMRING, GEL-ONE, GLASSIA , GOLYTELY, HUMATROPE, INCRUSE ELPT, INTRAROSA SUP, ISOSORBIDE DINITRATE TAB 40MG, KYPROLIS, LACRISERT, MENEST, metaxalone, methocarbamol, MIRVASO, NEULASTA, NUVARING, OSPHENA, oxymorphone er, PAXIL , PAXIL CR, PEXEVA, PREMARIN, PROLENSA, PROVAD, SANDOSTATIN, SIGNIFOR LAR, SOMAVERT, SUPREP, TAZORAC, TECFIDERA, TRACLEER, TRULANCE (applies to new starts only), UDENYCA, VIIBRYD, VISCO-3, ZALVIT, ZELAC, ZIRGAN
Moved from tier 2 (preferred) to tier 3 (nonpreferred): ARISTADA, NPLATE, PEGANONE, PROMACTA, RISPERDAL, XALKORI, ZYKADIA, ZYPREXA RELP
Removed from the Preventive Drug List: BEVYXXA, chlorothiazide, COUMADIN, guanabenz, PREPOPIK, simvastatin suspension

Additional updates:

Added to the Performance Drug List (commonly prescribed drugs): ALECENSA, ALUNBRIG, BREZTRI AERO, CLENPIQ, DOPTELET, DUROLANE, EMEND SUS, ERIVEDGE, EUFLEXXA, IMVEXXY, INBRIJA, NINLARO, NORDITROPIN, OCREVUS, ONE TOUCH TEST STRIPS/PRODUCTS, ORACEA, PERJETA, PERSERIS, PHESGO, TOUJEO/ TOUJEO MAX, VELCADE, XCOPRI, XOSPATA, ZIEXTENZO, ZIOPTAN
Moved from the Medications Requiring Prior Authorization to tier 3 (nonpreferred): FLAREX SUS, LAMICTAL, LAMICTAL XR
Added to the Preventive Drug List: BAFIERTAM, CONJUPRI, dimethyl fumarate delayed-rel, FINTLEPLA, KESIMPTA, SEMGLEE
A quantity limit will be required on the following specialty drugs: CYSTADROPS, ENSPRYNG, EVRYSDI, FINTEPLA, INQOVI, MYCAPSSA, VILTEPSO, WAKIX, XYWAV

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 January 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 January 1, benefits administrators will receive a Message Center notification directing them to their 2021 medical summary plan description (SPD), which includes 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.