NRECA Employee Benefits Weekly

Prescription Drug Coverage Updates Taking Effect January 1, 2022

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 January 1, 2022.

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 will mail a letter by December 1 to participants affected by the following updates:

  • Removed from the formulary and added to the Medications Requiring Prior Authorization list: ADRENALIN, AFINITOR, AIMOVIG, ARANESP, ATRIPLA, BALCOLTRA, BOTOX, budesonide 9mg tab, CINRYZE, ELIQUIS, FEIBA, HAEGARDA, ICLUSIG, invermectin 1% cream, LEUKINE, MULPLETA, NPLATE, SYMJEPI, tavaborole, TRUVADA, XALKORI
  • Moved from tier 2 (preferred) to tier 3 (nonpreferred): DOPTELET, REYVOW
  • Removed from the Preventive Drug List: DILATRATE-SR, FORTAMET, HALDOL, PLEGRIDY, PROBUPHINE, propranolol/hydrochlorothiazide, maprotiline, methyldopa/hydrochlorothiazide

Additional updates:

  • Added to the Performance Drug List (commonly prescribed drugs): AUVI-Q, AVONEX, BRUKINSA, ENSPRYNG, IMBRUVICA, KERENDIA, LUPR DEP-PED, MYFEMBREE, NATAZIA, NOVOSEVEN RT, ORLADEYO, PROMACTA, QELBREE, ROZLYTREK, SEVENFACT, SOOLANTRA CREAM 1% (Tier 1 Brand), TAVALISSE, UCERIS (Tier 1 Brand), VITRAKVI, WAKIX, WEGOVY, XYWAV, ZYKADIA
  • Moved from the Medications Requiring Prior Authorization list to tier 3 (nonpreferred): PLEGRIDY
  • Added to the Preventive Drug List: EPIDIOLEX, LYBALVI, THALITONE, WEGOVY
  • A quantity limit will be required on the following specialty drugs: AYVAKIT, BARACLUDE, EMPAVELI, REZUROCK, TRIKAFTA, VALCYTE

Updated drug lists available
No later than January 1, benefits administrators will receive a Message Center notification directing them to a medical plan summary of material modifications or a new medical summary plan description describing the updates 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.

Scroll to top