NRECA Employee Benefits Weekly

Prescription Drug Coverage Updates Taking Effect January 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 January 1, 2023.

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 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: ALIMTA, ARCALYST, ARNUITY ELLIPTA, ASACOL HD, ADDERALL XR, BENEFIX, CONCERTA, diclofenac 25mg capsule, diclofenac sol 2% pump, ESBRIET, FIRAZYR, FLOVENT DISKUS, IXINITY, MULTAQ, NEXTERONE, NITYR, NUCALA, NUCYNTA, NUCYNTA ER, QVAR REDIHALER, RIXUBIS, RUBRACA, SUBSYS, SUTENT, TOVIAZ, VOTRIENT
  • Moved from tier 2 (preferred) to tier 3 (nonpreferred): NARCAN, VELCADE
  • Removed from the Preventive Drug List: BONIVA, methyldopa

Additional updates:

  • Added to the Performance Drug List (commonly prescribed drugs): ADBRY, AIMOVIG, AKLIEF, ALPROLIX, amphetamine-dextroamphetamine mixed salts er, ARAZLO, CIBINQO, DAYVIGO, DOPTELET, ENDARI, FENSOLVI, GAVRETO, ILARIS, ILUMYA, INLYTA, LENVIMA, MENOPUR mesalamine delayed release 800mg, methylphenidate er, NEXAVAR, QULIPTA, RETEVMO, RHOFADE, RYTARY, SIKLOS, TEZSPIRE, TWYNEO, WINLEVI, XYNTHA, ZYDELIG
  • Removed from the Medications Requiring Prior Authorization to tier 3 (nonpreferred): MULPLETA
  • Added to the Preventive Drug List: TASCENSO ODT
  • A quantity limit will be required on the following specialty drugs: FYLNETRA, TADLIQ, XYREM

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 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.

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