NRECA Employee Benefits Weekly

Prescription Drug Coverage Updates Taking Effect July 1, 2021

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

Removed from the formulary and added to the Medications Requiring Prior Authorization list: ACUVAIL, APTIVUS, ATIVAN, AVASTIN, AZASITE, BETIMOL SOL, BROMSITE DROP, carisoprodol 250mg, CELEBREX, chlordiazepoxide-clidinium (NDCs: 11534019701, 51293069601, 51293069610), CILOXAN OINT, CILOXAN SOL, CRESEMBA, CUPRIMINE, DESFERAL, ELMIRON, EXJADE, FERRIPROX, FLAREX, flurandrenol cream, flurandrenol lotion, FML FORTE, FML SOP OINT, halcinonide cream 0.1%, HERCEPTIN, icosapent cap, INVELTYS, INVIRASE, JADENU, KUVAN, Lactojen, LASTACAFT, LEXIVA, LIBRAX, LITHOSTAT, luliconazole cream, LUPRON DEPOT PED, LUPRON DEPOT, MAXIDEX SUS 0.1% OP, NATURE-THROID, NEO-SYNALAR, NEVANAC, Nolix, NORPACE, NOXAFIL, NOURIANZ, PRED MILD SUS, PRENATAL VITAMINS – All brand products except CITRANATAL, PRILOSEC POW SUS, PROMETRIUM (specific NDC- 100mg-69543037210 and 200mg-69543037310), PROVIGIL, RIABNI, RITUXAN, RYTARY, SEASONIQUE, SYPRINE, THEO-24 CAP, THIOLA, THIOLA EC, TOBRADEX ST SUS, tramadol ext-rel cap, TRELSTAR MIXJECT, TRUXIMA, VIRACEPT, WESTHROID, WP THYROID, ZERVIATE, ZOLADEX, zolpidem sublingual

Moved from tier 2 (preferred) to tier 3 (nonpreferred): FIRAZYR, KALETRA

Removed from the Preventive Drug List: BYDUREON, CATAPRES, PRAVACHOL

Additional updates:

  • Added to the Performance Drug List (commonly prescribed drugs): ACCU-CHEK TEST STRIPS, ADVATE, AFSTYLA, APLENZIN, CUTAQUIG, ELOCTATE, ESPEROCT, FIRMAGON, KANJINTI, KYNMOBI, LONSURF, NATESTO GEL, PROLENSA, QSYMIA, RUXIENCE, STIVARGA, SUPPRELIN LA, TRAZIMERA, TRIPTODUR, VASCEPA, ZIRABEV
  • Added to the Preventive Drug List: ABILIFY MYCITE, BYDUREON BCISE, ELEPSIA XR, ORLADEYO
  • A quantity limit will be required on the following specialty drugs: APOKYN, AVSOLA, BENLYSTA, BRONCHITOL, KESIMPTA, KYNMOBI, ORLADEYO, ORGOVYX, OXLUMO, TEPMETKO, ZOKINVY
  • Removed from Medications Requiring Prior Authorization list to non-preferred or Tier 3: TRULANCE

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 July 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 July 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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