Prescription Drug Coverage Updates Taking Effect October 1, 2022
CVS Caremark™, NRECA’s pharmacy benefit manager, has announced changes to NRECA’s Medical Plan prescription drug coverage that will take effect October 1, 2022.
CVS Caremark continually reviews and updates drugs covered under the plan to help ensure NRECA Medical Plan 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 September 1 to participants affected by the following updates:
- Removed from the formulary (list of prescription drugs covered under the NRECA Medical Plan) and added to the Medications Requiring Prior Authorization List: betamethasone dipropionate ointment 0.05%, clobetasol emollient foam 0.05%, lansoprazole odt, Tovet Aerosol 0.05%
- Moved from tier 2 (preferred) to tier 3 (nonpreferred): LANOXIN TABLET 0.0625MG, TRIDESILON CREAM 0.05%
- Removed from the Preventive Drug List: NULYTELY
- Excluded from the formulary: APLENZIN, ARESTIN, AUVI-Q, CAMBIA, DENAVIR, EDLUAR, FENORTHO, FORFIVO XL, ketoprofen, NAFLON, OMNARIS, PRUDOXIN, QNASL, QNASL CHILDREN, RAYOS, SITAVIG, SPRIX, TREXIMET, XERESE, ZIPSOR, ZORVOLEX, ZYFLO (brand, generic and extended release)
- Added to the “medications requiring prior authorization” section of the summary plan description: Disposable Insulin Pumps and Supplies, GRALISE, HORIZANT, LYRICA, LYRICA CR, NUZYRA, OSMOLEX ER, QBREXZA, SIVEXTRO, SUCRAID, XHANCE
- A quantity limit will be required on the following non-specialty drugs: ADLYXIN, BYDUREON BCISE, BYETTA, OZEMPIC, RYBELSUS, TANZEUM, TRULICITY, VICTOZA
Additional updates:
- Added to the Performance Drug List (commonly prescribed drugs): ELIQUIS
- Moved from the Medications Requiring Prior Authorization List to tier 3 (nonpreferred): ASTAGRAF XL, CELLCEPT, ENVARSUS XR, MYFORTIC, PROGRAF, PROGRAF GRANULE, RAPAMUNE, ZORTRESS
- Added to the Preventive Drug List: MOUNJARO, NORLIQVA, ZTALMY
- A quantity limit will be required on the following specialty drugs: CAMZYOS, RADICAVA, TYVASO DPI, ZTALMY
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 October 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 October 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.