NRECA Employee Benefits Weekly

Prescription Drug Coverage Updates Taking Effect October 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 October 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 September 1 to participants affected by the following updates:

  • Removed from the formulary (all prescription drugs covered by NRECA) and added to the Medications Requiring Prior Authorization list: AKLIEF, ARAZLO, EPIDUO, EPIDUO FORTE, FINACEA, MIRVASO, MOUNJARO (effective July 15, 2023), NORITATE, RHOFADE, SOOLANTRA, WINLEVI PA
  • Moved from tier 2 (preferred) to tier 3 (nonpreferred): VYVANSE
  • Excluded from the formulary: diclofenac powder 50mg, ENTADFI, RYALTRIS, ZIEXTENZO
  • Step therapy will be required for the following drugs: ACANYA, ACZONE, AMZEEQ, BENZACLIN, BYDUREON BCise, BYETTA, CLEOCIN-T, CLINDACIN ETZ, CLINDACIN PAC, CLINDACIN-P, CLINDAGEL, DUAC, EVOCLIN, KLARON, NEUAC, ONEXTON, OZEMPIC, METROCREAM, METROGEL, MOUNJARO, ORACEA, RYBELSUS, TRULICITY, VICTOZA, ZILXI
  • Removed from the Preventive Drug List: CALAN SR, DRIZALMA, PEXEVA

Additional updates:

  • Added to the Performance Drug List (commonly prescribed drugs): AUSTEDO XR, MOUNJARO, VTAMA, ZORYVE
  • Added to the Preventive Drug List: ABILIFY, ASIMTUFII, ALTUVIIIO, ATORVALIQ, PERSERIS, REZVOGLAR, UZEDY
  • A quantity limit will be required on the following specialty drugs: AUSTEDO XR, BUPHENYL, BRUKINSA, DAYBUE, JOENJA, LIQREV, LUMRYZ, OLPRUVA, QALSODY, SOGROYA, VOWST, VYJUVEK, VYVGART HYTRULO

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.

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