NRECA Employee Benefits Weekly

Prescription Drug Coverage Updates Taking Effect October 1

Posted on Posted in Group Benefits

CVS Caremark™, NRECA’s pharmacy benefit manager, has announced changes to the NRECA Medical Plan’s Performance Drug List, effective October 1, 2019.

CVS Caremark continually reviews and updates the Performance Drug List, which is the formulary containing the most commonly prescribed brand and generic drugs, to help ensure NRECA participants have access to safe, reliable and affordable prescription drugs.

Note: Brand products are in all caps, branded generics in upper and lowercase Italics, and generic products in lowercase italics.

The following medications will be:

  • Moved from tier 3 (nonpreferred) to tier 2 (preferred): SKYRIZI
  • Removed from the High-deductible health plan (HDHP) Preventive Drug List: BYVALSON, chlorpropamide, CLOPIDOGREL KIT, methylclothiazide
  • Added to the Specialty Pharmacy Drug List: BALVERSA, DIACOMIT, DOVATO, EVENITY, MAVENCLAD, MAYZENT, TREMFYA, ZYKADIA

Regarding the following changes, CVS Caremark will mail a letter on or before September 1 to affected participants:

  • Moved from tier 2 (preferred) to tier 3 (nonpreferred): DIFFERIN, ORACEA, ANDROGEL GEL 1.62%, RANEXA, VESICARE
  • Moved off the Performance Drug List to the Medications Requiring Prior Authorization List*: ACIPHEX, BARACLUDE, BEYAZ, CIALIS, COLCRYS, COUMADIN, EVEKEO, FINACEA GEL, LAMICTAL, LAMICTAL XR, LEXAPRO, LIALDA, MINASTRIN 24 FE, MINIVELLE, MUPIROCIN, ONFI, ORTHO TRI-CYCLN LO, PERCOCET, PREVIDENT, PRISTIQ, PROZAC, RAPAFLO, SABRIL, SINGULAIR, SUBOXONE, TOPROL XL, VIVELLE-DOT, XANAX, XANAX XR, YAZ.
    *These may have less convenient dosage forms, more side effects or higher costs compared to alternative options on the CVS Caremark Drug List

Additionally, a quantity limit will be required on the following specialty drugs: BALVERSA, DIACOMIT, DOVATO, EVENITY, MAVENCLAD, MAYZENT, TREMFYA, ZYKADIA.

Updated drug lists available
The current Performance Drug List is available on the Checking Coverage page of the NRECA Employee Benefits website. Note that the Performance Drug List will not reflect the changes described 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.

In late September, 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 cooperative’s employees have questions about prescription drug coverage or about these changes, call CVS Caremark Customer Care at 888.796.7322.

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