Loading...Loading...November 14, 2023
Our pharmacy team updates our covered drug list (formulary) throughout the year based on FDA approval of new drugs, new generics, changes in drug costs, and the latest clinical safety and efficacy information. Annually, our formulary and associated lists (e.g., Optimum Value Medication List and Drug Exclusions with Alternatives) are fully updated based on market and strategic objectives. Changes that will have a positive effect on employees—such as removing a pre-authorization requirement—are generally implemented as soon as feasible throughout the year.
The 2024 updates include tier changes, formulary removals, and changes to the Optimum Value Medication List and Drug Exclusions with Alternatives. We’re mailing letters to employees affected by the annual formulary updates that outline any changes relevant to their prescriptions and actions they can take.
A few notable changes coming in 2024:
Given the new availability of several generic products and changes to manufacturer pricing and discounts, we’re updating our utilization management strategy. Branded Advair Diskus and Symbicort will become non-preferred in 2024 in favor of their generic alternatives. Flovent HFA, its authorized generic and Flovent Diskus will also become non-preferred in 2024 in favor of Arnuity, which contains the same active ingredients. Employees currently utilizing these products will be best served by changing to an alternative, which can largely be done automatically at the pharmacy.
Given the new availability of generic medications across several mechanisms of action, we’re updating our utilization management strategy. Beginning in 2024, all branded products (including preferred brands) will now require pre-authorization (PA) and trial of a generic product. Generics will continue to not require PA. Employees currently utilizing these products won’t be subject to additional PA requirements, but their cost-share may change.
Our Naloxone Value List offering has been renamed the Opioid Rescue Medication Value List to reflect new rescue products available that don't contain naloxone. This list includes high-value opioid rescue medications that process at $0 cost-share (subject to deductible for HDHPs), including over-the-counter naloxone (Narcan and RiVive). This offering is embedded for fully insured groups, and ASO groups can choose to opt out. The renaming will go into effect upon groups’ renewal in 2024.
As of Oct. 1, 2023, in Utah, Idaho and Washington, and Nov. 1, 2023, in Oregon, preferred GLP-1s (Ozempic, Mounjaro, Trulicity and Rybelsus) will require pre-authorization to ensure use for treatment of type 2 diabetes in line with current benefits. ASO groups may have selected different options for management of this drug category.
Questions? Please contact your account representative.