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Preferred Medication List

This 3-tier formulary design is typically used by mid-size employer groups (51-99 Employees) and large employer groups (100+ Employees), as well as individual members and their families or small employers. If your plan is considered a “Grandfathered” or “Grandmothered” plan, the Preferred Medication List applies. 

Examples of health plans using the Preferred Medication List:

  • Innova
  • Engage
  • HSA 2.0
  • HSA 3.0

Changes During a Plan Year

As new drugs and drug formulas become available, we evaluate them and update the formulary to get safer, more effective and valuable medications in members’ hands.

While most drugs will not change cost tiers during a benefit year, they may change if one of the following situations occur:

  • The same drug becomes available as a generic.
  • Safety or effectiveness concerns are raised.
  • We determine that changes to all of our benefit designs would overall be best for our members.

How will I know if a drug is changing?

Check the “Upcoming Changes” chart below. When drug coverage changes, it will be posted at least 30 days before the change. If we have safety concerns or if an equivalent generic becomes available, the change will be posted as soon as possible and may be less than 30 days before the change.
 

Finding your drug cost share

To find your cost share of your medication, first locate which tier your medication falls in by looking on the “Upcoming Medication Changes” list. If your medication is not on this list, then search for it in the Preferred Medication List. Once you’ve identified which tier it’s on, review your plan benefit summary, it will tell you your cost share for that tier.

Click here to access the online searchable formulary tool.

 

Upcoming Medication Changes List

 

Upcoming Formulary Changes
Drug Effective Date Change
Pataday® 01/01/18 Changing from tier 2 to tier 3. Generic available.
Alkeran® 01/01/18 Changing from tier 2 to tier 3. Generic available.

 

 Recent changes in the last 180 days
Drug Effective Date Change
sodium phenylbutyrate tablet (Buphenyl®) 09/20/17 Addition - Recent first time generic.
fosamprenavir tablet (Lexiva®) 09/18/17 Addition - Recent first time generic.
paroxetine mesylate (Brisdelle®) 09/18/17 Addition - Recent first time generic.
lanthanum (Fosrenol®) 08/30/17 Addition - Recent first time generic.
vigabatrin (Sabril®) 08/22/17 Addition - Recent first time generic.
prasugrel (Effient®) 08/17/17 Addition - Recent first time generic.
adapalene-benzoyl peroxide (Epiduo®) 08/03/17 Addition - Recent first time generic.
scopolamine patch (Transderm-Scop®) 08/02/17 Addition - Recent first time generic.
eletriptan (Relpax®), mesalamine DR (Lialda®), sevelamer (Renvela®) 07/25/17 Addition - Recent first time generic.
moxifloxacin (Vigamox®) 07/03/17 Addition - Recent first time generic.
Bydureon®, Byetta®, Janumet®, Janumet XR®, Januvia® 07/01/17 Prior authorization removed.
Onglyza®, Kombiglyze® XR, Victoza® 07/01/17 Changed from tier 3 to tier 2. Prior authorization removed.
Xultophy® 07/01/17 Prior authorization removed.
Descovy®, Odefsey® 07/01/17 Changed from tier 3 to tier 2.
Toujeo®, Tresiba® 07/01/17 Changed from tier 3 to tier 2.
Ergomar®, Migergot® 07/01/17 Changed from tier 2 to tier 3. Preferred alternatives available.
Benicar®, Benicar® HCT 07/01/17 Changed from tier 2 to tier 3. Generic available.
Tamiflu® 07/01/17 Changed from tier 2 to tier 3. Generic available.
Epipen® 07/01/17 Changed from tier 2 to tier 3. Generic available.
Kaletra® oral solution 07/01/17 Changed from tier 2 to tier 3. Generic available.
Cordran® ointment 07/01/17 Changed from tier 2 to tier 3. Generic available.
testosterone TD solution (Axiron®) 06/28/17 Addition - Recent first time generic. Prior authorization required.
melphalan (Alkeran®) 06/26/17 Addition - Recent first time generic.
olopatadine (Pataday®) 06/09/17 Addition - Recent first time generic.
Dupixent® 06/01/17 Changed from tier 3 to tier 2.
atomoxetine (Strattera®) 05/31/17 Addition - Recent first time generic.
quetiapine ER (Seroquel XR®) 05/10/17 Addition - Recent first time generic. Prior authorization required.
Ergomar®, Cafergot® and ergotamine tartrate/caffeine (generic), Migergot®, D.H.E. 45® and dihydroergotamine (generic), Migranal® 05/01/17 Prior Authorization required.
ezetimibe-simvastatin (Vytorin®) 04/26/17 Addition - Recent first time generic. Prior authorization required.
tazarotene 0.1% cream (Tazorac®) 04/05/17 Addition - Recent first time generic.
Nitrostat® 04/01/17 Changed from tier 2 to tier 3. Generic available.
Valcyte® oral solution 04/01/17 Changed from tier 2 to tier 3. Generic available.
Epzicom® 04/01/17 Changed from tier 2 to tier 3. Generic available.
Cordran® lotion 04/01/17 Changed from tier 2 to tier 3. Generic available.
Vagifem® 04/01/17 Changed from tier 2 to tier 3. Generic available.

 

Preferred Medication List

Use the online tool below to see information about a specific drug on your formulary

Preferred Medication List Search Tool

Prior Authorization Program

Substitution Process

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