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Coming in 2018: Updates to Our Covered Medications List

Coming in 2018: Updates to Our Covered Medications List
Beginning January 1, 2018, we're making changes to our covered medications list for commercial medical plans with pharmacy benefits, and Medex®' plans with the three-tier pharmacy benefit.

As part of these updates, certain medications will:

  • No longer be covered
  • Have a new dosing limit

Medications No Longer Covered
After reviewing each medication's cost and covered alternatives, we've removed the medications listed in the chart below from our covered medications list. However, when medically necessary, a member's doctor or prescriber may request a coverage exception; if approved, the medication will process at the highest tier.

Medication Class Non-Covered Medication or Supply Covered Alternative
Biguanides for Diabetes Generic Metformin Film Coated ER version of Fortamet Metformin 500mg, 850mg, 1000mg(Generic version of Glucophage)

Metformin ER 500mg, 750mg (Generic version of Glucophage XR)
Estrogen and Estrogen Modifiers Femring Estrace
Estring
Premarin
Glucagon-Like Peptide-1 Agents Tanzeum* Bydureon
Byetta
Trulicity
Novel Psychotropics Abilify
Geodon
Seroquel
Zyprexa
Zyprexa Zidis
aripiprazole
ziprasidone
quetiapine
olanzapine
olanzapine ODT

*Existing users may continue to fill this medication but will experience a tier change.

Medication with New Quality Care Dosing Limit
To make sure that the quantity and dose of a medication meets the Federal Drug Administration, manufacturer, and clinical recommendations, we are adding a Quality Care Dosing Limit to the following medication:

Medication Name Quality Care Dosing Limit
Humira Pediatric Crohn's Starter Pack 1 Pack (2 Syringes)

*This impacts new starts only. There will be no impacted member communications

Proton Pump Inhibitors Will Be Excluded from Pharmacy Coverage

Beginning January 1, 2019, all proton pump inhibitors will be excluded from our pharmacy benefit coverage, except for members under the age of 18 and those taking combination medications to treat H. Pylori. Formulary exceptions, including those previously approved, will no longer be available for this class of medication, except for members under the age of 18 and those taking combination medications to treat H. Pylori.

This change applies to all commercial plans, group Medex plans with the three-tier pharmacy benefit, and Managed Blue for Seniors plans. We will notify impacted members beginning in November 2018 prior to the change.

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