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We have a team of physicians and pharmacists—our Pharmacy and Therapeutics Committee (P&T)—who review our lists of covered medications (formularies) for safety and effectiveness. Based on recommendations from our P&T Committee, we occasionally make changes to the medications covered by our Formulary.
Medications on the formulary may change for the following reasons:
New medications become available and may be added to the formulary.
Brand-name medications become available as generic. As generic medications become available, the corresponding brand-name medications may be removed from the formulary.
New pharmacy management programs such as prior authorization, step therapy, or quantity limits are adopted for select medications.
In some cases, if you are already taking a medication when its coverage changes, you will be exempt from those changes for the remainder of the plan year. The exception to this exemption is when a generic medication replaces a brand-name medication in the formulary. When that occurs, we will notify you, in writing, 60 days before the change takes effect. However, the notice period is waived when a medication is removed for safety reasons.
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