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Pharmacy Formulary Program Updates

Changes to our pharmacy formulary program are coming in 2014. These changes apply to commercial plans with pharmacy benefits and to Medex®'plans with the three-tier pharmacy benefit, and they will affect:

  • Non-covered medication status
  • Medication tier status
  • Quality Care Dosing limits
  • Pharmacy medical policies, including prior authorization

In addition, we are making some changes that impact specialty medications.

We are expanding our list of specialty medications. Coverage will no longer be available for these specialty medications when they are purchased from a non-specialty retail pharmacy or from the mail service pharmacy. The list of medications that are not covered when administered in a doctor's office or outpatient hospital setting is also changing.

Coverage for all of these medications will only be available when purchased from a retail pharmacy in our specialty pharmacy network.

A full description of these changes will be available by October 15, 2013.

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