Pharmacy Benefit Updates

Our Formulary updates on a monthly basis. The following are example of changes that may occur. 

• Medications increasing/decreasing in copay - Medications may move from a higher Tier to a lower Tier when a generic becomes available.

• Medications excluded from benefit coverage - Some medications may no longer be covered when a generic becomes available. 

• Supply Limits - Decreasing or increasing supply limits for certain medications to align with the FDA-approved dosing interval. 

• Pharmacy Utilization Management - Adding or deleting Prior Authorization and Step Therapy to ensure beneficiaries are taking medications that are most appropriate.