We want to inform you about the following updated pharmacy utilization management requirements that will be effective February 1, 2016. Below is a high-level summary of the criteria, and more details can be found online.
Pharmacy Benefit Changes
The following requirement will apply to commercial members who have their pharmacy benefits with us. These changes will not apply to State Health Plan, Federal Employee Program, Medicare Part D members, or for any ASO employer groups that carve out their pharmacy benefits to another pharmacy benefits manager.
- Technivie—This medication currently requires prior approval. As of February 1, 2016, step therapy will also be required for ALL users.
This pharmacy utilization management change is effective February 1, 2016. If you have any questions, please contact us via the Provider Blue LineSM at 1.800.214.4844.