Rx Utilization Management Change Effective May 1, 2016

We want to inform you about the following new pharmacy utilization management requirements that will be effective May 1, 2016 (change was originally scheduled for February 1, 2016).  Below is a high-level summary of the criteria. More details can be found online.

Pharmacy Benefit Change

The following requirement will apply to commercial members who have their pharmacy benefit coverage with us. This change 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.

New Requirement

• Glumetza—This medication will require prior review and step therapy for ALL users.

This pharmacy utilization management change will be effective May 1, 2016.  If you have any questions, please contact us via the Provider Blue Line^SM at 1.800.214.4844.