Reminder: Pharmacy Coverage Changes
Noncovered Drugs
Effective for fill dates on or after February 1, 2021, CarePartners of Connecticut no longer covers brand name Tecfidera®. Instead, the interchangeable generic dimethyl fumarate will be covered. For members for whom Tecfidera is medically necessary, the prescribing provider must submit a formulary exception request for the member to continue taking the drug.
Effective for fill dates on or after March 1, 2021, CarePartners of Connecticut no longer covers brand name Zytiga® 500mg. Instead, the interchangeable generic abiraterone 500mg will be covered. For members for whom Zytiga 500mg is medically necessary, the prescribing provider must submit a formulary exception request for the member to continue taking the drug.
Quantity Limit (QL) Additions
As previously communicated, and effective for fill dates on or after June 1, 2021, CarePartners of Connecticut will apply a QL to Rinvoq™, Skyrizi® and Stelara® (see specific QL in grid below). For members taking these drugs over the indicated QL prior to June 1, 2021, coverage will continue without disruption through December 31, 2021. The prescribing provider must submit a QL exception request for the member to obtain one of the following drugs over the allowed quantity.
|
Drug |
QL |
|---|---|
|
Rinvoq |
30 tabs/30 days |
|
Skyrizi |
1 kit/28 days |
|
Stelara |
1ml/28 days |
Preferred Long-Acting Colony Stimulating Factors: Neulasta® (pegfilgrastim) and Fulphila™ (pegfilgrastim-jmdb)
Effective for fill dates on or after July 1, 2021, the preferred long-acting colony stimulating factors will be Neulasta (pegfilgrastim) and Fulphila (pegfilgrastim-jmdb).