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RBS/ANH formulary changes

Effective July 1, 2016, there are some significant changes in the drug formulary for Regence and Asuris. The formulary determines which medications are covered and at what level.

There are four types of changes:

  • Tier changes – Medications moving from Tier 2 (name-brand preferred) to Tier 3 (non-preferred).
  • Pre-authorization – Several types of medications, were added to the tier requiring pre-authorization. This pre-authorization requirement applies to people already taking the medication, as well as new users.
  • Removal – There are some non-FDA approved medications that were on the formulary because they predated the FDA approval process. These medications are no longer covered.
  • Specialty medication list – Several medications are now categorized as specialty medications. While a prescription for these medications can be filled at any pharmacy, including OptumRx mail order, they are limited to a 30-day supply and as such are not eligible for the mail order prescription discount.
  • For the HealthFirst 250 plan, medications that moved from their current tier to the specialty medication tier now require a $100 copay. If ordered through the OptumRx mail order system, the 3 fills for 2 copays prescription discount still applies.

The carrier will communicate directly with the member regarding all of these transitions to make them as smooth as possible.

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