November 19, 2020
Starting January 1, 2021, the following drugs will require a new prior authorization.
| Condition |
Drugs Requiring a New Prior Authorization |
Preferred Alternatives |
| High Cholesterol |
Praluent®(alirocumab) |
|
| Inflammatory |
Apriso® (mesalamine)
Asacol® HD (mesalamine) |
- Mesalamine tablets
- Balsalazide tablet
|
| Inflammatory |
Colazal®(balsalazide)
Delzicol®
(mesalamine)
Dipentum®
(olsalazine)
Giazo ™ (balsalazide)
Lialda ™ (mesalamine)
Pentasa®
(mesalamine) |
|
| Inflammatory |
Cosentyx® (secukinumab) |
|
| Inflammatory |
Viberzi ® (eluxadoline) |
|
| Rare Disease |
Sucraid®
(sacrosidase) |
|
| Weight Loss |
Contrave® (naltrexone-bupropion)
Qsymia®
(phentermine-topiramate)
Saxenda®
(liraglutide)
Xenical®
(orlistat) |
|
New prescriptions: For prescriptions dispensed on or after January 1, 2021, you’ll need to submit a prior authorization.
Existing prescriptions: If you determine a preferred alternative isn’t appropriate for a patient already taking one of the listed prescriptions, you’ll need to submit a prior authorization and the patient must meet all criteria. If no preferred alternative is listed,the prior authorization will contain other requirements to ensure appropriate use. Patients who receive an approved prior authorization may have higher out-of-pocket costs than a preferred alternative drug depending on their health plan.
Communication to members: We mailed a letter to affected members on November 1, 2020 and encouraged them to contact their provider.
Contact: Call our pharmacy services team at 888-261-1756 if you have questions. Our pharmacy services team is available Monday through Friday from 7:30 a.m. - 6 p.m., Pacific Time.