2018 Formulary Changes Contribute to Prior Authorization Increase

December 14, 2017  |  Jessica Behrendsen

Article image

CoverMyMeds cites health plan formulary requirements as one of the most common reasons for provider adoption of an electronic prior authorization (ePA) solution.

As we move into a new year, many health plans make changes to their formularies in order to control costs and provide the best possible therapy options for patients. While these changes are always important, it can be frustrating from the position of a provider to know what medication is or isn’t covered for a patient moving into the new year.

With that in mind, we reached out to some of our internal clinical experts who sifted through the 2018 formulary updates and provided us with what they thought were the most important changes to note this year. Take a look:

2018 Formulary Updates

ESI Commercial National Preferred Formulary

Adding: Tymlos

Removing: Forteo

View the formulary »

CVS Caremark Commercial Standard Control Formulary

Adding: Invokana, Invokamet and Invokamet XR (was previously excluded), Symbicort (was previously excluded)

Removing: Jardiance, Synjardy, Synjardy XR

View the formulary »

OptumRX Medicare (UnitedHealth and AARP, Among Others)

Xarelto and Eliquis (covered without the need for PA) on the majority of formularies

View the OptumRx formulary »

View the UnitedHealth formulary »

Aetna Commercial

Making Humira non-preferred

View the formulary »

Cigna Commercial Standard Preferred Drug List

Removing: Invokana, Invokamet, Invokamet XR, OxyContin, NovoLog, Lantus and Toujeo

View the formulary »

CoverMyMeds’ ePA solution is the best way to keep up with formulary changes for medication that requires PA, ensuring your patients are getting their needed medication, and to lighten your workload this busy time of year.

Join the more than 700,000 providers already using the CoverMyMeds solution by signing up here.

Questions? Our dedicated support team is here to help. Call 866-452-5017 or click to chat in bottom right corner of the screen.

Share this article on Facebook Share this article on Twitter Share this article on LinkedIn Share this article via email