Pharmacy Formulary and Medical Policy Changes
Starting January 2025, some drugs will have a formulary drug list change. Find out more on our drug list changes page.
Also, starting January 2025, the following drugs will require a new prior authorization:
| Condition | Drugs Requiring a New Prior Authorization | Preferred Alternatives |
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| Asthma |
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| Cancer |
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| Fertility Support |
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| Inflammatory Diseases |
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| Rare Diseases |
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* Available for current users only.
New prescriptions: For prescriptions dispensed on or after January 2025, you will need to submit a prior authorization.
Existing prescriptions: If you determine a preferred alternative isn’t appropriate for a member already taking one of the prescriptions above, you will need to submit a prior authorization, and the member must meet all criteria. Members who receive an approved prior authorization may have higher out-of-pocket costs than a preferred alternative drug depending on their health plan.
Communication: If the member picked up the drug from a pharmacy, they were mailed a letter on November 1, 2024, encouraging them to contact their provider. We also notified you of the change in our October 2024 Provider News.
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. to 6 p.m. Pacific Time.