Every year, OptumRx, the City’s Pharmacy Benefit Manager updates its Prescription Drug List. Some drugs have been removed from the list and others added. If you are taking a medication that was impacted by a change, you would have received a letter in the mail from OptumRx. The letter would indicate the medication you currently are prescribed, as well as the recommended substitution. For those currently receiving prescriptions, the change goes into effect February 1, 2019.
You can find the Prescription Drug List and the Drug Exclusions on the Human Resources website - Prescription Drug List 2019 and Drug Exclusions
Decisions to add or remove a medication from the drug list are not taken lightly. A medication is removed when it costs more than drugs that are just as effective and cost less, or the drug can be obtained over the counter at Walmart or Target. The result is you can still get affordable drugs that meet your needs. In addition, there are significant savings for you and the City, which are key to keeping your premiums from increasing.
In a situation where you have tried other medications and only the one being excluded works best for your condition, your physician may write an appeal letter to request you continue using the medication. Contact your doctor to change your prescription, or you can work with Jordan White at Compass. She will work with your doctor to have your medication changed. Contact Jordan for more details.
For a more detailed explanation you may read the attached memo. The Human Resources Benefits staff is happy to answer questions about these changes. Call 972-941-7115.