Humana announces prescription drug changes for 2016

Humana announces prescription drug changes for 2016

Bulletin Type: 
Carrier Notices

Effective January 1, 2016, Humana will update its prescription drug list (PDL) for small groups 2-99. The changes can range from complete removal from the list of covered drugs, or new requirements impacting quantity, type and authorization.

How to read the annual Drug List change:

Coverage status (CVG):

Certain medications that were previously not covered by your plan will be added to your Drug List for 2016, while other medications will be removed.

+ CVG (addition); CVG (no change); -CVG (removal)

Prior authorization (PA):

Some medications will require your doctor to gain prior authorization from Humana before the prescription can be filled. Without prior authorization, the medication will cost full price.

+ PA (addition); +PA* (addition applies only to new prescriptions); PA (no change); -PA (removal)

Quantity limits (QL):

There may be limits on the amount of medication dispensed at one time. These limits are typically in place as a safety precaution or healthcare concern and can help prevent misuse.

+ QL (addition); QL (no change); -QL (removal)

Step therapy (ST):

Before a prescription is filled for a medicine that costs more, you may be required to try an equally effective, but lower cost, medication first.

+ST (addition); +ST* (addition applies only to new prescriptions); ST (no change); -ST (removal)

Specialty medications (SP):

These types of medications are most likely high-cost/high-technology medicines that require special dispensing and monitoring. Specialty medicine coverage varies by plan.

+ SP (addition); SP (no change); -SP (removal)

Humana recommends speaking with your physician or healthcare provider if your medicine has an additional requirement.

To see the list of drugs affected by the change, click here.

For a full list of covered drugs, click here.

If you have any questions, please contact your Bukaty Companies Benefit Consultant at 913.345.0440.

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