2024 formulary coverage changes
CarePartners of Connecticut is incorporating a number of updates to our drug formularies for the 2024 plan year, which are summarized below.
Drugs moving to non-covered status
Effective for fill dates on or after Jan. 1, 2024, CarePartners of Connecticut will no longer cover certain drugs, including drugs with interchangeable generics or therapeutic alternatives. Refer to this document for the list of drugs moving to non-covered status.
For members currently taking these drugs, coverage will continue without disruption through Dec. 31, 2023. If you are a prescribing provider and you wish for a member to continue taking a drug on this list, you’ll need to submit a formulary exception request.
All members currently utilizing the following select drugs will be grandfathered for 2024 to ensure that there is no member impact or disruption to their therapy.
- Apomorphine injection
Drugs moving to a higher tier
For fill dates beginning Jan. 1, 2024, certain drugs will be moving to a higher tier, as indicated on this list.
For members currently taking these drugs, their current coverage will continue unchanged through Dec. 31, 2023.
If an impacted patient cannot afford the new copay, please refer to the formulary for potential therapeutic alternatives at lower tiers. If the available alternatives are not clinically appropriate, a tier exception can be requested and will be reviewed in accordance with CMS regulations, as not all drugs are eligible for tier exceptions.
Addition of prior authorization requirements
CarePartners of Connecticut will require prior authorization for the glucagon-like peptide-1 (GLP-1) class of drugs for 2024, which includes Byetta, Bydureon, Ozempic, Trulicity, Mounjaro, Rybelsus, and Victoza.
Please keep in mind that the prescribing and utilization of these medications for weight loss is considered inappropriate, and is not allowed by the Centers for Medicare and Medicaid Services.
Members with a confirmed diagnosis of type 2 diabetes mellitus in CarePartners of Connecticut’s medical system will be grandfathered for 2024, and will not need to obtain a prior authorization. Members without this diagnosis who want to continue coverage will need to obtain a prior authorization, which will only be eligible for approval if they have a Part D covered indication.
Members who will not be grandfathered for 2024 will be notified.
Preferred product change for long-acting muscarinic agonists
The following changes will apply for respiratory products in the long-acting muscarinic agonists class of drugs, effective Jan. 1, 2024 for the plans listed above:
- Spiriva Handihaler and its generic are moving to non-formulary (Spiriva Handihaler may still be available, when appropriate, through the formulary exception process)
- Incruse Ellipta will be added to Tier 3
- Spriva Respimat will remain on the formulary at Tier 3 for 2024
- CarePartners of Connecticut will notify affected members and providers and provide a list of covered formulary alternatives to Spiriva Handihaler to Incruse Ellipta
Enhanced coverage for select Part D-excluded drugs
For fill dates beginning Jan. 1, 2024, we’re adding coverage for the following select erectile dysfunction drugs, vitamins and minerals, and cough and cold products typically excluded by Medicare Part D. (A quantity limit of 4 tabs per 30 days will be placed on erectile dysfunction drugs.)
FOLIC ACID TAB
HYD POL/CPM SUS
PROMETH VC/ SYP CODEINE
SILDENAFIL CITRATE TAB
VARDENAFIL TAB ODT
VITAMIN D CAP
Preferred continuous glucose monitors
Freestyle and Dexcom continuous glucose monitoring products will be preferred at parity for 2024. Prior authorization will continue to be required for these products.