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2022 STAR+PLUS MMP Pharmacy Benefit Drug List Changes

Date: 12/03/21

Each year Superior HealthPlan STAR+PLUS Medicare-Medicare Plan (MMP) reviews the list of drugs covered by our plan as part of our annual drug list review process. This review may result in some medications having changes such as:

  • Moving to a higher or lower tier.
  • Being added or removed from the drug list.
  • Having a new special requirement.

To assist providers, below is a list of drugs that will removed from the MMP drug list, effective January 1, 2022. Formulary alternative(s) for these drugs are also included. Please note:

  • This list is non-comprehensive but highlights the most commonly prescribed drugs impacted by this annual review.
  • We may cover a temporary supply of up to 30 days if filled at a retail pharmacy, or 31 days if filled at a long-term care pharmacy during the first 90 days of the calendar year.
  • For more details, please reference the Evidence of Coverage.

 What you need to do:

  • Work with your patients currently taking any of the medications listed below to find other options. Often, a covered generic or alternative may be available.
  • You should have received a fax with impacted MMP members that lists alternatives. Please use this to guide your members’ transition.

Product Name

Formulary Alternative

SPIRIVA HANDIHALER

ANORO ELLIPTA, BREO ELLIPTA, INCRUSE ELLIPTA

OMEGA-3-ACID ETHYL ESTERS

VASCEPA

SPIRIVA RESPIMAT

ANORO ELLIPTA, BREO ELLIPTA, INCRUSE ELLIPTA

PROAIR RESPICLICK

VENTOLIN HFA

INVOKANA

FARXIGA, JARDIANCE

PREMARIN CRM

DELESTROGEN, ESTRADIOL

FLUOXETINE HCL TABS

FLUOXETINE HCL CAPS

STIOLTO RESPIMAT

 

ANORO ELLIPTA, BEVESPI AEROSPHERE, BREO ELLIPTA, BREZTRI AEROSPHERE,  TRELEGY ELLIPTA

VENLAFAXINE HCL ER

VENLAFAXINE HCL ER CAPS

PRADAXA

JANTOVEN, WARFARIN

GLYBURIDE

GLIPIZIDE, GLIMEPIRIDE

TRAZODONE HCL TABS 300MG

TRAZODONE HCL TABS 150MG

If you determine that it is necessary for your patient to continue to receive the non-formulary drug in 2022, you will need to submit a Drug Coverage Determination Form as soon as possible. These forms are located on our website by visiting the Coverage Determinations and Redeterminations for Drugs webpage.

If you have any questions, please contact Superior’s Pharmacy Department at 1-800-867-6564.