Utilization Management (UM) Changes – Effective July 1, 2021
Notices of prior authorization, quantity limits and step therapy changes
Notice:
Certain states require OptumRx to communicate prior authorization changes before the effective date. The following July 1, 2021 flyers are sent to members to outline the drugs affected by prior authorization, quantity limits, and step therapy based on benefit plan designs. Please review each document for more details.
Please note: these changes may not reflect final P&T Committee determinations. These changes are specific to prescription drug benefits only, and do not reflect changes that may occur at the health plan level. Prescribers are strongly encouraged to check with the health plan for other changes that may occur.
combined formulary change flyers - effective july 1, 2021
- Utilization Management (UM) Program Requirements [Download link]
Premium, select, and premium value formulary um drug lists - effective july 1, 2021
- Premium Prior Authorization [Download link]
- Premium Quantity Limit [Download link]
- Premium Step Therapy [Download link]
- Select Prior Authorization [Download link]
- Select Quantity Limit [Download link]
- Select Step Therapy [Download link]
- Premium Value Prior Authorization [Download link]
- Premium Value Quantity Limit [Download link]
- Premium Value Step Therapy [Download link]
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