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Notice of Changes to Prior Authorization Requirements

(Effective January 1, 2020)
Prior authorization, quantity limits, and step therapy changes


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Notice:

Certain states require OptumRx to communicate prior authorization changes before the effective date. The following January 1, 2020 flyers 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.

 

 

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PREMIUM FORMULARY CHANGES (EFFECTIVE JANUARY 1, 2020)

Premium Non-Specialty Prior Auth Changes
Download (PDF 342KB)

Premium Non-Specialty Quantity Limit Changes
Download (PDF 172KB)

Premium Step Therapy Changes
Download (PDF 86KB)

 

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SELECT FORMULARY CHANGES (EFFECTIVE JANUARY 1, 2020)

Select Non-Specialty Prior Auth Changes
Download (PDF 78kB)

Select Non-Specialty Quantity Limit Changes
Download (PDF 166KB)

Select Step Therapy Changes
Download (PDF 108KB)