Utilization Management (UM) Changes – Effective January 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 January 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 jANUARY 1, 2021
- Utilization Management (UM) Program Requirements [Download link]
- Clinical Program Requirements [Download link]
Premium and select um drug lists - effective January 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]
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