Drug coverage decisions and new offerings from OptumRx, Caremark, Cigna and Wellcare made the list of the top-read drug coverage news in 2022.
Beginning in 2023, Cigna will offer three new Medicare supplemental Prescription Drug Plans (PDPs) in all 50 states, the District of Columbia and Puerto Rico. All plans have $0 copay options for select medications purchased through preferred home delivery. Additionally, Cigna will offer Medicare Advantage (MA) plans with enhanced features and benefits in 581 counties within 28 states.
Beginning in 2023, OptumRx plans to include on its formularies Amgen’s Amjevita, a biosimilar of AbbVie’s blockbuster rheumatoid arthritis drug Humira (adalimumab), as well as two additional biosimilars. The new biosimilars will be available on the Select and Premium formularies, according to a company spokesperson. No information has been provided on tiering or utilization management strategies that could be employed.
OptumRx has made a number of utilization management changes — requiring prior authorization or step therapy and putting quantity limits — on its formularies effective Jan. 1, 2023. The PBM now requires prior authorization for 16 products, including 11 that are used to treat patients with diabetes.
CVS Caremark has released its Performance Drug List, Standard Control, for April 2022. Effective April 1, the company has removed 20 products from its Standard Control formulary when compared with the list effective from January 2021. CVS Caremark has also added several products, including some branded therapies.
Beginning in January 2023, Wellcare will expand its range of Medicare Advantage and Medicare Prescription Drug Plan offerings. Its pharmacy offerings will be expanded to include 102 plans nationwide and will include $0 copays for COVID-19 vaccines and testing. Additionally, Amazon is now a preferred retail pharmacy. All plans will include a $0 tier 1 benefit when filled at preferred pharmacies, including Amazon, Walgreens, CVS, and most grocers.