Formulary Update (July 2024)
Posted on July 2, 2024
Health New England’s formularies are located at healthnewengland.org. At the top of the page, use the “Find A Drug” tool.
Prescription Drug Coverage- Commercial
Note: Tier 1 – lowest copay level; Tier 2 – mid copay level; Tier 3 – highest copay level
For 5-tier formulary- Tier 4-lowest specialty tier; Tier 5-highest specialty tier
Step Therapy Drug changes effective July 1, 2024:
For Health New England to cover the step therapy drugs listed here, you first must try the corresponding first line drugs. If Health New England has paid a claim for the first line drug within the previous 365 days, then you are eligible for coverage of the step therapy drug.
The use of samples does not satisfy the requirements of documented usage of a first line drug or medical necessity for a step therapy drug.
If it is medically necessary for you to use a step therapy drug before trying a first line drug, then your provider can contact Health New England to request a medical review.
All new Step Therapy requirements apply only to new prescriptions.
| You must try: | First Line Drugs: |
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| Before HNE will cover: | Step Therapy Drug(s): |
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| Effective July 1, 2024, The Following Medications Require Prior Authorization Thru Optum | ||
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| Effective July 1, 2024, The Following Medications are Not Covered | ||
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| Effective July 1, 2024, The Following Medications Require Prior Authorization Thru Optum | ||
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