Prescription Drug Coverage – Medicaid
Posted on May 28, 2019
Step Therapy Drug changes effective
July 1, 2019:
For BeHealthy Partnership to cover the Step Therapy drugs listed here, you first must try the corresponding First Line drugs. If BeHealthy Partnership has paid a claim for the First Line drug within the previous 180 or 360 days (depending on the First Line drug), 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 doctor can contact BeHealthy Partnership to request a medical review.
All new Step Therapy requirements apply only to new prescriptions.
| You must try: | First Line Drug(s): |
|
| Before BEHEALTHY PARTNERSHIP will cover: | Step Therapy Drug(s): |
|
| You must try: | First Line Drug(s): |
|
| Before BEHEALTHY PARTNERSHIP will cover: | Step Therapy Drug(s): |
|
Quantity Limit Additions
Starting July 1, 2019, BEHEALTHY PARTNERSHIP will add Quantity Limits to the drugs below.
| Drug Name | Quantity Limit per 30 day supply (unless otherwise specified) |
|
45 grams |
|
6 tablets |
|
8 patches |
New Prior Authorizations (PA) effective July 1, 2019:
|
Prior Auth thru Optum |
Effective July 1, 2019, the following medications will require Prior Authorization:
|
