Health New England\u2019s formularies are located at healthnewengland.org. At the top of the page, use the \u201cFind A Drug\u201d tool.<\/p>\n
Prescription Drug Coverage- Commercial<\/p>\n
Note: Tier 1 \u2013 lowest copay level; Tier 2 \u2013 mid copay level; Tier 3 \u2013 highest copay level Step Therapy Drug changes effective July 1, 2024:<\/strong><\/p>\n 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.<\/p>\n 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.<\/strong><\/p>\n 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.<\/p>\n All new Step Therapy requirements apply only to new prescriptions.<\/p>\n <\/td>\n<\/tr>\n Health New England\u2019s formularies are located at healthnewengland.org. At the top of the page, use the \u201cFind A Drug\u201d tool. Prescription Drug Coverage- Commercial Note: Tier 1 \u2013 lowest copay level; Tier 2 \u2013 mid copay level; Tier 3 \u2013 highest copay level For 5-tier formulary- Tier 4-lowest specialty tier; Tier 5-highest specialty tier Step […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[],"class_list":["post-8573","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-2eh","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8573","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/comments?post=8573"}],"version-history":[{"count":6,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8573\/revisions"}],"predecessor-version":[{"id":8588,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/8573\/revisions\/8588"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=8573"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=8573"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=8573"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nFor 5-tier formulary- Tier 4-lowest specialty tier; Tier 5-highest specialty tier<\/strong><\/em><\/p>\n\n\n
\n You must try:<\/strong><\/td>\n First Line Drugs:<\/strong><\/td>\n \n \n
\n Before HNE will cover:<\/strong><\/td>\n Step Therapy Drug(s):<\/strong><\/td>\n \n \n
\n Effective July 1, 2024, The Following Medications Require Prior Authorization Thru Optum<\/strong><\/td>\n<\/tr>\n \n \n \n
\n Effective July 1, 2024, The Following Medications are Not Covered<\/strong><\/td>\n<\/tr>\n \n \n \n
\n Effective July 1, 2024, The Following Medications Require Prior Authorization Thru Optum<\/strong><\/td>\n<\/tr>\n \n \n \n