If you’re continuing to use acute or maintenance medications in the new benefits year, you need to check the formulary (the list of covered medications) to see if your medication requires your prescriber to send additional information to Navitus, the health system’s pharmacy benefit manager (PBM).

• This step is needed, even if your medication was approved by your previous plan, to ensure it is covered under the health system’s plan.
• To know if your medication(s) requires action, look at the “special code” column on the formulary. If it says:
  • PA: it requires a prior authorization.
  • ST: it requires step therapy (prescribed after trying a less costly, clinically equivalent medication first).
  • RDX: it may only be prescribed for a specific medical diagnosis.
• Here is a guide with more helpful hints on how to read the formulary.
• If the formulary says PA, ST or RDX, ask your prescriber to send information to Navitus by March 15, 2024. If you do not take this step, your medication will not be covered.
• If the “special code” column next to your medication is blank, this step is not needed.