Prescription Drug Formulary Changes

Date: 06/01/20

PO Box 733

Elk Grove Village, IL 60009-0733

Dear YouthCare Provider,

This is an important message from YouthCare HealthChoice Illinois. YouthCare would like to inform you of upcoming changes to our prescription drug formulary.

On July 1, 2020, the coverage of Emgality Inj 120 mg/ml is changing for all members. Effective July 1, 2020, this medication will either be removed from the formulary (list of covered medications) OR will be given new limits that may affect medication coverage. Please reference the tables below for information regarding medication changes and alternative preferred agents.

YouthCare would like to work with you to help transition the impacted members onto a preferred formulary alternative. If a member requires continued therapy for a medication that has been changed, please submit a prior authorization with appropriate clinical documentation. Prior authorizations can be submitted by fax at 1- 866-399-0929.

Impacted Medication	Medication Change
Emgality Inj 120 mg/ml	Non-preferred after 7/1/20

Note: Active prior authorizations for this medication will not be affected.

If you have any questions, please call YouthCare Provider Services at 1-844-289-2264.

Sincerely,

YouthCare