Preferred Drug List (PDL) Updates
This is an essential message from YouthCare HealthChoice Illinois (YouthCare).
YouthCare would like to inform you that the status of the medications listed below will be changing on October 15th, 2023.
Impacted Medication |
Change |
Alternative |
|---|---|---|
Mirena, CPT code J7298 |
Not covered under pharmacy benefit |
Covered under medical benefit |
Liletta, CPT code J7297 |
Not covered under pharmacy benefit | Covered under medical benefit |
Skyla, CPT code J7301 |
Not covered under pharmacy benefit | Covered under medical benefit |
Kyleena, CPT code J7296 |
Not covered under pharmacy benefit | Covered under medical benefit |
Paragard, Intrauterine copper CPT code J7300 |
Not covered under pharmacy benefit | Covered under medical benefit |
If you have any questions, please call YouthCare Provider Services at 844-289-2264.
This is an essential message from YouthCare HealthChoice Illinois (YouthCare).
YouthCare would like to inform you that the status of the medications listed below will be changing on October 15th, 2023.
| Impacted Medication | Change |
|---|---|
| Albuterol Sulfate Syrup
|
Non-Preferred |
If you have any questions, please call YouthCare Provider Services at 844-289-2264.
This is an important message from YouthCare HealthChoice Illinois (YouthCare).
YouthCare would like to inform you that the coverage of the medications listed below has changed, effective 07/01/2023, for all members. Please reference the table for information regarding medication changes.
Impacted Medication |
Change of as 7/1/2023 |
Preferred Agents |
|---|---|---|
ALBUTEROL SULFATE |
NON-PREFERRED |
NA |
SUNLENCA (TBPK, SOLN) |
PREFERRED WITH PA
|
NA |
EMGALITY (SOAJ, SOSY) |
PREFERRED WITH PA
|
NA |
LURASIDONE HYDROCHLORIDE (TABS) |
PREFERRED
|
NA |
MAVYRET (PACK, TABS) |
PREFERRED
|
NA |
SOFOSBUVIR/VELPATASVIR |
PREFERRED
|
NA |
Please note: Active prior authorizations for this medication will not be affected.
If you have any questions, please call YouthCare Provider Services at 844-289-2264.
This is an important message from YouthCare HealthChoice Illinois (YouthCare).
YouthCare would like to inform you that the coverage of the medications listed below has changed, effective April 1, 2023, for all members. Please reference the table for information regarding medication changes.
| Impacted Medication | Change |
Preferred Agents |
|---|---|---|
AUSTEDO PATIENT TITRATION KIT (TBPK) |
Preferred with PA |
NA |
AUSTEDO (TABS) |
Preferred with PA |
NA |
| INGREZZA (CAPS) | Preferred with PA |
NA |
| INGREZZA (CPPK) | Preferred with PA |
NA |
| BERINERT | Preferred with PA |
NA |
Please note: Active prior authorizations for this medication will not be affected.
If you have any questions, please call YouthCare Provider Services at 844-289-2264.
YouthCare would like to inform you that the status of the medications listed below will change.
| Impacted Medication | Change |
|---|---|
All Enbrel Products |
Preferred with Prior Authorization after 02/01/2023 |
Tamiflu Brand |
Non-preferred after 03/01/2023 |
If you have any questions, please call YouthCare Provider Services at 844-289-2264.
YouthCare would like to inform you that the status of the medications listed below will be changing on February 1, 2023.
| Impacted Medication | Change |
|---|---|
All Enbrel Products |
Preferred with PA |
If you have any questions, please call YouthCare Provider Services at 844-289-2264.
YouthCare would like to inform you that the status of the medications listed below will be changing on February 1st, 2023.
| Impacted Medication | Change |
|---|---|
All Enbrel Products |
Non-Preferred |
Brand Strattera Capsule |
Preferred |
Cosentyx; Cosentyx Sensoready pen |
Preferred with Prior Authorization |
If you have any questions, please call YouthCare Provider Services at 844-289-2264.
YouthCare would like to inform you that the status of the metformin listed below will be changing on December 1, 2022, for members under the care of the Department of Children and Family Services. The medicine will require form CFS 431-A (also known as a consent form) to be submitted to DCFS when prescribed within 100 days of the below medications
- Aripiprazole
- Olanzapine Pamoate
- Aripiprazole Lauroxil
- Olanzapine-Fluoxetine
- Asenapine Maleate
- Olanzapine-Samidorphan L-Malate
- Asenapine TD Patch
- Paliperidone
- Brexipiprazole
- Paliperidone Palmitate
- Cariprazine HCL
- Quetiapine Fumarate
- Clozapine
- Risperidone
- Iloperidone
- Risperidone Microspheres
- Lumateperone Tosylate
- Ziprasidone HCl
- Lurasidone HCl
- Ziprasidone Mesylate
- Olanzapine
Please fax form CFS 431-A to 312-814-7015.
Note: Active consent for these medications will not be affected.
If you have any questions, please call YouthCare Provider Services at 844-289-2264.
YouthCare would like to inform you that the coverage of the medications listed below has changed, effective October 1, 2022, for all members. Please reference the table for information regarding medication changes.
| Impacted Medication | Change |
Preferred Agents |
|---|---|---|
INVEGA HAFYERA |
Preferred with prior authorization after 10/1/22 |
NA |
DYANAVEL XR |
Preferred with prior authorization after 10/1/22 |
NA |
JORNAY PM
|
Preferred with prior authorization after 10/1/22 |
NA |
MODAFINIL
|
Preferred after 10/1/22 |
NA |
| DAYTRANA | Non Preferred after 10/1/22 | NA |
Please note: Active prior authorizations for this medication will not be affected.
If you have any questions, please call YouthCare Provider Services at 844-289-2264.
Please read this important message from YouthCare HealthChoice Illinois (YouthCare) to all prescribers and providers.
Please be advised that coverage of the medications listed below is changing on July 1, 2022, for all members. Reference the table below for medication change information.
| Impacted Medication | Change |
Preferred Agents |
|---|---|---|
APRETUDE |
Preferred after 7/1/22 |
NA |
CARGLUMIC ACID |
Preferred, with a prior authorization after 7/1/22 |
NA |
KERENDIA (except NDC: 50419054170) |
Preferred, with a prior authorization after 7/1/22 |
NA |
LIVTENCITY |
Preferred, with a prior authorization after 7/1/22 |
NA |
Note: Active prior authorizations for these medications will not be affected.
If you have any questions, please call YouthCare Provider Services at 844-289-2264.
YouthCare would like to inform you that the coverage of the medications listed below is changing on April 15, 2022 for all members. Please reference the table 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.
| Impacted Medication | Change |
Preferred Agents |
|---|---|---|
FLUTICASONE PROPIONATE/SALMETEROL |
Non-preferred after 4/15/22 |
ADVAIR DISKUS® ADVAIR HFA® AIRDUO DIGIHALER 55/14® AIRDUO DIGIHALER 113/14® AIRDUO DIGIHALER 232/14® AIRDUO RESPICLICK 55/14® AIRDUO RESPICLICK 113/14® AIRDUO RESPICLICK 232/14® |
ADVAIR DISKUS ADVAIR HFA |
Preferred after 4/15/22 |
NA |
WIXELA INHUB |
Non-preferred after 4/15/22 |
ADVAIR DISKUS® ADVAIR HFA® AIRDUO DIGIHALER 55/14® AIRDUO DIGIHALER 113/14® AIRDUO DIGIHALER 232/14® AIRDUO RESPICLICK 55/14® AIRDUO RESPICLICK 113/14® AIRDUO RESPICLICK 232/14® |
AIRDUO DIGIHALER 55/14 AIRDUO DIGIHALER 113/14 AIRDUO DIGIHALER 232/14 |
Preferred after 4/15/22 |
NA |
AIRDUO RESPICLICK 55/14 AIRDUO RESPICLICK 113/14 AIRDUO RESPICLICK 232/14 |
Preferred after 4/15/22 |
NA |
ANORO ELLIPTA |
Preferred after 4/15/22 |
NA |
BEVESPI AEROSPHERE |
Non-preferred after 4/15/22 |
Anoro Elipta ® |
INCRUSE ELLIPTA |
Preferred after 4/15/22 |
NA |
SPIRIVA RESPIMAT |
Preferred after 4/15/22 |
NA |
MYFEMBREE |
Preferred after 4/15/22 |
NA |
QULIPTA |
Preferred after 4/15/22 |
NA |
APO-VARENICLINE |
Non-preferred after 4/15/22 |
Varinecline |
Note: Active prior authorizations for this medication will not be affected.
If you have any questions, please call YouthCare Provider Services at 844-289-2264.
Note: This notice replaces the previous notice dated 2/15/21.
YouthCare would like to inform you after August 1, 2021 melatonin will not be covered. This includes instances in which DCFS consent has been received. The change is being enacted due to the Center for Medicare and Medicaid’s (CMS) classification of melatonin and state of Illinois Department of Health and Family Services’ (HFS) rules.
For questions or additional information about this change please contact YouthCare Provider Services at 844-289-2264.
YouthCare would like to inform you that the coverage of long acting antipsychotic injectables (Abilify Maintena ®, Aristada ®, Aristada Initio ®, Invega Sustenna ®, and Invega Trinza ®) is changing on June 15, 2021 for all members. Effective June 15, 2021, these medications will be preffered with a prior authorization. Please reference the table 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 faxing 844-989-0154.
Impacted Medication |
Medication Change |
|---|---|
Abilify Maintena ® |
Preferred with prior authorization after 6/15/2021 |
Aristada ® |
Preferred with prior authorization after 6/15/2021 |
Aristada Initio ® |
Preferred with prior authorization after 6/15/2021 |
Invega Sustenna ® |
Preferred with prior authorization after 6/15/2021 |
Invega Trinza ® |
Preferred with prior authorization after 6/15/2021 |
Note: Active prior authorizations for this medication will not be affected.
If you have any questions, please call YouthCare Provider Services at 844-289-2264.
YouthCare would like to inform you that the coverage of Metformin Hydrochloride ER Modified Release (GLUMETZA) and Metformin Hydrochloride ER Osmotic (FORTAMET) is changing on May 15, 2021 for all members. Effective May 15, 2021, this medication will be removed from the formulary. Please reference the table 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 faxing 844-989-0154.
Impacted Medication |
Medication Change |
Preferred agents |
|---|---|---|
Metformin Hydrochloride ER Modified Release (GLUMETZA ®) |
Non-preferred after 5/15/21 |
|
Metformin Hydrochloride ER Osmotic (FORTAMET ®) |
Non-preferred after 5/15/21 |
|
Note: Active prior authorizations for this medication will not be affected.
If you have any questions, please call YouthCare Provider Services at 844-289-2264.