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Preferred Drug List (PDL) Updates

Youth Care Health Choice Illinois logo

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 10/01/2023, for all members. Please reference the table for information regarding medication changes.

Impacted Medication

Change

Preferred Agents

AUVI-Q (Auto-Injector)

 

PREFERRED

 

NA

ORSERDU (Tabs)

 

PREFERRED

 

NA

ENDARI (Pack)

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.

Youth Care Health Choice Illinois logo

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.

Youth Care Health Choice Illinois logo

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.

Youth Care Health Choice Illinois logo

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.

Youth Care Health Choice Illinois logo

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.

Youth Care Health Choice Illinois logo

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.

Youth Care Health Choice Illinois logo

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.

Youth Care Health Choice Illinois logo

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.

Youth Care Health Choice Illinois logo

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.

Youth Care Health Choice Illinois logo

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

DAYTRANANon Preferred after 10/1/22NA

 

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.

Youth Care Health Choice Illinois logo

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.

Youth Care Health Choice Illinois logo

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.

Youth Care Health Choice Illinois logo

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.

Youth Care Health Choice Illinois logo

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.

Youth Care Health Choice Illinois logo

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 hcl er 500 mg tablet
  • Metformin hcl er 750 mg tablet
  • Metformin hcl 1,000 mg tablet
  • Metformin hcl 500 mg tablet
  • Metformin hcl 850 mg tablet

Metformin Hydrochloride ER Osmotic (FORTAMET ®)

Non-preferred after 5/15/21

  • Metformin hcl er 500 mg tablet
  • Metformin hcl er 750 mg tablet
  • Metformin hcl 1,000 mg tablet
  • Metformin hcl 500 mg tablet
  • Metformin hcl 850 mg tablet

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.