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Preferred Drug List (PDL) Updates

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.

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 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 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	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.

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 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.

Dear Provider,

This is an important message from YouthCare HealthChoice Illinois (YouthCare).

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

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.

Sincerely,

YouthCare HealthChoice Illinois