Several changes to Medical Mutual members’ pharmacy benefits will be effective July 1, 2022. These changes are listed below.
Formulary Updates with Express Scripts
Formularies with Express Scripts are being updated effective July 1, 2022. These changes will have minimal impact on MMO groups and members. Medications on the lists below will change categories as noted (i.e., moving cost-share tiers, being excluded from coverage):
- National Preferred Formulary Exclusion List Changes
- National Preferred Formulary Exclusions (Full List)
- High Performance Plus Formulary Exclusion List Changes
Drug Surveillance Updates for Basic/Basic Plus Formulary
There are some medications which are excluded today under National Preferred and High Performance formularies which will now also be excluded under the Basic/Basic Plus Formulary through the Drug Surveillance program. A list of the changes can be found here. As a reminder, this program helps to save MMO groups money and ensure that members are on the right medication to treat their condition. Additional information on the Drug Surveillance program can be found in the Drug Surveillance flyer.
SaveOnSP Drug Lists Effective July 1, 2022, Now Available
Updated drug lists for the SaveOnSP program effective July 1, 2022, are now available. SaveOnSP now includes more than 200 specialty medicines filled through Accredo, Gentry, and University Hospitals. MetroHealth pharmacy is also able to file SaveOnSP claims for CLE-Care groups. As a reminder, the SaveOnSP Exclusive list is for Fully Insured Major Medical groups and features a narrowed and more targeted list of drugs that have very large amounts of manufacturer assistance.
- MedMutual 2022 SaveOnSP National Preferred Formulary Standard Drug List
- MedMutual 2022 SaveOnSP National Preferred Formulary Public Entity Drug List
- MedMutual 2022 SaveOnSP Basic Plus Formulary Public Entity Drug List
- MedMutual 2022 SaveOnSP Basic Plus Formulary Standard Drug List
- MedMutual 2022 SaveOnSP Exclusive Drug List for Fully Insured Major Med
Contact your Cornerstone representative with any questions.