Provider Bulletin

May 2025



In this bulletin, we’ll share important Pharmacy updates, including medications added to our Site of Care Program and July 1, 2025 changes to non-preferred medications and formulary exclusions. 

Medications Added to the Site of Care Program  

We are pleased to expand our Site of Care program with 47 new medications. Click here to view the new additions.

Non-Preferred Medications

Effective July 1, 2025, step therapy requirements for medical benefits will expand. Members using medications that are no longer preferred or are removed from the formulary will receive at least 60 days' advance notice. Please note that some products may be preferred in one drug class but non-preferred in another, and vice versa. 

Non-Preferred as of 7/1/2025

Medications that are subject to voluntary Site of Care transition are denoted with an asterisk (*).

Medication Exclusions 

Effective July 1, 2025, several drug classes have new exclusions. If there is a clinical reason, identified by your doctor, that requires you to continue taking your current medication your doctor can request a coverage review. Please note this is not an all-inclusive list of exclusions. For a complete listing of exclusions, click here. 

Single-Source Brand & Generic Medication Exclusions as of July 1, 2025

The following drug classes have new exclusions for July 1, 2025. Bolded excluded medications are new for July 1, 2025.

Multi-Source Brand Exclusions as of July 1, 2025

The generic equivalents of the following brand-name medications are covered on the National Preferred Formulary. FDA-approved generic medications meet strict standards and contain the same active ingredients as their corresponding brand-name medications, although they may have a different appearance.

LIVALO                                TACLONEX

SPRYCEL                            TYKERB

Additional Medication Changes

Excluded to Preferred as of July 1, 2025

ARALAST NP                    GLASSIA

Non-Preferred to Preferred as of July 1, 2025

PREGNYL

Effective July 1, 2025, Stelara (ustekinumab) will be non-preferred.

Preferred Products

SELARSDI (ustekinumab-aekn)

USTEKINUMAB-TTWE

YESINTEK (ustekinumab-kfce)

Resources  

Explore our new website and provider resources

If you have any questions

please email:

provider@healthoptions.org