We are thrilled to be working with you throughout the 2024 Annual Enrollment period. We highly value the collaborative relationship we have invested in and built together.
We want to keep you fully informed and ensure that our partnership remains transparent and effective.
In this regard, we have an important update to be aware of as we begin AEP.
AEP Drug Pricing Tool & Prescription Drug List
The 2024 drug pricing tool is now available; however, more updates will occur to fix existing coverage inaccuracies. The current drug pricing tool requires ADDITONAL steps to validate accurate coverage.
At this time when using the tool, coverage results do not accurately reflect those drugs needing utilization management (prior authorization, step therapy or quantity limit), drugs excluded by Medicare but covered under our enhanced benefit, and drugs not covered under our formulary.
The grid below shows what is currently accurate and what needs to be updated.
| Drug Category | Prescription Drug List: Drug Status |
Drug Pricing Tool: Coverage Status |
Drug Pricing Tool: Drug Pricing |
| Formulary: drug is covered [no UM* requirement(s)] |
Formulary (Tier level) | Formulary | Pricing is available |
| Formulary: drug is covered [w/UM* requirement(s)] |
Formulary (Tier level) and UM requirements detailed |
Not Covered | Pricing is not available |
| Enhanced covered drug | Formulary | Not Covered | Pricing is not available |
| Non-Formulary: drug is not covered | Non-Formulary | Covered | Pricing is available |
- Accurate information
- Inaccurate information
- *Utilization Management: Prior Authorization, Step Therapy and/or Quantity
To see a plan’s accurate drug coverage, please click here for a step-by-step tutorial on how you can still validate and utilize the search.
We continue to work with OptumRX, our PBM, to fix this issue and improve the overall drug lookup process for you and your clients. We will notify you as updates occur.
Please reach out to Medicare Broker Support or your Broker Manager with any questions or issues.