Pancreatic Enzyme Replacement Drugs Reclassified as of Jan. 1, 2023
Effective Jan. 1, 2023, pancreatic enzyme replacement medications (i.e., Creon, ZenPep, Viokace, Pancreaze, and Pertzye) will be reclassified as medications dispensed through U-M's specialty pharmacy. These medications require special storage and handling, have special administration requirements, necessitate close monitoring, and/or are high cost.
Please note: Copays and prior authorizations will stay the same.
- Michigan residents: This change will require the use of the Michigan Medicine Specialty Pharmacy for future fills.
- Non-Michigan residents: This change will require the use of Magellan Rx Specialty Pharmacy or Birdi for future fills. Each of these pharmacies offers free shipping.
These medications are limited to a maximum 34-day supply per fill.
Weight Loss GLP-1 Coverage Tier Update (effective March 1, 2023)
Effective March 1, 2023, GLP-1 weight loss medications (i.e., Wegovy and Saxenda), will be considered non-preferred brand (tier 3) medications, and require a higher member copay.
If you are interested in using a similar formulary product with a lower copay, please discuss the preferred alternative product(s) listed below with your doctor or pharmacist.
Similar products may include:
- Phentermine tablets – generic (tier 1), lowest copay
- Bupropion-naltrexone oral tablets (Contrave) – preferred brand (tier 2), lower copay
- Phentermine-topiramate oral capsules (Qsymia) – preferred brand (tier 2), lower copay
Updated 11/14/22
Diabetes, Cancer Drug Changes to Formulary
Effective Jan. 1, 2023, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.
- Basaglar will become non-formulary.
- Branded Lantus, Semglee YFGN, and Tresiba will be excluded from coverage.
** Please note: Generic insulin Glargine, insulin Glargine YFGN, and insulin Degludec will be available with no member copay.
- Levemir will move to Tier 3.
- Granix will move to Tier 3.
Updated 9/12/22
COVID-19 Rapid Tests Covered Through Prescription Drug Plan
Per federal mandate, faculty and staff may receive up to eight OTC rapid antigen COVID-19 tests every 30 days at retail pharmacies. The mandate specifies that consumers are to receive these tests at no charge.
Most pharmacies are complying with the mandate. However, if you plan to use a new or unfamiliar pharmacy, call ahead. Ask whether the pharmacy is processing these claims using your Prescription Plan Drug card at the time of purchase (resulting in no copay), or if it will charge you at the point of purchase. If you are charged, you may seek reimbursement by filing a claim to Magellan Rx.
Updated 6/10/22
Jan. 19, 2022: Some of the information below has changed since first publication. As the federal mandate for health insurers to cover the cost of rapid antigen COVID-19 tests is implemented nationwide, different pharmacies are reimburing in different ways. U-M Benefits is working diligently with its pharmacy benefit manager, Magellan Rx, and its network pharmacies to standardize this benefit.
At-Home COVID 19 Tests Covered by Health Plans
As of Jan. 15, 2022, U-M’s Prescription Drug Plan covers FDA-approved rapid antigen COVID-19 tests at retail pharmacies. This is part of a federal mandate to fight the nationwide surge of omicron-related infections.
Each member is eligible for up to eight tests every 30 days, per covered individual for the duration of the mandate.
The federal mandate requires pharmacies to cover the tests at no cost to the member or dependents. As members have purchased tests, however, different pharmacies are processing the benefit in different ways.
Call your pharmacy before you make the trip to find out how it's processing the benefit. You'll know what to expect when you get there.
Steps for Reimbursement
Purchase at the pharmacy, in person
- Show your prescription drug card at the pharmacy counter.
- You may be told that you must pay for the tests, then file for reimbursement. Or, your card may be accepted as payment. Members report different experiences at different pharmacies.
- If you paid when you purchased the tests, save the original receipt, fill out a prescription drug claim form, then send both to Magellan Rx.
Purchase online
- Pay for the purchase at the time of order.
- Save your original receipt, fill out a prescription drug claim form, then send both to Magellan Rx.
- Tests purchased secondhand from resellers are not covered.
For more details, visit the COVID-19 Information for Employees page.
View more details and frequently asked questions under "Rapid COVID-19 Test Reimbursement."
Updated 11/8/21
Check this page frequently for the latest information regarding the Prescription Drug Plan formulary, changes to coverage policies, and other relevant news for plan members.
Drug Recalls
The University of Michigan's Prescription Drug Plan will keep members up-to-date with important information regarding drug recalls. Members potentially impacted by a drug recall related to a medication's safety or efficacy may receive a letter from Magellan Rx with information about the recall, and what they should do for next steps. For more information on recent drug recalls, visit Magellan Rx's website or visit the FDA’s website.
COVID-19 Vaccine Updates
The COVID-19 vaccine is a covered pharmacy-administered vaccine. U-M’s benefits plans cover approved vaccinations under both your pharmacy through the U-M Prescription Drug Plan and through your U-M health plan. Approved vaccines require no co-pay on your part. When receiving your vaccine at a pharmacy, provide either your medical or drug plan ID card. To avoid confusion, don't use both cards at the same time. Learn about COVID-19 vaccine eligibility and availability.
Pharmacy Benefits and Advisory Committee (PBAC) Updates
The Pharmacy Benefits and Advisory Committee (PBAC), consisting of clinical subject matter experts within Michigan Medicine and the University of Michigan, meets regularly to review and approve changes to the Prescription Drug Plan formulary. Check the formulary for up to date formulary status. Formulary status is subject to change. Here are the latest updates.
February 2023
Effective Feb. 1, 2023, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.
New Drug Products and Biosimilars Added to Formulary
- Adagrasib 200 mg tablets (Krazati) – Tier 2, PA, QL, split fill
December 2022
Effective Dec. 1, 2022, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.
New Drug Products and Biosimilars Added to Formulary
- Dextroamphetamine 4.5, 9, 13.5, 18 mg/9-hour patch (Xelstrym) – Tier 3, PA, QL
- Dextromethorphan-bupropion 45-105 mg tablet (Auvelity) – non-formulary, QL
- Futibatinib 4 mg tablet (Lytgobi) – Tier 2, specialty, PA, QL
- Pegfilgrastim-pbbk 6 mg/0.6 mL syringe (Fylnetra) – Tier 2, specialty, QL
- Furosemide 80 mg/10 mL subcutaneous injection on-body kit (Furoscix) – Tier 3, LDD, PA, QL
New Generics Added to Formulary
- Roflumilast 250 and 500 mcg tablet (generic for Daliresp)
November 2022
New Drug Products and Biosimilars Added to Formulary
Effective Nov. 1, 2022, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.
- Deucravacitinib 6 mg tablet (Sotyktu) – Tier 3, specialty, PA, QL
- Edaravone oral suspension (Radicava ORS) – Tier 2, LDD, PA, QL
- Ibrutinib 70 mg/mL oral suspension (Imbruvica) – Tier 2, specialty, PA, QL
- Lumacaftor-ivacaftor 75-94 mg granule packet (Orkambi) – Tier 2, specialty, PA, QL
- Tadalafil 20 mg/5 mL oral suspension (Tadliq) – Tier 3, specialty, PA, QL
- Clindamycin phosphate 2% vaginal gel (Xaciato) – non-formulary, QL
New Generics Added to Formulary
- Fingolimod 0.5 mg capsule (generic for Gilenya)
- Orlistat 120 mg capsule (generic for Xenical)
- Icosapent ethyl 500 mg capsule (generic for Vascepa)
- Timolol maleate 0.25% PF eye drop (generic for Timoptic Ocudose)
- Tazarotene 0.05% and 0.1% gel (generic for Tazorac)
- Estradiol 0.1% (0.25 mg), (0.5 mg), (0.75 mg), (1 mg) and (1.25 mg) gel packet (generic for Divigel)
October 2022
New Drug Products Added to Formulary
Effective Oct. 1, the following changes will be made to the Prescription Drug Plan's formulary. Review the formulary.
- Oteseconazole 150 mg capsules (Vivjoa) – Tier 3, PA, QL
- Sirolimus 0.2% gel (Hyftor) – Tier 2, LDD, PA, QL
- Roflumilast 0.3% cream (Zoryve) – Tier 3, specialty, PA, QL
- Filgrastim-ayow (Releuko) – Tier 2, specialty, QL
- Tenapanor 50 mg tablets (Ibsrela) – Tier 3, PA, QL (2 per day)
New Generics Added to Formulary
- Sodium sulfate-potassium sulfate-magnesium sulfate solution (generic for Suprep)
- Lenalidomide 2.5 mg and 20 mg capsule (generic for Revlimid)
August 2022
New Drug Products Added to Formulary
Effective Aug. 1, 2022, the following changes will be made to the Prescription Drug Plan's formulary. Review the formulary.
- Tirzepatide injection (Mounjaro) – Tier 3, ST, QL, AL (≥ 18 years)
- Tapinarof 1% cream (Vtama) – Tier 3, specialty, PA, QL
- Ranolazine ER 500 mg and 1,000 mg granule packet (Aspruzyo sprinkle) – Tier 3, AL (≤ 10 years), QL
- Treprostinil 16 mcg, 32 mcg, 48 mcg, and 64 mcg dry powder inhaler (Tyvaso DPI) – Tier 3, LDD, PA, QL
- Measles, mumps and rubella vaccine live/pf (Priorix) – Tier 0, QL
New Generics and Biosimilars Added to Formulary
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Dabigatran 75 mg and 100 mg capsule (generic for Pradaxa)
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Vilazodone 10 mg, 20 mg, 40 mg tablet (generic for Viibryd)
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Lacosamide 10 mg/mL solution (generic for Vimpat)
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Bexarotene 1% gel (generic for Targretin)
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Mesalamine ER 500 mg capsule (generic for Pentasa)
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Sorafenib 200 mg tablet (generic for Nexavar)
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Methylphenidate 10 mg, 15 mg, 20 mg, and 30 mg/9-hour patch (generic for Daytrana)
June 2022
New Drug Products Added to Formulary
Effective June 1, 2022, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.
- Ganaxolone (Ztalmy) – Tier 2, LDD, PA, QL
- Mavacamten (Camzyos) – Tier 3, specialty, PA, QL
- Testosterone undecanoate 112.5 mg capsules (Tlando) Tier 3, PA, QL
- Amlodipine besylate 1 mg/mL oral solution (Norliqva) – Tier 3, AL
New Generics and Biosimilars Added to Formulary
May 2022
New Drug Products Added to Formulary
Effective May 2, 2022, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.
- Daridorexant (Quviviq) – Tier 3, ST, QL, age limit (age ≥ 18 years)
- Pacritinib (Vonjo) – Tier 2, Specialty, PA, QL, split fill
- Mitapivat (Pyrukynd) – Tier 2, LDD, PA, QL
- Semaglutide 8 mg/3 ml pens (Ozempic) – Tier 2, ST, QL, age limit (age ≥ 18 years)
- Upadacitinib 45 mg tablets (Rinvoq) – Tier 2, Specialty, PA, QL
- Siponimod 1 mg (Mayzent) – Tier 2, QL, Specialty
- Tenofovir alafenamide/Emtricitabine 120-15 mg tablet (Descovy) – Tier 2, Specialty/HIV, PA, QL
- Naloxone 5 mg/0.5 ml syringe (Zimhi) – Tier 3, QL
New Generics and Biosimilars Added to Formulary
- Digoxin 62.5 mcg tablet (generic for Lanoxin)
- Lenalidomide 5, 10, 15, 25 mg capsule (generic for Revlimid)
- Diclofenac potassium 25 mg capsule (generic for Zipsor)
- Lacosamide 50, 100, 150, 200 mg tablet (generic for Vimpat)
- Baclofen 5 mg/5 mL oral solution (generic for Ozobax)
March 2022
New Drug Products Added to Formulary
Effective March 1, 2022, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.
New Generics and Biosimilars Added to Formulary
February 2022
New Drug Products Added to Formulary
Effective Feb. 1, 2022, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.
New Generics and Biosimilars Added to Formulary
-
Glycopyrrolate 1 mg/5 ml solution (generic for Cuvposa)
-
Naloxone hydrochloride 4 mg nasal spray (generic for Narcan)
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Norethindrone-ethinyl estradiol 1-35 28 tablet (generic for Nylia)
January 2022
New Drug Products Added to Formulary
Effective Jan. 1, 2022, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.
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Varenicline Tartrate nasal spray (Tyrvaya) – Tier 2, PA, QL
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Odevixibat (Bylvay) – Tier 2, LDD, PA
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Maralixibat (Livmarli) – Tier 2, LDD, PA
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Belzutifan (Welireg) – Tier 2, LDD, PA, QL
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Asciminib (Scemblix) – Tier 2, PA, QL
New Generics and Biosimilars Added to Formulary
- Glycopyrrolate 1 mg/5 ml solution (generic for Cuvposa)
- Naloxone hydrochloride 4 mg nasal spray (generic for Narcan)
- Norethindrone-ethinyl estradiol 1-35 28 tablet (generic for Nylia)