Utilization Management (UM) Changes – Effective January 1, 2023

Notices of prior authorization, quantity limits and step therapy changes

Notice:

Certain states require Optum Rx to communicate prior authorization changes before the effective date. The following January 1, 2023 flyers are sent to members to outline the drugs affected by prior authorization, quantity limits, and step therapy based on benefit plan designs. Please review each document for more details.

Please note: these changes may not reflect final P&T Committee determinations. These changes are specific to prescription drug benefits only, and do not reflect changes that may occur at the health plan level. Prescribers are strongly encouraged to check with the health plan for other changes that may occur.

combined formulary change flyers - effective JANUARY 1, 2023

• Utilization Management (UM) Program Requirements  [Download]

Premium, select, and premium value formulary um drug lists - effective January 1, 2023

• Premium Prior Authorization [Download]
  
• Premium Quantity Limit [Download]
  
• Premium Step Therapy [Download]
  
• Select Prior Authorization [Download]
• Select Quantity Limit [Download]
• Select Step Therapy [Download]
  
• Premium Value Prior Authorization [Download] 
  
• Premium Value Quantity Limit [Download]
  
• Premium Value Step Therapy [Download]