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OAR Submits Letter to the Department of Medicaid on Formulary Driven Switches

posted: December 2, 2019

Coverage changes have occurred under Paramount plans due to the way Paramount is now managing their pharmacy benefits. Magellan Rx Management, a pharmacy benefit manager (PBM), is under contract with Paramount to manage their prescription drug formulary. As a result of this contractual arrangement, two infusion treatments for rheumatic diseases, Remicade and Inflectra, have been removed from coverage for beneficiaries under the Medicaid plan; as well as for those with commercial and Medicare plans.

While Paramount is allowing temporary coverage for patients on Remicade and Inflectra who were previously authorized for treatments prior to April 1, 2019, after the authorization period for those treatments expire or exceed one-year, coverage will then cease.  Patients will be forced to switch to the new preferred biosimilar, Renflexis, unless they have failed on this treatment before.

In October, OAR submitted a letter to the Department of Medicaid expressing opposition to the forced medication switch.

View the Letter