CurrentColorado Rocky Mountain Health PlansPolicy N/A

Temporary coverage of alternative medications during drug shortages

Temporarily adds therapeutic equivalents and alternative drugs to Prescription Drug Lists (PDLs) for all plans to address FDA/ASHP-recognized medication shortages; affects members covered by Colorado Rocky Mountain Health Plans and related UnitedHealthcare affiliates.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicyTemporary coverage of alternative medications during drug shortages

Policy CodePolicy N/A

Change TypeAdded temporary coverage for listed alternatives

Effective DateVaries by drug (see policy)

Next Review DateN/A

Key ActionDo not submit prior authorization or step therapy requirements for the listed alternative medications while shortages persist.

SourceLink

POLICY UPDATE CHANGES

Temporary coverage of specified therapeutic equivalent and alternative medications during drug shortages was added to PDLs for all plans.

Coverage will be reevaluated and members notified when shortages are no longer in effect.

No PA or step therapyNo PA or step therapy

7Drugs listed

YesEffective dates included

Temporary Coverage Criteria for Alternative Medications

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Temporary alternative medication coverage

Covered when ALL of the following are met

Policy conditions: The listed alternative or therapeutic equivalent is for a medication currently identified as in shortage by FDA or ASHP; the alternative is one of the medications named in the policy; coverage is temporary and tied to the shortage status.

No prior authorization or step therapy required while shortage is in effect.

No explicit exclusions are listed for the temporary coverage of therapeutic equivalents and alternative medications included in this notice. The source document does not identify any drugs, member groups, or clinical situations that are excluded from the temporary coverage changes.

There are no not medically necessary statements specified in this policy. The document does not list any conditions or uses for which the temporarily covered alternatives are considered not medically necessary.

Provider Action & Authorization Rules

Prior Authorization

Prior Authorization Waived

Prior authorization will not be required for the listed alternative medications during the declared shortages. We will reevaluate coverage and notify providers when shortages end. Shortages are identified per FDA (fda.gov/drugshortages) and ASHP (ashp.org/drugshortages).

Affected alternatives temporarily covered: Vyvanse (lisdexamfetamine dimesylate) — effective January 1, 2024
Concerta® (methylphenidate ER osmotic release) — effective September 1, 2024
Gastrocrom® (cromolyn sodium liquid) — effective April 3, 2024
Tamiflu (oseltamivir) — effective February 4, 2026
Estradiol patches (Climara, Minivelle, Vivelle-Dot) — effective March 12, 2026

Step Therapy

Step Therapy Waived

Step therapy will not be required for the listed alternative medications during the declared shortages. Prescribers should document clinical rationale in the record as usual; no additional documentation beyond standard medical record notes is required for these temporary overrides.

Same affected alternatives as listed under Prior Authorization Waived

Documentation Required

Documentation

No additional documentation requirements are specified beyond routine medical record documentation. Providers should retain usual prescribing documentation in the patient record; the plan may review records as part of routine claims audit activity.

Denial Risk

Denial Triggers

There are no specified denial triggers for these alternative medications while the shortages persist; prior authorization and step therapy requirements are waived for the listed alternatives until reevaluation.

Policy Background and Rationale

This policy temporarily expands coverage for specified therapeutic equivalents and alternative medications in response to recognized medication shortages identified by the U.S. Food and Drug Administration and the American Society of Health-System Pharmacists. Coverage for the named alternatives is effective on the dates listed in the notice and will remain in effect for the duration of the shortage; the policy states that coverage will be reevaluated and members notified when shortages are no longer in effect. During the shortage period, prior authorization and step therapy will not be required for the listed alternatives.

Key Definitions

Medication shortages — definition

DefinitionDrug shortages referenced are those listed by the U.S. Food and Drug Administration (fda.gov/drugshortages) and the American Society of Health-System Pharmacists (ashp.org/drugshortages).

ScopeThis definition applies to medications identified as in shortage by FDA or ASHP for the purposes of temporary coverage of therapeutic equivalents and alternatives.

Source sitesU.S. Food and Drug Administration drug shortages webpage; American Society of Health‑System Pharmacists drug shortages webpage.

Policy implicationMedications must be listed as in shortage on FDA or ASHP shortage lists to trigger the temporary coverage provisions in this policy.

Initial Coverage for Temporary Alternatives

Initial coverage for alternatives

Initial coverage rules for temporary alternatives

Initial coverage: The listed alternative is covered effective on the specified date and during the declared shortage; no prior authorization or step therapy required.

Coverage will be reevaluated and members notified when the shortage is no longer in effect.

Step therapy requirement	Details
Step therapy waived	Step therapy is not required for the listed alternative medications during the declared shortages. The policy states that prior authorization and step therapy will not be required for these alternative medications; coverage will be reevaluated and members notified when shortages are no longer in effect.