Medications Covered Under the Pharmacy Benefit Only
Defines pharmaceutical products that are covered exclusively under the pharmacy benefit (not the medical benefit) for Neighborhood Health Plan of Rhode Island commercial members, including prior authorization requirement and member notification when benefit changes.
Policy last reviewed 4/2021, 6/2022, 5/2023; lists Hemlibra as covered exclusively on the pharmacy benefit.
Coverage Summary
This policy defines that certain medications are covered exclusively through the pharmacy benefit rather than the medical benefit. Members and providers will receive a 60-day advance notification if the member obtained the medication under the medical benefit within the previous 180 days.
Pharmacy Benefit Exclusive Coverage
The following pharmaceutical products are covered and available exclusively on the Pharmacy Benefit:
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