Posted in In The Know Series, Insurance, Updates

UnitedHealthCare Commercial Plans: Pharmacy coverage for Taltz and Siliq coverage for 2020.

Pharmacy Benefit change for UnitedHealthCare Commercial Plans– starting 01/01/2020-biologics Taltz and Siliq will no longer be COVERED (where state law allows) , for the UnitedHealthCare Commercial Plans.

The other preferred/covered biologics are:









*Please check out the pharmacy criteria for the coverage of these above mentioned biologics.


** The pharmacy WILL NOT automatically substitute Taltz or Siliq for the covered medications. Provider will need to write a NEW prescription and send it over to the pharmacy (to help reduce the out of pocket cost, for the patients).

Posted in In The Know Series, Insurance, Training

UHC Commercial and Oxford updated policy for Eucrisa® (crisaborole)

Eucrisa® (crisaborole) coverage has gone through changes in the past 2 years.

In this episode we will cover only the coverage for UHC Commercial + Oxford policies

Things to take in consideration:

  1. Eucrisa® (crisaborole) is part of Pharmacy Benefit for UHC Commercial + Oxford policies.
  2.  It is a Step Therapy
  3. Policy was created in 07/2017 and Updated with no changes on 07/2018
  4. Effective Date is 10/01/2018
  5. Authorization is given for 12 months
  6. If the patient had samples of Eucrisa prior to the provider initiating Prior approval, that patient still needs to meet the Step Therapy requirement

Please look below for reference:




Posted in Insurance

Exchange plan buyers beware…

Recently, I had the pleasure of meeting and with a Merk rep, Gina. I always get plenty of reps during my time @ Dr. Celina John’s Office. The visit is usually involves the doctor and the rep. However this time both her and I struck a coversation about medication coverage and pharmacies.

Although, I personally do not have this problem with pharmacies I found out from Gina that she was a victim of a pharmacy charging her a $120 copay for a medication (generic)?!

She, just like many other thousands of people has an exchange medical plan and until recently she thought that she would have no problem of using her local pharmacy for her medications. But to her suprise, she paid a whoping $120 copay for a medication that she thought had no copay at all. Why this happened? Well, it’s because that particular pharmacy was OON (out of network) with the particular exhange medical plan that she acquiered. What?! I personally do not know any doctor office that takes a copy of your pharmacy card. I always ask the patient for their pharmacy information-for escripts purposes.

In the end the moral of the story is that anyone that has an exchange medical plan please call the pharmacy number on your card and find out if a particular pharmacy you are going to use is INN (in network/ participates) with your plan. This way you will avoid those costly $120 copays, like Gina had to pay, and obtain your medication for low or no copay.