Horizon Formulary Updates

See Below Horizon Brief Notes Regarding Formulary Updates

Applies to: Individual, Small Group and Midsize Fully Insured (Excluding Public Sector) and Level Funded Markets

Updates to the Prescription Drug Formularies for 2023

Horizon is continually looking for ways to help members achieve their best health while managing costs for your clients and their covered employees. That’s why Horizon Pharmacy is updating its formularies (drug lists) to make it clearer which medicines are on the formulary and which have a non-formulary status. This update will help drive utilization toward safe, effective and less-costly medicines.

Some Medicines Will Be Non-Formulary

Effective January 1, 2023, certain medicines will be moving to a non-formulary status. Covered employees and their covered dependents who are impacted by this change — as well as their doctors — have been notified via mail. An alternative is available for each medicine that moves to non-formulary status.

For reference, the 2023 Health Insurance Marketplace Formulary (used for individual and small group on- and off-exchange) and the 2023 Classic Drug Formulary (used for the 51+ midsize market) are posted online.

Medicines that are moving to a non-formulary status remain eligible for coverage under the members’ pharmacy benefits at the same level as formulary medicines, if medically necessary. Impacted members and their doctors have been notified as to which formulary alternatives are available.

Next Steps for Impacted Members
If a member’s doctor believes it is medically necessary to continue taking a non-formulary medicine, the doctor may submit a Formulary Exception form to Prime Therapeutics, Horizon’s pharmacy benefit manager. The Formulary Exception form will then be reviewed and a decision made.

If your clients’ covered employees have questions, need information about formulary alternatives or need help with requesting a formulary exception, they can call Pharmacy Member Services at 1-800-370-5088 24/7