Oxford Health has just announced changes to their PDL for small groups in NY, NJ, and CT beginning January 1st, 2013. The big change this quarter involves Lipitor coverage, which will only affect NY and CT groups at this time.

We have confirmed that Lipitor may be obtained through prior authorization for NY & CT groups. Physicians will need to prove medical necessity before dispensing this particular medication as opposed to others (similar to the previous Nexium changes). This process is ONLY for the Oxford platform. Under the UHC platform, Lipitor is totally excluded for fully insured groups.

Attached below are two pieces from Oxford detailing the upcoming changes to their PDL:

Oxford – Updates to your prescription benefits Effective Jan 1 2013
Oxford Advantage PDL and Benefit Plan Updates Summary

Remember, the generic equivalent of Lipitor (atorvastatin) is now available and covered by Oxford.