Preferred Drug List (PDL) Updates

This is an update to the YouthCare HealthChoice Illinois (YouthCare) Preferred Drug List..

Coverage of the medications listed below has changed, effective November 1, 2024, for all members. Please reference the table for changes.

Note: Active prior authorizations for the medication(s) listed will not be affected.

For questions, please call YouthCare Provider Services at 844-289-2264.

Impacted Medication	Change	Preferred Agents or New Limits
ENDARI POW 5GM	Coverage	Preferred
VICTOZA INJ 18MG/3ML	Coverage	Preferred
LIRAGLUTIDE INJ 18MG/3ML	Coverage	Preferred
MYRBETRIQ TAB 25MG and 50 mg	Coverage	Non-preferred
MIRABEGRON TAB 25MG ER and 50 MG ER	Coverage	Preferred
MYRBETRIQ SUS 8MG/ML	Coverage	Non-preferred
EMFLAZA TAB 6MG, 18 MG, 30 MG, 36 MG	Coverage	Non-preferred
DEFLAZACORT TAB 6MG, 18 MG, 30 MG, 36 MG	Coverage	Non-preferred
EMFLAZA SUS 22.75/ML	Coverage	Non-preferred
DEFLAZACORT SUS 22.75MG	Coverage	Non-preferred

This is an update to the YouthCare HealthChoice Illinois (YouthCare) Preferred Drug List..

Coverage of the medications listed below has changed, effective February 1, 2025, for all members. Please reference the table for changes.

Note: Active prior authorizations for the medication(s) listed will not be affected.

For questions, please call YouthCare Provider Services at 844-289-2264.

Impacted Medication	Change	Preferred Agents or New Limits
L-GLUTAMINE POW 5GM	Coverage	Non-preferred

This is an update to the YouthCare HealthChoice Illinois (YouthCare) Preferred Drug List.

Coverage of the medications listed below has changed, effective December 1, 2024, for all members. Please reference the table for changes.

Note: Active prior authorizations for the medication(s) listed will not be affected.

If you have any questions, please call the pharmacy help desk at 844-289-2264.

Impacted Medication	Change	Preferred Agents or New Limits
AMLADEX TAB	Coverage Change	Removed from Preferred Drug list

This is an update to the YouthCare HealthChoice Illinois (YouthCare) Preferred Drug List.

Coverage of the medications listed below has changed, effective December 1, 2024, for all members. Please reference the table for changes.

Note: Active prior authorizations for the medication(s) listed will not be affected.

If you have any questions, please call the pharmacy help desk at 844-289-2264.

Impacted Medication	Change	Preferred Agents or New Limits
DERMACINRX FOLIFLEX CAPLET	Coverage Change	Removed from Preferred Drug list
DERMACINRX VITRAMYN CAPLET	Coverage Change	Removed from Preferred Drug list
DERMACINRX VITRANOL CAPLET	Coverage Change	Removed from Preferred Drug list
DERMACINRX VITREXATE CAPLET	Coverage Change	Removed from Preferred Drug list
DEKAS PLUS SOFTGEL	Coverage Change	Removed from Preferred Drug list
All Multivitamins and Vitamins	New Limits	Vitamins are limited to $300 per claim Multivitamins are limited to $450 per claim

This is an update to the YouthCare HealthChoice Illinois (YouthCare) Preferred Drug List.

Coverage of the medications listed below will change, effective August 1, 2024, for all members. Please reference the table for changes.

Note: Active prior authorizations for the medication(s) listed will not be affected.

For questions, please call YouthCare Provider Services at 844-289-2264.

Impacted Medication	Change	Preferred Agents or New Limits
Trulicity	Coverage Change	Preferred with Diabetes Diagnosis; all other diagnosis submit Prior Authorization
Victoza	Coverage Change	Preferred with Diabetes Diagnosis; all other diagnosis submit Prior Authorization

This is an update to the YouthCare HealthChoice Illinois (YouthCare) Preferred Drug List.

Coverage of the medications listed below will change, effective September 17, 2024, for all members. Please reference the table for changes.

Note: Active prior authorizations for the medication(s) listed will not be affected.

For questions, please call YouthCare Provider Services at 844-289-2264

Impacted Medication	Change	New Limit
Trulicity Soln Pen-injector 0.75 MG/0.5ML Trulicity Soln Pen-injector 1.5 MG/0.5ML Trulicity Soln Pen-injector 3 MG/0.5ML Trulicity Soln Pen-injector 4.5 MG/0.5ML Byetta Soln Pen-injector 5 MCG/0.02ML Byetta Soln Pen-injector 10 MCG/0.04ML Bydureon Extended Release Susp Auto-Injector 2 MG/0.85ML Victoza Soln Pen-injector 18 MG/3ML (6 MG/ML) Adlyxin Soln Pen-injector 20 MCG/0.2ML (100 MCG/ML) Adlyxin Pen-inj Starter Kit 10 MCG/0.2ML & 20 MCG/0.2ML Rybelsus Tab 3 MG Rybelsus Tab 7 MG Rybelsus Tab 14 MG Ozempic Soln Pen-inj 0.25 or 0.5 MG/DOSE (2 MG/1.5ML) Ozempic Soln Pen-inj 1 MG/DOSE (2 MG/1.5ML) Ozempic Soln Pen-inj 0.25 or 0.5 MG/DOSE (2 MG/3ML) Ozempic Soln Pen-inj 1 MG/DOSE (4 MG/3ML) Ozempic Soln Pen-inj 2 MG/DOSE (8 MG/3ML) Mounjaro Soln Pen-injector 2.5 MG/0.5ML Mounjaro Soln Pen-injector 5 MG/0.5ML Mounjaro Soln Pen-injector 7.5 MG/0.5ML Mounjaro Soln Pen-injector 10 MG/0.5ML Mounjaro Soln Pen-injector 12.5 MG/0.5ML Mounjaro Soln Pen-injector 15 MG/0.5ML Saxenda (Weight Management) Soln Pen-Injector 6 MG/ML Wegovy (Weight Mngmt) Soln Auto-Injector 0.25 MG/0.5ML Wegovy (Weight Mngmt) Soln Auto-Injector 0.5 MG/0.5ML Wegovy (Weight Mngmt) Soln Auto-Injector 1 MG/0.5ML Wegovy (Weight Mngmt) Soln Auto-Injector 1.7 MG/0.75ML Wegovy (Weight Mngmt) Soln Auto-Injector 2.4 MG/0.75ML Zepbound (Weight Mngmt) Soln Auto-Injector 2.5 MG/0.5ML Zepbound (Weight Mngmt) Soln Auto-Injector 5 MG/0.5ML Zepbound (Weight Mngmt) Soln Auto-Injector 7.5 MG/0.5ML Zepbound (Weight Mngmt) Soln Auto-Injector 10 MG/0.5ML Zepbound (Weight Mngmt) Soln Auto-Injector 12.5 MG/0.5ML Zepbound (Weight Mngmt) Soln Auto-Injector 15 MG/0.5ML	New limits	Restricted to one medication (GLP-1 receptor agonists) per month

This is an update to the YouthCare HealthChoice Illinois (YouthCare) Preferred Drug List.

Coverage of the medications listed below will change, effective August 15, 2024, for all members. Please reference the table for changes.

Note: Active prior authorizations for the medication(s) listed will not be affected.

For questions, please call YouthCare Provider Services at 844-289-2264.

Impacted Medication	Change	New Limit
Wellfola	New Status	Non-preferred

To our provider partners in healthcare,

This is an essential message from YouthCare HealthChoice Illinois (YouthCare).

Coverage of the medications listed below will change, effective August 1, 2024. For questions, please call YouthCare Provider Services at 844-289-2264.

Impacted Medication	Change	New Limit
GENICIN VITA-Q	New Status	Non-preferred
FOLIKA-MG	New Status	Non-preferred
TM-DAILY	New Status	Non-preferred
STROVITE ONE	New Status	Non-preferred
MVW Complete	New Status	Non-preferred
STROVITE FORTE	New Status	Non-preferred

To our provider partners in healthcare,

This is an essential message from YouthCare HealthChoice Illinois (YouthCare).

Coverage of the medications listed below will change, effective August 1, 2024. For questions, please call YouthCare Provider Services at 844-289-2264.

Impacted Medication	Change	New Limit
TWIST TOP LANCETS 30G	New Status	Non-Preferred
NOVA SAFETY LANCETS 28G	New Status	Non-Preferred
NOVA SAFETY LANCETS 23G	New Status	Non-Preferred
LANCETS 30G TWIST TOP	New Status	Non-Preferred
ULTILET SAFETY LANCETS 21G X 2.2MM	New Status	Non-Preferred
ULTILET LANCETS 33G	New Status	Non-Preferred
SMARTEST LANCETS 28G	New Status	Non-Preferred
HAEMOLANCE	New Status	Non-Preferred
HAEMOLANCE LOW FLOW LANCETS	New Status	Non-Preferred
ASSURE HAEMOLANCE PLUS PEDIATRIC BLADE	New Status	Non-Preferred
ASSURE HAEMOLANCE PLUS HIGH FLOW 18G	New Status	Non-Preferred
ASSURE HAEMOLANCE PLUS NORMAL FLOW 21G	New Status	Non-Preferred
ASSURE HAEMOLANCE PLUS LOW FLOW 25G	New Status	Non-Preferred
ASSURE HAEMOLANCE PLUS MICRO FLOW 28G	New Status	Non-Preferred
HAEMOLANCE PLUS	New Status	Non-Preferred
HAEMOLANCE PLUS PEDIATRIC FLOW	New Status	Non-Preferred
HAEMOLANCE PLUS MAX FLOW	New Status	Non-Preferred
HAEMOLANCE PLUS	New Status	Non-Preferred
HAEMOLANCE PLUS HIGH FLOW	New Status	Non-Preferred
HAEMOLANCE PLUS LOW FLOW	New Status	Non-Preferred
SAFE-T-LANCE PLUS SAFETYLANCET HIGH FLOW	New Status	Non-Preferred
SAFE-T-LANCE PLUS SAFETYLANCET NORMAL FLOW	New Status	Non-Preferred
SAFE-T-LANCE PLUS SAFETYLANCET LOW FLOW	New Status	Non-Preferred
ULTILET SAFETY LANCETS 21G X 2.2MM	New Status	Non-Preferred
SAFETY LANCETS 21G	New Status	Non-Preferred
UNISTIK 3 GENTLE	New Status	Non-Preferred
IN TOUCH STERILE LANCETS30G	New Status	Non-Preferred
ACCU-CHEK SAFE-T-PRO LANCETS	New Status	Non-Preferred
BD MICROTAINER LANCETS	New Status	Non-Preferred
FREESTYLE UNISTICK II LANCETS	New Status	Non-Preferred
HAEMOLANCE PLUS	New Status	Non-Preferred
HAEMOLANCE PLUS	New Status	Non-Preferred
HAEMOLANCE PLUS LOW FLOW	New Status	Non-Preferred
UNISTIK 3 GENTLE	New Status	Non-Preferred
TRAVEL LANCETS 30G	New Status	Non-Preferred
SHOPKO ON-THE-GO COMFORTLANCETS 30G	New Status	Non-Preferred
WALGREENS ADVANCED TRAVELLANCETS 28G	New Status	Non-Preferred
COAGUCHEK LANCETS	New Status	Non-Preferred
ACCU-CHEK SAFE-T-PRO PLUSLANCETS	New Status	Non-Preferred
SOLUS V2 PRESSURE ACTIVATED SAFETY LANCETS 28G	New Status	Non-Preferred
TRUEPLUS SAFETY LANCETS 28G	New Status	Non-Preferred
TRUEPLUS SAFETY LANCETS 28G	New Status	Non-Preferred
TRUEPLUS SAFETY LANCETS 28G	New Status	Non-Preferred
TRUEPLUS SAFETY LANCETS 28G	New Status	Non-Preferred
TRUEPLUS SAFETY LANCETS 28G	New Status	Non-Preferred
DRUG MART ON-THE-GO LANCETS GENTLE 30G	New Status	Non-Preferred
UNISTIK 3 GENTLE	New Status	Non-Preferred
UNISTIK 3 GENTLE	New Status	Non-Preferred
SAPS HEALTH PLUS TWIST TOP LANCETS 30G	New Status	Non-Preferred
TRUE COMFORT TWIST TOP LANCETS 30G	New Status	Non-Preferred
GLOBAL INJECT EASE LANCETS 28G	New Status	Non-Preferred
GLOBAL INJECT EASE LANCETS 30G	New Status	Non-Preferred
EMBRACE PRESSURE ACTIVATED SAFETY LANCET/21G	New Status	Non-Preferred
EMBRACE PRESSURE ACTIVATED SAFETY LANCET/28G	New Status	Non-Preferred
VERIFINE SAFETY LANCET MINI 28G X 1.8MM	New Status	Non-Preferred
VERIFINE SAFETY LANCET MINI 30G X 1.8MM	New Status	Non-Preferred
VERIFINE SAFETY LANCET MINI 21G X 2.4MM	New Status	Non-Preferred
VERIFINE SAFETY LANCET MINI 23G X 1.8MM	New Status	Non-Preferred
TRAVEL LANCETS ADVANCED 28G	New Status	Non-Preferred
CLEVER CHOICE COMFORT EZLANCETS 28G	New Status	Non-Preferred
CLEVER CHOICE COMFORT EZLANCETS 23G	New Status	Non-Preferred
CLEVER CHOICE COMFORT EZLANCETS 21G	New Status	Non-Preferred
CLEVER CHOICE COMFORT EZLANCETS 21G	New Status	Non-Preferred
CLEVER CHOICE COMFORT EZLANCETS 28G	New Status	Non-Preferred
CLEVER CHOICE COMFORT EZLANCETS 23G	New Status	Non-Preferred
LANCETS 33G UNIVERSAL DESIGN	New Status	Non-Preferred
ULTRA-THIN II AUTO LANCET	New Status	Non-Preferred
MONOLETTOR SAFETY LANCETS	New Status	Non-Preferred
LANCETS	New Status	Non-Preferred
BD MICROTAINER LANCETS	New Status	Non-Preferred
BD MICROTAINER LANCETS	New Status	Non-Preferred
SAFETY LANCETS	New Status	Non-Preferred
PHARMACIST CHOICE ULTRA THIN LANCETS	New Status	Non-Preferred
PHARMACIST CHOICE ULTRA THIN LANCETS	New Status	Non-Preferred
PHARMACIST CHOICE ULTRA THIN LANCETS 33G	New Status	Non-Preferred
PHARMACIST CHOICE ULTRA THIN LANCETS 33G	New Status	Non-Preferred
COMFORT TOUCH LANCETS ULTRA THIN 31G	New Status	Non-Preferred
EASY COMFORT LANCETS 30G/THIN TOP	New Status	Non-Preferred
SAPSCARE TWIST TOP LANCETS 30G	New Status	Non-Preferred
ADVOCATE SAFETY LANCETS	New Status	Non-Preferred
SAPS HEALTH TWIST TOP LANCETS 30G	New Status	Non-Preferred
SAPS HEALTH CARE TWIST TOP LANCETS	New Status	Non-Preferred
AQUALANCE LANCETS ULTRA THIN 30G	New Status	Non-Preferred
ASSURE COMFORT LANCETS ULTRA THIN 28G	New Status	Non-Preferred
EASY COMFORT LANCETS	New Status	Non-Preferred
PRO COMFORT LANCETS 30G	New Status	Non-Preferred
PRO COMFORT LANCETS 31G	New Status	Non-Preferred
VERIFINE UNIVERSAL LANCETS 33G	New Status	Non-Preferred
VERIFINE UNIVERSAL LANCETS 30G	New Status	Non-Preferred
VERIFINE UNIVERSAL LANCETS 28G	New Status	Non-Preferred
EASY COMFORT LANCETS 30G/PULL TOP	New Status	Non-Preferred
COMFORT TOUCH LANCETS ULTRA THIN 31G	New Status	Non-Preferred
PHARMACIST CHOICE ULTRA THIN LANCETS 31G	New Status	Non-Preferred
LANCETS 30G	New Status	Non-Preferred
EASY COMFORT LANCETS TWIST TOP	New Status	Non-Preferred
ADVOCATE LANCETS	New Status	Non-Preferred
ADVOCATE LANCETS	New Status	Non-Preferred
CARETOUCH SAFETY LANCETS/26G	New Status	Non-Preferred
CARETOUCH SAFETY LANCETS/28G	New Status	Non-Preferred
CARETOUCH SAFETY LANCETS/30G	New Status	Non-Preferred
COMFORT TOUCH PLUS SAFETY LANCETS PRESSURE ACTIVATED 28G	New Status	Non-Preferred
SAFETY LANCETS 21G	New Status	Non-Preferred
SAFETY LANCETS 23G	New Status	Non-Preferred
SAFETY LANCETS 28G	New Status	Non-Preferred
SAFETY LANCETS/PRESSURE ACTIVATED/28G	New Status	Non-Preferred
CLEVER CHOICE COMFORT EZLANCETS 28G	New Status	Non-Preferred
TRUE COMFORT SAFETY LANCETS/30G	New Status	Non-Preferred
SAFETY LANCET 30G/PRESSURE ACTIVATED	New Status	Non-Preferred
TRUE COMFORT TWIST TOP LANCETS 30G	New Status	Non-Preferred
PURE COMFORT LANCETS 30G	New Status	Non-Preferred
PRO COMFORT SAFETY LANCETS 30G PRESSURE ACTIVATED	New Status	Non-Preferred
ADVOCATE SAFETY LANCETS 26G	New Status	Non-Preferred
COMFORT TOUCH PLUS SAFETY LANCETS PRESSURE ACTIVATED 30G	New Status	Non-Preferred
SAFETY LANCETS 28G	New Status	Non-Preferred
COMFORT TOUCH PLUS SAFETY LANCETS PRESSURE ACTIVATED 28G	New Status	Non-Preferred

To our provider partners in healthcare,

This is an essential message from YouthCare HealthChoice Illinois (YouthCare).

Coverage of the medications listed below will change, effective August 1, 2024. For questions, please call YouthCare Provider Services at 844-289-2264.

Impacted Medication	Change	New Limit
Alcohol Prep Pads	New Status	Non-Preferred
ALCOHOL PREP PADS	New Status	Non-Preferred
SAPS HEALTH ALCOHOL PREPPADS	New Status	Non-Preferred
PURE COMFORT ALCOHOL PREPPADS	New Status	Non-Preferred
TRUE COMFORT ALCOHOL PREP PADS	New Status	Non-Preferred
EASY COMFORT ALCOHOL PADS	New Status	Non-Preferred
ALCOHOL PREP PADS	New Status	Non-Preferred
SAPS HEALTH ALCOHOL PREPPADS	New Status	Non-Preferred
SAPS HEALTH CARE ALCOHOLPREP PADS	New Status	Non-Preferred
SAPS CARE ALCOHOL PREP PADS	New Status	Non-Preferred
PRO COMFORT ALCOHOL PADS	New Status	Non-Preferred
PHARMACIST CHOICE ALCOHOL PRED PADS	New Status	Non-Preferred
ALCOHOL PADS	New Status	Non-Preferred
ALCOHOL PREP PAD	New Status	Non-Preferred
ALCOH-GLOVE CONTOURED WIPE	New Status	Non-Preferred

To our provider partners in healthcare,

This is an essential message from YouthCare HealthChoice Illinois (YouthCare).

YouthCare would like to inform you that the status of the medications listed below will be changing on June 1, 2024.

For questions, please call YouthCare Provider Services at 844-289-2264.

Impacted Medication	Change	New Limits
Symbicort Inhaler	Monthly limit	Increase to 2 inhalers per month

This is an important message from YouthCare HealthChoice Illinois (YouthCare).

YouthCare would like to inform you that the coverage of the medications listed below has changed, effective 10/01/2023, for all members. Please reference the table for information regarding medication changes.

Impacted Medication	Change	Preferred Agents
AUVI-Q (Auto-Injector)	PREFERRED	NA
ORSERDU (Tabs)	PREFERRED	NA
ENDARI (Pack)	PREFERRED	NA

Impacted Medication

Change

Preferred Agents

AUVI-Q (Auto-Injector)

PREFERRED

NA

ORSERDU (Tabs)

PREFERRED

NA

ENDARI (Pack)

PREFERRED

NA

Please note: Active prior authorizations for this medication will not be affected.

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

This is an essential message from YouthCare HealthChoice Illinois (YouthCare).

YouthCare would like to inform you that the status of the medications listed below will be changing on October 15^th, 2023.

Impacted Medication	Change	Alternative
Mirena, CPT code J7298	Not covered under pharmacy benefit	Covered under medical benefit
Liletta, CPT code J7297	Not covered under pharmacy benefit	Covered under medical benefit
Skyla, CPT code J7301	Not covered under pharmacy benefit	Covered under medical benefit
Kyleena, CPT code J7296	Not covered under pharmacy benefit	Covered under medical benefit
Paragard, Intrauterine copper CPT code J7300	Not covered under pharmacy benefit	Covered under medical benefit

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

This is an essential message from YouthCare HealthChoice Illinois (YouthCare).

YouthCare would like to inform you that the status of the medications listed below will be changing on October 15^th, 2023.

Impacted Medication	Change
Albuterol Sulfate Syrup	Non-Preferred

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

This is an important message from YouthCare HealthChoiceIllinois (YouthCare).

YouthCare would like to inform you that the coverage of the medications listed below has changed, effective 07/01/2023, for all members. Please reference the table for information regarding medication changes.

Impacted Medication	Change of as 7/1/2023	Preferred Agents
ALBUTEROL SULFATE	NON-PREFERRED	NA
SUNLENCA (TBPK, SOLN)	PREFERRED WITH PA	NA
EMGALITY (SOAJ, SOSY)	PREFERRED WITH PA	NA
LURASIDONE HYDROCHLORIDE (TABS)	PREFERRED	NA
MAVYRET (PACK, TABS)	PREFERRED	NA
SOFOSBUVIR/VELPATASVIR	PREFERRED	NA

Please note: Active prior authorizations for this medication will not be affected.

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

This is an important message from YouthCare HealthChoice Illinois (YouthCare).

YouthCare would like to inform you that the coverage of the medications listed below will change, effective July 1, 2023, for all members. Please reference the table for information about medication changes.

Impacted Medication	Change	Preferred Agents
Invega Hafyera	New Age Limit: Minimum age of 18 years	NA
Invega Trinza	New Age Limit: Minimum age of 18 years	NA
Invega Sustenna	New Age Limit: Minimum age of 18 years	NA
Vraylar	New Age Limit: Minimum age of 18 years	NA

Please note: Active prior authorizations for this medication will not be affected.

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

This is an important message from YouthCare HealthChoice Illinois (YouthCare).

YouthCare would like to inform you that the coverage of the medications listed below will change, effective May 15, 2023, for all members. Please reference the table for information about medication changes.

Impacted Medication	Change	Preferred Agents
Aripiprazole IM For ER Susp Prefilled Syringe 300 MG	New Age Limit: Minimum age of 18 years	NA
Aripiprazole IM For ER Susp Prefilled Syringe 400 MG	New Age Limit: Minimum age of 18 years	NA
Aripiprazole IM For Extended Release Susp 300 MG	New Age Limit: Minimum age of 18 years	NA
Aripiprazole IM For Extended Release Susp 400 MG	New Age Limit: Minimum age of 18 years	NA

Please note: Active prior authorizations for this medication will not be affected.

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

This is an essential from YouthCare HealthChoice Illinois (YouthCare).

YouthCare would like to inform you that initial prescription logic used for opioids and benzodiazepines will be changing on May 8, 2023.

Impacted Medication	Change
Opioids	Initial fill limit will be a maximum of 5 days' supply
Benzodiazepines	Initial fill limit will be a maximum of 14 days' supply

After the initial fill, prescriptions for these medications may be filled for a 30 days' supply.

The initial fill limit applies to participants who have not had another opioid or benzodiazepine claim within the previous 60 days.

For patients who have been diagnosed with a chronic painful condition, such as cancer or sickle cell disease, providers can ask for prior authorization for starting chronic opioid therapy. Upon approval, the 5-day initial fill limit will be waived. Those who have a prescription will subsequently be eligible for ongoing 30-day refills without further prior authorization restrictions

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

This is an important message from YouthCare HealthChoice Illinois (YouthCare).

YouthCare would like to inform you that the coverage of the medications listed below has changed, effective April 1, 2023, for all members. Please reference the table for information regarding medication changes.

Impacted Medication	Change	Preferred Agents
AUSTEDO PATIENT TITRATION KIT (TBPK)	Preferred with PA	NA
AUSTEDO (TABS)	Preferred with PA	NA
INGREZZA (CAPS)	Preferred with PA	NA
INGREZZA (CPPK)	Preferred with PA	NA
BERINERT	Preferred with PA	NA

Please note: Active prior authorizations for this medication will not be affected.

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

This is an important message from YouthCare HealthChoice Illinois (YouthCare).

YouthCare would like to inform you that the status of the medications desmopressin acetate and oxybutynin chloride will change on May 1, 2023, for members under the care of the Department of Children and Family Services.

The medicines will require form CFS 431-A (also known as a consent form) to be submitted to DCFS when prescribed within 100 days of the below medication.

Aripiprazole

Aripiprazole Lauroxil

Asenapine Maleate

Asenapine TD Patch

Brexipiprazole

Cariprazine HCL

Clozapine

Iloperidone

Lithium

Lumateperone Tosylate

Lurasidone HCl

Olanzapine

Olanzapine Pamoate

Olanzapine-Fluoxetine

Olanzapine-Samidorphan L-Malate

Paliperidone

Paliperidone Palmitate

Quetiapine Fumarate

Risperidone

Risperidone Microspheres

Ziprasidone HCl

Ziprasidone Mesylate

Please fax form CFS 431-A to 312-814-7015.

Note: Active consent for these medications will not be affected.

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

YouthCare would like to inform you that the status of the medications listed below will change.

Impacted Medication	Change
All Enbrel Products	Preferred with Prior Authorization after 02/01/2023
Tamiflu Brand	Non-preferred after 03/01/2023

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

YouthCare would like to inform you that the status of the medications listed below will be changing on February 1, 2023.

Impacted Medication	Change
All Enbrel Products	Preferred with PA

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

This is an essential message from YouthCare HealthChoice Illinois (YouthCare).

YouthCare would like to inform you that the status of the medications listed below will be changing on February 1, 2023.

Impacted Medication	Change
All Enbrel Products	Non-Preferred
Brand Strattera Capsule	Preferred
Cosentyx; Cosentyx Sensoready pen	Preferred with Prior Authorization

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

This is an important message from YouthCare HealthChoice Illinois (YouthCare).

YouthCare would like to inform you that the status of the metformin listed below will be changing on December 1, 2022, for members under the care of the Department of Children and Family Services. The medicine will require form CFS 431-A (also known as a consent form) to be submitted to DCFS when prescribed within 100 days of the below medications

The medicines will require form CFS 431-A (also known as a consent form) to be submitted to DCFS when prescribed within 100 days of the below medication.

Aripiprazole

Aripiprazole Lauroxil

Asenapine Maleate

Asenapine TD Patch

Brexipiprazole

Cariprazine HCL

Clozapine

Iloperidone

Lithium

Lumateperone Tosylate

Lurasidone HCl

Olanzapine

Olanzapine Pamoate

Olanzapine-Fluoxetine

Olanzapine-Samidorphan L-Malate

Paliperidone

Paliperidone Palmitate

Quetiapine Fumarate

Risperidone

Risperidone Microspheres

Ziprasidone HCl

Ziprasidone Mesylate

Please fax form CFS 431-A to 312-814-7015.

Note: Active consent for these medications will not be affected.

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

This is an important message from YouthCare HealthChoice Illinois (YouthCare).

YouthCare would like to inform you that the status of the medications listed below will be changing on November 1, 2022, for members under the care of the Department of Children and Family Services. The medicines will require form CFS 431-A (also known as a consent form) to be submitted to DCFS.

Please fax form CFS 431-A to 312-814-7015.

Brexipiprazole

Bupropion Hydrobromide

Desvenlafaxine

Doxepin HCl (Sleep)

Haloperidol Lactate (oral solution)

Imipramine Pamoate

Loxapine (aerosol)

Naltrexone (Contrave ®)

Naltrexone HCl-Bupropion HCl

Naltrexone-Triamcinolone (Naltrexone implant)

Nicotine Polacrilex (gum/llozenge)

Olanzapine Pamoate

Olanzapine-Samidorphan L-Malate

Selegiline

Viloxazine HCl (ADHD)

Ziprasidone Mesylate

Note: Active consent for these medications will not be affected.

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

YouthCare would like to inform you that the coverage of the medications listed below has changed, effective October 1, 2022, for all members. Please reference the table for information regarding medication changes.

Impacted Medication	Change	Preferred Agents
INVEGA HAFYERA	Preferred with prior authorization after 10/1/22	NA
DYANAVEL XR	Preferred with prior authorization after 10/1/22	NA
JORNAY PM	Preferred with prior authorization after 10/1/22	NA
MODAFINIL	Preferred after 10/1/22	NA
DAYTRANA	Non Preferred after 10/1/22	NA

Please note: Active prior authorizations for this medication will not be affected.

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

Please read this important message from YouthCare HealthChoice Illinois (YouthCare) to all prescribers and providers.

Please be advised that coverage of the medications listed below is changing on July 1, 2022, for all members. Reference the table below for medication change information.

Impacted Medication	Change	Preferred Agents
APRETUDE	Preferred after 7/1/22	NA
CARGLUMIC ACID	Preferred, with a prior authorization after 7/1/22	NA
KERENDIA (except NDC: 50419054170)	Preferred, with a prior authorization after 7/1/22	NA
LIVTENCITY	Preferred, with a prior authorization after 7/1/22	NA

Note: Active prior authorizations for these medications will not be affected.

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

YouthCare would like to inform you that the coverage of the medications listed below is changing on April 15, 2022 for all members. Please reference the table below for information regarding medication changes and alternative preferred agents.

YouthCare would like to work with you to help transition the impacted members onto a preferred formulary alternative. If a member requires continued therapy for a medication that has been changed, please submit a prior authorization with appropriate clinical documentation.

Impacted Medication	Change	Preferred Agents
FLUTICASONE PROPIONATE/SALMETEROL	Non-preferred after 4/15/22	ADVAIR DISKUS® ADVAIR HFA® AIRDUO DIGIHALER 55/14® AIRDUO DIGIHALER 113/14® AIRDUO DIGIHALER 232/14® AIRDUO RESPICLICK 55/14® AIRDUO RESPICLICK 113/14® AIRDUO RESPICLICK 232/14®
ADVAIR DISKUS ADVAIR HFA	Preferred after 4/15/22	NA
WIXELA INHUB	Non-preferred after 4/15/22	ADVAIR DISKUS® ADVAIR HFA® AIRDUO DIGIHALER 55/14® AIRDUO DIGIHALER 113/14® AIRDUO DIGIHALER 232/14® AIRDUO RESPICLICK 55/14® AIRDUO RESPICLICK 113/14® AIRDUO RESPICLICK 232/14®
AIRDUO DIGIHALER 55/14 AIRDUO DIGIHALER 113/14 AIRDUO DIGIHALER 232/14	Preferred after 4/15/22	NA
AIRDUO RESPICLICK 55/14 AIRDUO RESPICLICK 113/14 AIRDUO RESPICLICK 232/14	Preferred after 4/15/22	NA
ANORO ELLIPTA	Preferred after 4/15/22	NA
BEVESPI AEROSPHERE	Non-preferred after 4/15/22	Anoro Elipta ®
INCRUSE ELLIPTA	Preferred after 4/15/22	NA
SPIRIVA RESPIMAT	Preferred after 4/15/22	NA
MYFEMBREE	Preferred after 4/15/22	NA
QULIPTA	Preferred after 4/15/22	NA
APO-VARENICLINE	Non-preferred after 4/15/22	Varinecline

Note: Active prior authorizations for this medication will not be affected.

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

Note: This notice replaces the previous notice dated 2/15/21.

YouthCare would like to inform you after August 1, 2021 melatonin will not be covered. This includes instances in which DCFS consent has been received. The change is being enacted due to the Center for Medicare and Medicaid’s (CMS) classification of melatonin and state of Illinois Department of Health and Family Services’ (HFS) rules.

For questions or additional information about this change please contact YouthCare Provider Services at 844-289-2264.

YouthCare would like to inform you that the coverage of long acting antipsychotic injectables (Abilify Maintena ®, Aristada ®, Aristada Initio ®, Invega Sustenna ®, and Invega Trinza ®) is changing on June 15, 2021 for all members. Effective June 15, 2021, these medications will be preffered with a prior authorization. Please reference the table below for information regarding medication changes and alternative preferred agents.

YouthCare would like to work with you to help transition the impacted members onto a preferred formulary alternative. If a member requires continued therapy for a medication that has been changed, please submit a prior authorization with appropriate clinical documentation. Prior authorizations can be submitted by faxing 844-989-0154.

Impacted Medication	Medication Change
Abilify Maintena ®	Preferred with prior authorization after 6/15/2021
Aristada ®	Preferred with prior authorization after 6/15/2021
Aristada Initio ®	Preferred with prior authorization after 6/15/2021
Invega Sustenna ®	Preferred with prior authorization after 6/15/2021
Invega Trinza ®	Preferred with prior authorization after 6/15/2021

Note: Active prior authorizations for this medication will not be affected.

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

YouthCare would like to inform you that the coverage of Metformin Hydrochloride ER Modified Release (GLUMETZA) and Metformin Hydrochloride ER Osmotic (FORTAMET) is changing on May 15, 2021 for all members. Effective May 15, 2021, this medication will be removed from the formulary. Please reference the table below for information regarding medication changes and alternative preferred agents.

YouthCare would like to work with you to help transition the impacted members onto a preferred formulary alternative. If a member requires continued therapy for a medication that has been changed, please submit a prior authorization with appropriate clinical documentation. Prior authorizations can be submitted by faxing 844-989-0154.

Impacted Medication	Medication Change	Preferred agents
Metformin Hydrochloride ER Modified Release (GLUMETZA ®)	Non-preferred after 5/15/21	Metformin hcl er 500 mg tablet Metformin hcl er 750 mg tablet Metformin hcl 1,000 mg tablet Metformin hcl 500 mg tablet Metformin hcl 850 mg tablet
Metformin Hydrochloride ER Osmotic (FORTAMET ®)	Non-preferred after 5/15/21	Metformin hcl er 500 mg tablet Metformin hcl er 750 mg tablet Metformin hcl 1,000 mg tablet Metformin hcl 500 mg tablet Metformin hcl 850 mg tablet

Note: Active prior authorizations for this medication will not be affected.

If you have any questions, please call YouthCare Provider Services at 844-289-2264.

Preferred Drug List (PDL) Updates

2024 Illinois YouthCare Preferred Drug List Updates

2023 Illinois YouthCare Preferred Drug List Updates

2022 Illinois YouthCare Preferred Drug List Updates

2021 Illinois YouthCare Preferred Drug List Updates

Preferred Drug List (PDL) Updates

2024 Illinois YouthCare Preferred Drug List Updates

12/12/24: Endari, Victoza, Myrbetriq, Emflaza – Status Change

11/21/24: L Glutamine Pow – Status Change

9/27/24: Amladex – Status change

9/24/24: DermacinRx products and Dekas – Status change; All Multivitamin and vitamins – New Limit

8/2/2024: Trulicity and Victoza – Status Change (preferred with diabetes Diagnosis)

7/30/2024: GLP-1 receptor agonist (diabetes medication) – New Limit

7/09/2024: Wellfola – Status Change

5/31/2024: Certain multivitamins and Vitamins – Status Change

5/31/2024: Certain Diabetes lancet supplies – Status Change

5/31/2024: Certain Alcohol prep pads – Status Change

5/03/2024: Symbicort Inhaler – New Limit

2023 Illinois YouthCare Preferred Drug List Updates

11/06/2023: AUVI-Q (auto- inj), ORSEDU (tabs), ENDARY (pack) – Status change

08/10/2023: Progestin Intrauterine Device (IUD) – Status Change

08/09/2023: Albuterol Sulfate Syrup – Status Change

07/11/2023: Albuterol Sul, Sunlenca, Emgality; Lurasidone HCL, Mavyret, Epclusa – Status Change

5/18/2023 Invega Hafyera, Invega Trinza, Invega Sustenna, Vraylar – New age limit (Minimum age 18 years)

4/26/2023: Aripiprazole IM for ER susp prefilled Sryng and susp – New age limit (Minimum age 18 years)

4/01/2023: Opioids and Benzodiazepines – New Fill Limit

03/30/2023: Austedo (TBPK, Tabs) Ingrezza (caps, CPPK), Berinert – Status Change

03/29/2023: Member under care of DCFS; additional Psychiatric medication will require form CFS 431-A

02/24/2023: All Enbrel products and Brand Tamiflu – Status Change

01/24/2023: All Enbrel Products – Status Change

01/01/2023: Brand Strattera, Cosentyx, Cosentyx Sensoready – Status Change

2022 Illinois YouthCare Preferred Drug List Updates

11/01/2022: Member under care of DCFS Metformin may require CFS 431-A form

09/29/2022: Member under care of DCFS, additional Psychiatric medications may require CFS 431-A

08/19/2022: Invega Hafyera, Dyanavel XR, Jornay PM, Modafinil, Daytrana – Status Change

05/25/2022: Apretude, Carglumic acid, Kerendia, Livtencity – Status Change

03/09/2022: Certain inhalers, Myfembree, Qulipta Perferred – Status Change

2021 Illinois YouthCare Preferred Drug List Updates

06/28/2021: Melatonin – Status Change

05/15/2021: Certain long acting antipsychotic injectables – Status change

04/09/2021: GLUMETZA®,FORTAMET ® – Status Change