Pharmacy Information and Preferred Drug List Changes - First Quarter 2025
Date: 01/29/25
Attention: Sublocade and Brixadi Update for Medicaid
Currently, both long-acting buprenorphine injections, Sublocade and Brixadi, are available without prior authorization. Both Sublocade and Brixadi are covered under the medical benefit (buy and bill) or under the pharmacy benefit. When dispensed under the pharmacy benefit, Specialty Pharmacy (Acaria Health) is not required but is available if you would like the medication shipped to your office. Please refer to the FDA labeling for Sublocade and Brixadi for dosing.
Update: Flu & COVID Vaccine Coverage for Members Under 19 Years Old
Trillium Community Health Plan covers COVID-19 and seasonal influenza (flu) vaccines for Oregon Health Plan (OHP) members under age 19 administered by pharmacies not enrolled in the Vaccines for Children (VFC) program effective January 1, 2025. Pharmacies not enrolled in VFC may bill Trillium Community Health Plan for these vaccines when administered to OHP members under age 19. This authorization does not extend to other vaccinations.
Reminder: The Outpatient Prior Authorization Request Form Has Been Updated
* Includes Update to the Fax Number to Submit Requests for Buy & Bill Drugs
The form for manually submitting prior authorization (PA) requests for outpatient services, including buy and bill drugs, was updated at the end of 2024. The main update to the PA request form was the change in the fax number to submit PA requests for Buy & Bill drugs. The new fax number for Buy & Bill Drug requests is 833-782-0054. To help ensure that your requests are properly routed for review and there is no delay in determination please ensure that you and your staff are using the updated form and current fax number corresponding to the request type when submitting requests. The updated form (PDF) is posted on our website.
This update has no impact to PA requests submitted through the provider portal.
Trillium Community Health Plan Preferred Drug List Changes
Trillium’s Preferred Drug List (PDL) is updated monthly and is available online. View this notice (PDF) for a summary of the PDL changes made in the first quarter of 2025. For the most current preferred drug list, visit the Pharmacy section of our website.
Quarterly Update on Pharmacy Coverage Guidelines
The P&T Committee determines updates to coverage guidelines (criteria) based on quarterly, comprehensive reviews. Criteria serves as a reference for providers to use when prescribing pharmaceutical products for Trillium members with pharmacy coverage. Prior authorization (PA) does not guarantee payment. PA determination is based on multiple factors in conjunction to the criteria posted in drug coverage guidelines. These factors include but are not limited to: treatment of a funded vs non-funded condition as defined by the Oregon Prioritized List and applicable guidelines; prior trial and failure of agents on the PDL; comparative costs of available treatment options.
View this notice (PDF) for all the updated or new Trillium Community Health Plan coverage guidelines that were approved by P&T in the first quarter of 2025. All coverage guidelines will go into effect April 1, 2025 and will become available to view in their entirety at our website approximately 2 weeks prior to their implementation date.
Additional Information
For additional information regarding changes to the Trillium Preferred Drug List (PDL), contact Trillium by telephone at 1-877-600-5472. For the most current version of the PDL, visit the Pharmacy section of the Trillium website.
For additional information on medication coverage guidelines, visit the Provider Resources section of Trillium’s website.
If you have questions regarding the information contained in this update, contact Trillium Provider Services through the Provider Resources section of the Trillium website or by telephone at 1-877-600-5472.