Formulary Changes
Nebraska Total Care continually evaluates our Value-Add Formulary (PDF) to make sure our members receive clinically appropriate and cost conscious drug therapy.
Effective August 1, 2022, the following medications have been added to the Nebraska Total Care Value-Add Formulary:
- Aristada Initio Injection - Quantity Limit of 2.4ML per claim
- Lybalvi (olanzapine/samidorphan) - Prior Authorization, Quantity Limit of 1 tablet per day
- Invega Hafyera - Quantity Limit of 3.5ml per 180 days
- Chlorpromazine solution 30mg/ml - Prior Authorization