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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.

Heritage Health - Nebraska Total Care 

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