This document summarizes upcoming changes to the CenCal CareConnect (HMO D-SNP) Medicare Part D formulary. These changes will take effect on the date listed below.
If your medication is affected, your pharmacy may dispense a formulary alternative. If you or your prescriber believe a specific medication is medically necessary, your prescriber may request a formulary exception.
For questions, please call Member Services at 1-877-814-1861 (TTY: CA Relay at 711), 7 days a
week, 8 a.m. to 8 p.m. PT.
How and When Formulary Changes May Occur
CenCal CareConnect may make changes to its formulary during the plan year in certain situations, including:
- When a new generic version of a brand-name drug becomes available, the brand drug
may be removed and the generic drug added immediately. - When the FDA determines a drug is unsafe or the manufacturer removes a drug from the
market. - For other changes that affect members currently taking a drug, the Plan generally
provides at least 30 days’ advance notice, or notice at the time of refill along with a
temporary supply, as required by Medicare rules.
Summary of Changes
| Brand Drug Removed | Formulary Change | Formulary Alternative (Tier) | Effective Date |
|---|---|---|---|
| Mavenclad 10 mg oral tablet | Removal of Brand and added generic to formulary | Cladribine 10 mg oral tablet (Tier 5) | 08/01/2026 |
| Astagraf XL 0.5 mg oral cap er 24h | Removal of Brand and added generic to formulary | Tacrolimus XL 0.5 mg oral cap er 24h (Tier 4) | 08/01/2026 |
| Astagraf XL 1 mg oral cap er 24h | Removal of Brand and added generic to formulary | Tacrolimus XL 1 mg oral cap er 24h (Tier 4) | 08/01/2026 |
| Astagraf XL 5 mg oral cap er 24h | Removal of Brand and added generic to formulary | Tacrolimus XL 5 mg oral cap er 24h (Tier 5) | 08/01/2026 |
| Atrovent HFA 17 mcg inhalation HFA aerosol adapter | Removal of Brand and added generic to formulary | Ipratropium bromide 17 mcg inhalation HFA aerosol adapter (Tier 4) | 08/01/2026 |
| Edurant 25 mg oral tablet | Removal of Brand and added generic to formulary | Rilpivirine 25 mg oral tablet (Tier 5) | 08/01/2026 |
Important Information
- These changes represent brand to generic substitutions.
- Generic alternatives are FDA-approved and therapeutically equivalent to the brand product.
- Your cost share may differ based on your benefit level and subsidy status.
- Formulary alternatives listed are in the same drug class and are considered clinically
appropriate; only your prescriber can determine the most appropriate medication for you.
Requesting an Exception
If you or your prescriber believe the brand medication is medically necessary:
- Your prescriber may submit a formulary exception request.
- Requests will be reviewed based on clinical criteria and medical necessity.
- For more information about coverage decisions and exceptions, please refer to your
Evidence of Coverage (EOC).
Member Services
If you have questions about these changes or your medications, contact Member Services using
the number on your CenCal CareConnect member ID card.
Disclaimer
This document is provided for informational purposes only and does not include member-specific
information. The formulary and coverage rules may change. For the most current information,
please refer to the official CenCal CareConnect formulary or contact Member Services.
Member Services toll-free / Servicios para Miembros número gratuito: 1-877-814-1861 (TTY: CA Relay at 711) 7 days a week 8 a.m. to 8 p.m. PT / 7 días a la semana 8 a.m. a 8 p.m. hora del Pacífico
www.cencalhealth.org/careconnect