Pending changes to the approved drug list
From time to time, we add or remove drugs from the approved drug list (formulary). We also may change their tier, which determines how much you pay for them. We make these changes based on the scientific evidence we have of their value in helping people get well and stay healthy.
If you are taking a drug that is being removed
If we remove drugs from the formulary during the year, we'll notify you of the change at least 30 days before the date that the change becomes effective. The exceptions to this 30-day notice are when the FDA decides a drug is not safe, or if a drug manufacturer removes the drug from the market.
We may also immediately remove a brand name drug if we are replacing it with a new generic drug that will appear on the same or lower cost sharing tier and with the same or fewer restrictions. If you are currently taking that brand name drug, we may not tell you in advance before we make that change, but we will later provider you with information about the specific change(s) we have made.
You may ask Priority Health to make an exception for you so you can continue taking a drug that's removed from the formulary. We must make a decision within 72 hours of your request. Contact Customer Service to make these requests.
Learn more about asking for an exception.
Current and pending changes to the 2022 approved drug list
- Jump down to Changes/removals from the approved drug list
KEY:
- ALL CAPS = Brand names
- Lower case = Generic
- B/D = Coverage varies under Medicare Part B (medical) vs. Part D (prescription) benefits
- HI = Home infusion drug
- LA = Limited availability (available only at certain pharmacies)
- PA = Prior authorization from Priority Health is required
- QL = Quantity limits apply
- ST = Step therapy, trying other drugs first is required
Additions effective June 1, 2022
| Drug name | Tier | Category | Notes |
|---|---|---|---|
| lacosamide tablet 50mg | 4 | Anticonvulsants: Sodium Channel Agents | QL (30 EA per 30 days)A |
| aztreonam injection 2gm | 4 | Antibacterials: Antibacterials, Other | HI |
| CIMDUO® | 5 | Antivirals: Anti-HIV Agents, Nucleoside And Nucleotide Reverse Transcriptase Inhibitors (Nrti) | QL (30 EA per 30 days) |
| MAYZENT® 0.25MG START-1MG MAINT | 5 | Central Nervous System Agents: Multiple Sclerosis Agents | PA |
| MAYZENT® 1 MG TABLET | 5 | Central Nervous System Agents: Multiple Sclerosis Agents | PA, QL (30 EA per 30 days) |
| RINVOQ® ER 45 MG TABLET | 5 | Immunological Agents: Immunological Agents, Other |
|
| OZEMPIC® 2 MG/DOSE (8 MG/3 ML) | 4 | Blood Glucose Regulators: Antidiabetic Agents | ST |
Additions effective May 1, 2022
| Drug name | Tier | Category | Notes |
|---|---|---|---|
| CORTROPHIN™ | 5 | Hormonal Agents, Stimulant/Replacement/Modifying/(Adrenal) | PA |
| DESCOVY® 120-15 MG TABLET | 5 | Antivirals: Anti-Hiv Agents, Nucleoside And Nucleotide Reverse Transcriptase Inhibitors (Nrti) | |
| lenalidomide capsule 10mg, 15mg, 25mg, 5mg | 5 | Antineoplastics: Antiangiogenic Agents | PA, QL (30 EA per 30 days), LA |
| LEQVIO® | 5 | Cardiovascular Agents: Dyslipidemics, Other | PA, QL (4.5 ML per 365 days) |
| LIVTENCITY™ | 5 | Antivirals: Anti-cytomegalovirus (CMV) Agents | PA, QL (120 EA per 30 days) |
| TAKHZYRO® 300 MG/2 ML SYRINGE | 5 | Immunological Agents: Angioedema Agents | PA, QL (4 ML per 30 days) |
| TALZENNA® CAPSULE 0.5MG, 0.75MG | 5 | Antineoplastics: Molecular Target Inhibitors | PA, QL (30 EA per 30 days) |
| TEZSPIRE™ | 5 | Respiratory Tract/Pulmonary Agents: Respiratory Tract Agents, Other | PA, QL (1.91 ML per 30 days) |
| VOXZOGO™ | 5 | Metabolic Bone Disease Agents | PA, QL (30 EA per 30 days) |
Additions effective Apr. 1, 2022
| Drug name | Tier | Category | Notes |
|---|---|---|---|
| betaine 1 gram/1.9ml powder | 5 | Genetic Or Enzyme Or Protein Disorder: Replacement, Modifiers, Treatment | LA |
| maraviroc tablet 150mg, 300mg | 5 | Antivirals: Anti-HIV Agents, Other | |
| QUADRACEL® DTAP-IPV | 3 | Immunological Agents: Vaccines | |
| RINVOQ® ER 30MG TABLET | 5 | Immunological Agents: Immunological Agents, Other | PA, QL (30 EA per 30 days) |
Additions effective Mar. 1, 2022
| Drug name | Tier | Category | Notes |
|---|---|---|---|
| APRETUDE ER 600 MG/3 ML VIAL | 5 | Antivirals: Anti-HIV Agents, Integrase Inhibitors (INSTI) | QL (21 ML per 365 days) |
| BESREMI® PFS | 5 | Immunological Agents: Immunostimulants | PA, QL (2 ML per 30 days) |
| DUPIXENT® 100MG/0.67ML SYRINGE | 5 | Immunological Agents: Immunological Agents, Other | PA |
| EPCLUSA® 150MG-37.5MG ORAL PELLET | 5 | Antivirals: Anti-Hepatitis C (Hcv) Agents | PA |
| EPCLUSA® 200MG-50MG ORAL PELLET | 5 | Antivirals: Anti-Hepatitis C (Hcv) Agents | PA |
| EPRONTIA™ 25MG/ML SOLUTION | 4 | Anticonvulsants: Anticonvulsants, Other | ST, QL (480 ML per 30 days) |
| everolimus 1mg tablet | 5 | Immunological Agents: Immunosuppressants | B/D |
| EXKIVITY™ | 5 | Antineoplastics: Molecular Target Inhibitors | PA, QL (120 EA per 30 days) |
| ezetimibe/rosuvastatin | 2 | Cardiovascular Agents: Dyslipidemics, Other | QL (30 EA per 30 days) |
| naloxone hcl 4mg nasal spray | 2 | Anti-Addiction/Substance Abuse Treatment Agents: Opioid Reversal Agents | QL (2 EA per 30 days) |
| nylia™ 1-35 28 tablet | 2 | Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers): Estrogens | |
| SCEMBLIX® | 5 | Antineoplastics: Molecular Target Inhibitors | PA, QL (300 EA per 30 days) |
| TAVNEOS™ | 5 | Immunological Agents: Immunological Agents, Other | PA, QL (180 EA per 30 days) |
| TICOVAC 2.4 MCG/0.5 ML SYRINGE | 3 | Immunological Agents: Vaccines | |
| TRUDHESA™ | 4 | Antimigraine Agents: Ergot Alkaloids | PA, QL (4 ML per 30 days) |
| XARELTO® 1 MG/ML SUSPENSION | 3 | Blood Products and Modifiers: Anticoagulants | QL (600 ML per 30 days) |
Additions effective Feb. 1, 2022 |
|||
| Drug name | Tier | Category | Notes |
|---|---|---|---|
| BIKTARVY® TABLET 30-120-15 MG ORAL | 5 | Antivirals: Anti-Hiv Agents, Integrase Inhibitors (Insti) |
QL (30 EA per 30 days) |
| carglumic acid tablet 200mg oral | 5 | Electrolytes/Minerals/Metals/Vitamins: Electrolyte/Mineral Replacement | PA, LA |
| DENGVAXIA® SUSPENSION RECONSTITUTED SUBCUTANEOUS | 3 | Immunological Agents: Vaccines | |
| difluprednate emulsion 0.05% ophthalmic | 3 | Ophthalmic Agents: Ophthalmic Anti-inflammatories | ST |
| DUPIXENT® SOLUTION PREFILLED SYRINGE 100 MG/0.67ML SUBCUTANEOUS | 5 | Immunological Agents: Immunological Agents, Other | PA |
| everolimus tablet 1 mg oral | 5 | Immunological Agents: Immunosuppressants | B/D |
| GVOKE® KIT SOLUTION 1 MG/0.2ML SUBCUTANEOUS | 3 | Blood Glucose Regulators: Antidiabetic Agents |
QL (0.8 ML per 30 days) |
| MAVYRET® PACKET 50-20 MG ORAL | 5 | Antivirals: Anti-hepatitis C (HCV) Agents | PA, QL (140 EA per 28 days) |
| meropenem 1 g | 4 | Antibacterials: Cabapenems | |
| sajazir™ | 5 | Immunological Agents: Angioedema Agents | PA |
Changes/removals from the approved drug list
Changes/removals effective Jun. 1, 2022 |
||
| Drug name | Tier | Notes |
|---|---|---|
| CYSTADANE® ORAL POWDER |
5 | Removed brand from formulary; generic added |
| VIMPAT® 50MG | 4 | Removed brand from formulary; generic added |
Changes/removals effective May 1, 2022 |
||
| Drug name | Tier | Notes |
|---|---|---|
| CARBAGLU® ORAL TABLET 200 MG | 5 | Removed brand from formulary; generic added |
| INTRON® A INJECTION SOLUTION 10000000 UNIT/ML | 5 | Removed from formulary; discontinued |
| INTRON® A INJECTION SOLUTION 6000000 UNIT/ML | 5 | Removed from formulary; discontinued |
| ORGOVYX® | 5 | Revised QL to 32 EA per 30 days |
| SELZENTRY® ORAL TABLET 150 MG, 300MG | 5 | Removed brand from formulary; generic added |
| TRI-PREVIFEM® ORAL TABLET 0.18/0.215/0.25 MG-35 MCG | 2 | Removed from formulary; discontinued |
| XARELTO® 1 MG/ML SUSPENSION | 3 | Revised QL to 620 ML per 30 days |
Changes/removals effective Mar. 1, 2022 |
||
| Drug name | Tier | Notes |
|---|---|---|
| NARCAN® NASAL LIQUID | 2 | Removed brand from formulary; generic added |
| ZORTRESS® 1MG TABLET | 5 | Removed brand from formulary; generic added |
Changes/removals effective Feb. 1, 2022 |
||
| Drug name | Tier | Notes |
|---|---|---|
| AFINITOR DISPERZ® ORAL TABLET SOLUBLE 3 MG, 5 MG |
5 | Removed brand from formulary; generic added |
| AFINITOR® ORAL TABLET 10 MG | 5 | Removed brand from formulary; generic added |
| BYSTOLIC® | 4 | Removed brand from formulary; generic added |
| CHANTIX® | 4 | Removed brand from formulary; generic added |
| CHANTIX® CONTINUING MONTH PAK | 4 | Removed brand from formulary; generic added |
| ciclopirox 8% solution | 2 | Quantity Limit changed to 13.2 ML per 30 days |
| COSENTYX® (300 MG DOSE) SOLUTION PREFILLED SYRINGE 150 MG/ML SUBCUTANEOUS | 5 | Quantity Limit changed to 5 ML per 28 days |
| DUREZOL® OPHTHALMIC EMULSION 0.05 % | 3 | Removed brand from formulary; generic added |
| INVEGA TRINZA® | 5 | Removed Quantity Limit |
| loteprednol etabonate ophthalmic gel 0.5 % | 3 | Lowered tier |
| loteprednol etabonate ophthalmic suspension 0.5 % | 3 | Lowered tier |
| LUMAKRAS™ | 5 | Quantity Limit changed to 240 EA per 30 days |
| PAXIL® ORAL SUSPENSION | 4 | Removed brand from formulary; generic added |
Drug tiers
Tier 1: Preferred Generic
Tier 2: Generic
Tier 3: Preferred Brand
Tier 4: Non-Preferred Drug
Tier 5: Specialty