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 60 days before the date that the change becomes effective. The exceptions to this 60-day notice are when the FDA decides a drug is not safe, or if a drug manufacturer removes the drug from the market.

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 2019 approved drug list

Additions to the formulary 

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 March 1, 2019

Drug name Tier Category Notes
abiraterone acetate oral tablet 250mg
5 Antineoplastics: Antineoplastics, other PA
ACTEMRA® ACTPEN
4 Immunological agents: Immunomodulators PA; QL (3.6ml per 28 days)
cinacalcet HCl tablet 30mg 3 Metabolic bone disease agents: Metabolic bone disease agents B/D; QL (60 ea. per 30 days)
cinacalcet HCl tablet 60mg
5 Metabolic bone disease agents: Metabolic bone disease agents
B/D; QL (60 ea. per 30 days)
cinacalcet HCl tablet 90mg
5 Metabolic bone disease agents: Metabolic bone disease agents
B/D; QL (120 ea. per 30 days)
clobazam oral tablet 10mg
4 Anticonvulsants: Gamma-aminobutyric acid (Gaba) augmenting agents
PA; QL (60 ea. per 30 days)
INVELTYS™
4 Ophthalmic agents: Ophthalmic anti-inflammatories
 
mesalamine rectal suppository 1000mg
4 Inflammatory bowel disease agents: Aminosalicylates
 
OXERVATE™
5 Ophthalmic agents: Ophthalmic agents, other
PA
pimecrolimus cream 1%
3 Dermatological agents: Dermatological agents

TIROSINT® oral capsule 175mcg, 200mcg 4 Hormonal agents, stimulant/replacement/modifying (thyroid): Hormonal agents, stimulant/replacement/modifying (thyroid)

tramadol ER tablet 300mg
2 Analgesics: Opioid analgesics, long-acting
QL (30 ea. per 30 days)
UDENYCA™
5 Blood products/modifiers/volume expanders: Blood formation modifiers

vigabatrin tablet 500mg
5 Anticonvulsants: Gamma-aminobutyric acid (Gaba) augmenting agents
LA
XELPROS™
3 Ophthalmic agents: Ophthalmic prostaglandin and prostamide analogs

XOSPATA® tablet 40mg
5 Antineoplastics: Molecular targetinhibitors
PA

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Changes to/removals from the formulary

 

Changes/deletions effective March 1, 2019

Drug name Tier Notes
ZYTIGA® oral tablet 250mg N/A Removed brand from formulary; generic added