From time to time, we add drugs to or remove them from Priority Health formularies. We also may change their tier, which determines how much a member pays for a drug. The Priority Health Pharmacy & Therapeutics (P&T) committee is a group of network physicians and pharmacists that help us make these changes based on scientific evidence we have of their value in helping people get well and stay healthy. Below is a list of the pending changes made by the P&T committee on January 19, 2016.

Medicare Part D formulary changes: These changes will not be implemented until Priority Health receives CMS approval. For drugs covered by Medicare Part B, prescribers must follow WPS-Medicare local coverage determinations.

Medicaid formulary changes: Are reported separately.

ARISTRADA
(aripiprazole lauroxil)

• Commonly used for:

  Schizophrenia

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. specialty*

  Medicare: Part B

• What changed/notes

  *Added coverage under medical benefit

  Est. annual cost: $9,500

• Effective date

  03/01/2016

COTELLIC
(cobimetinib)

• Commonly used for:

  Metastatic melanoma

• Formulary (ACA-compliant plans)

  Commercial group/individual: Pref. specialty

  Medicare: T5

• What changed/notes

  PA required

  Est. annual cost: $73,000

• Effective date

  03/01/2016

DARZALEX
(daratumumab)

• Commonly used for:

  Multiple myeloma

• Formulary (ACA-compliant plans)

  Commercial group/individual: Pref. specialty*

  Medicare: Tier 5, B/D

• What changed/notes

  *Added coverage under medical benefit

  Est. annual cost: $166,000

• Effective date

  03/01/2016

DURLAZA
(aspirin ER)

• Commonly used for:

  Stroke and heart attack prevention

• Formulary (ACA-compliant plans)

  Commercial group/individual: Excluded

  Medicare: Excluded

• What changed/notes

  Excluded

  Est. annual cost: $2,160

• Effective date

  03/01/2016

EMPLICITI
(elotuzumab)

• Commonly used for:

  Multiple myeloma

• Formulary (ACA-compliant plans)

  Commercial group/individual: Pref. specialty*

  Medicare: Tier 5, B/D

• What changed/notes

  *Added coverage under medical benefit

  Est. annual cost: $160,000

• Effective date

  03/01/2016

GENVOYA
(elvitegravir/cobicistat/ emtricitabine/tenofovir alafenamide)

• Commonly used for:

  HIV

• Formulary (ACA-compliant plans)

  Commercial group/individual: Pref. specialty

  Medicare: Tier 5

• What changed/notes

  QL: 1 tablet daily

  Est. annual cost: $31,000

• Effective date

  03/01/2016

GLEOSTINE
(lomustine, CCNU)

• Commonly used for:

  Brain tumors or Hodgkin's disease

• Formulary (ACA-compliant plans)

  Commercial group/individual: Pref. brand

  Medicare: Tier 3

• What changed/notes

  Added to formulary

  Est. annual cost: $5,500

• Effective date

  03/01/2016

IMLYGIC
(talimogene)

• Commonly used for:

  Malignant melanoma

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. specialty*

  Medicare: Part B

• What changed/notes

  PA required

  Est. annual cost: $194,000

• Effective date

  03/01/2016

NINLARO
(ixazomib)

• Commonly used for:

  Multiple myeloma

• Formulary (ACA-compliant plans)

  Commercial group/individual: Pref. specialty

  Medicare: Tier 5

• What changed/notes

  QL: 3 capsules every 28 days

  Est. annual cost: $113,000

• Effective date

  03/01/2016

NUCALA
(mepolizumab)

• Commonly used for:

  Asthma

• Formulary (ACA-compliant plans)

  Commercial group/individual: Pref. specialty*

  Medicare: Part B

• What changed/notes

  PA required

  Est. annual cost: $32,500

• Effective date

  03/01/2016

NUWIQ
(coagulation factor VIII [recombinant])

• Commonly used for:

  Hemophilia A

• Formulary (ACA-compliant plans)

  Commercial group/individual: Pref. specialty

  Medicare: Part B

• What changed/notes

  Must be ordered from a Network Hemophilia Pharmacy

  Est. annual cost: Varies

• Effective date

  03/01/2016

ONIVYDE
(irinotecan)

• Commonly used for:

  Pancreatic cancer

• Formulary (ACA-compliant plans)

  Commercial group/individual: Pref. specialty*

  Medicare: Part B

• What changed/notes

  PA required

  Est. annual cost: $120,000

• Effective date

  03/01/2016

OXAYDO
(oxycodone)

• Commonly used for:

  Pain

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. brand

  Medicare: NF

• What changed/notes

  PA required

  ST: Must first try two of the following: immediate-release hydromorphone, methadone, morphine sulfate, oxycodone and oxymorphone for Commercial

  Manufacturer has not signed a coverage gap discount program agreement for Medicare

  Est. annual cost: $24,000

• Effective date

  03/01/2016

SEEBRI NEOHALER
(glycopyrrolate)

• Commonly used for:

  COPD

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. brand

  Medicare: Tier 3

• What changed/notes

  QL: 1 inhaler every 30 days

  AL: must be age 40 or older

  Est. annual cost: $3,600

• Effective date

  03/01/2016

STRENSIQ
(asfotase alfa )

• Commonly used for:

  Hypophosphatasia

• Formulary (ACA-compliant plans)

  Commercial group/individual: Pref. specialty

  Medicare: Tier 5

• What changed/notes

  PA required

  Limited distribution drug

  Est. annual cost: Varies

• Effective date

  03/01/2016

TAGRISSO
(osimertinib)

• Commonly used for:

  Non-small cell lung cancer

• Formulary (ACA-compliant plans)

  Commercial group/individual: Pref. specialty

  Medicare: Tier 5

• What changed/notes

  PA required

  QL: 1 tablet daily

  Est. annual cost: $153,000

• Effective date

  03/01/2016

TOLAK
(fluorouracil)

• Commonly used for:

  Actinic keratosis

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. brand

  Medicare: Tier 4

• What changed/notes

  QL: 1 tube every 30 days

  Est. annual cost: $1,350

• Effective date

  03/01/2016

TRESIBA FLEXTOUCH
(insulin degludec )

• Commonly used for:

  T2DM

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. brand

  Medicare: Tier 4

• What changed/notes

  ST: Must first try Lantus for commercial

  Est. annual cost: $6,000 (1 box/month)

• Effective date

  03/01/2016

UTIBRON NEOHALER
(indacaterol/glycopyrrolate)

• Commonly used for:

  COPD

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. brand

  Medicare: Tier 3

• What changed/notes

  QL: 1 inhaler every 30 days

  Must be age 40 or older

  Est. annual cost: $3,600

Effective date

03/01/2016

VARUBI
(rolapitant)

• Commonly used for:

  Chemotherapy-induced nausea and vomiting

• Formulary (ACA-compliant plans)

  Commercial group/individual: NF

  Medicare: Part B

• What changed/notes

  Not added to commercial formulary

  Est. cost: $530/dose

• Effective date

  03/01/2016

VIBERZI
(eluxadoline)

• Commonly used for:

  IBS-D

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. brand

  Medicare: NF

• What changed/notes

  Added to commercial formulary

  Manufacturer has not signed a coverage gap discount program agreement for Medicare

  Est. annual cost: $11,520

• Effective date

  03/01/2016

YONDELIS
(trabectedin)

• Commonly used for:

  Soft-tissue sarcoma

• Formulary (ACA-compliant plans)

  Commercial group/individual: Pref. specialty*

  Medicare: Part B

• What changed/notes

  Added coverage under medical benefit

  PA required

  Est. annual cost: $138,000

• Effective date

  03/01/2016

The P&T Committee reviewed the medical criteria for 50 drugs on the Approved Drug List

Prior authorization requirements were updated for the following drugs were update. Go to the drug auth forms page for details:

Actemra Amitriptyline (Medicare) Androderm Androgel Aveed Axiron Daliresp (Commercial, Medicaid) First-Testosterone

Fortesta Olysio (Medicare) Opdivo Sovaldi (Medicare) Striant Testim Testopel Yervoy (Commercial, Medicaid)

No changes were made to the following prior authorization requirements:

Abilify (Medicare) Adempas Boniva IV (Commercial, Medicaid) Botulinum toxin Cialis (Medicare) Daliresp (Medicare) Digoxin (Medicare) Esbriet Eszopiclone (Medicare) Fabrazyme (Commercial, Medicaid) Fulyzaq (Commercial, Medicaid) Hyaluronic acid derivatives (Commercial, Medicaid) Imbruvica Increlex (Commercial, Medicaid) Lemtrada (Commercial, Medicaid) Lucentis (Commercial, Medicaid) Macugen (Commercial, Medicaid) Myalept (Commercial, Medicare)

Nebupent (Medicare) Ofev Omega-3-acid ethyl esters (Commercial, Medicaid) Opsumit Phenobarbital (Medicare) Remodulin (Commercial, Medicaid) Revatio Ruconest (Commercial) Sovaldi (Commercial) Suboxone (Medicare) Surmontil (Medicare) Torisel (Medicare) Tyvaso Valchlor Vascepa Viekira Pak Xiaflex

Note: For the precertification requirements for medications requiring prior approval, visit the Drug authorizations forms page and click on the applicable prior authorization form.