From time to time, we add drugs to or remove them from Priority Health formularies and the Approved Drug List formulary lookup tool. 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 summary of the pending changes made by the P&T committee on Jan. 17, 2017.

Medicare Part D formulary 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.

INFLECTRA (infliximab-dyyb)

• Commonly used for: 

  Inflammatory conditions (e.g. Crohn's disease, Ulcerative colitis, etc.)

• Formulary (ACA-compliant plans):

  Commercial group/individual: Non-Preferred Specialty

  Medicare: Part D T5

• What changed/notes:

  PA for Commercial, Individual and Medicare

• Effective date:

  03/01/2017

LARTRUVO (olaratumab)

• Commonly used for:

  Soft tissue sarcoma

• Formulary (ACA-compliant plans):

  Commercial group/individual: Medical Benefit-Preffered Specialty

  Medicare: Part D T5

• What changed/notes:

  PA for all Lobs

  PA - B vs D for Medicare

• Effective date:

  03/01/2017

RAYALDEE (calcifediol)

• Commonly used for:

  Hyperparathyroidism

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-Formulary

  Medicare: Non-Formulary

• What changed/notes

  Not added to formulary

• Effective date

  03/01/2017

SUSTOL (granisetron ER subq injection)

• Commonly used for:

  Chemotherapy-induced nausea and vomiting

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-Formulary

  Medicare: Part D T5

• What changed/notes

  Not added to formulary for Commercial and Individual

  PA for Medicare

• Effective date

  03/01/2017

SYNAREL (nafarelin acetate)

• Commonly used for:

  Endometriosis

• Formulary (ACA-compliant plans)

  Commercial group/individual: Preferred specialty

  Medicare: No change

• What changed/notes

  Updated to Preferred Specialty

• Effective date

  03/01/2017

TAYTULLA (norethindrone acetate 1 mg, ethinyl estradiol 20 mcg, ferrous fumarate 75 mg)

• Commonly used for:

  Contraceptive

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-preferred brand

  Medicare: Part D T4

• What changed/notes

  Added as Non-Preferred Brand

• Effective date

  03/01/2017

The P&T Committee reviewed the medical criteria for 56 drugs on the Approved Drug List

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

Actermra Aubagio Avonex Betaseron Cimzia Cosentyx Enbrel

Extavia Glatopa Humira Kineret Orencia Otezla Plegridy

Rebif Remicade Simponi Soliris Stelara Taltz Tecfidera

Vascepa - Commercial Xeljanz Yervoy Zinbryta

No changes were made to the following prior authorization requirements:

Boniva Esbriet Fabrazyme First Testosterone Fortesta Imlygic Increlex

Lemtrada Lucentis Macugen Myalept Natesto Nebupent Non-Covered Medication

Ofev Olysio Onivyde Opsumit Phenobarbital Remodulin Ruconest

Strensiq Striant Surmontil Synribo Tagrisso Tyvaso Valchlor

Vascepa - Medicare Xiaflex Yondelis