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 May 17, 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.

Advair

• Commonly used for:

  Asthma

• Formulary (ACA-compliant plans)

  Commercial group/individual: No change

  Medicare: No change

• What changed/notes

  ST: Requires a trial with Dulera or Symbicort for commercial members

  Est. annual cost: N/A

• Effective date

  07/01/2016

ADZENYS XR - ODT
(amphetamine)

• Commonly used for:

  ADHD

• Formulary (ACA-compliant plans)

  Commercial group/individual: NF

  Medicare: NF

• What changed/notes

  Not added to formulary

  Est. annual cost: $6,500

• Effective date

  07/01/2016

DAKLINZA
(daclatisvir)

• Commonly used for:

  Hepatitus C

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. specialty

Medicare: No change

• What changed/notes

  Moved from Preferred to Non-preferred for commercial members; they must use Zepatier for genotype 1 and 4

  Est. annual cost: N/A

• Effective date

  06/10/2016

DYNAVEL XR
(amphetamine)

• Commonly used for:

  ADHD

• Formulary (ACA-compliant plans)

  Commercial group/individual: NF

  Medicare: NF

• What changed/notes

  Not added to formulary

  Est. annual cost: $2,800

• Effective date

  07/01/2016

EMVERM
(mebendazole)

• Commonly used for:

  Pinworm infection

• Formulary (ACA-compliant plans)

  Commercial group/individual: Not covered

  Medicare: NF

• What changed/notes

  QL: Up to 6 tablets per claim

  ST: Must first try pyrantel and albendazole

  Est. annual cost: N/A

• Effective date

  07/01/2016

HARVONI
(ledipasvir/ sofosbuvir)

• Commonly used for:

  Hepatitius C

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. specialty

  Medicare: No change

• What changed/notes

  Moved from Preferred to Non-preferred for commercial members; they must use Zepatier for genotype 1 and 4

  Est. annual cost: N/A

• Effective date

  07/01/2016

IDELVION
(Factor IX albumin fusion protein, recombinant)

• Commonly used for:

  Hemophilia B

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. specialty, medical benefit

  Medicare: Part B

• What changed/notes

  Must use a network hemophilia pharmacy

  Est. annual cost: Varies

• Effective date

  07/01/2016

KOVALTRY
(antihemophilic factor, Factor VIII)

• Commonly used for:

  Hemophilia A

• Formulary (ACA-compliant plans)

  Commercial group/individual: Preferred specialty

  Medicare: Part B

• What changed/notes

  Must use a network hemophilia pharmacy

  Est. annual cost: Varies

• Effective date

  07/01/2016

ODEFSEY
(FTC/TAF/RPV)

• Commonly used for:

  HIV

• Formulary (ACA-compliant plans)

  Commercial group/individual: Preferred specialty

  Medicare: Tier 5

• What changed/notes

  QL: Once daily

  Est. annual cost: $28,000

• Effective date

  07/01/2016

QUILLICHEW ER
(methyphenidate)

• Commonly used for:

  ADHD

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. brand

  Medicare: NF

• What changed/notes

  AL: 4 years and up

  QL: Once daily

  Est. annual cost: $3,200

• Effective date

  07/01/2016

SPRITAM
(levetiracetam)

• Commonly used for:

  Seizures

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. brand

  Medicare: Tier 4

• What changed/notes

  QL: 3 packets daily

  ST: Must first try levetiracetam immediate release

  Est. annual cost: $7,800

• Effective date

  07/01/2016

TALTZ
(ixekizumab)

• Commonly used for:

  Plaque psoriasis

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. specialty

  Medicare: Tier 5

• What changed/notes

  PA required

  Est. annual cost: $79,000

• Effective date

  07/01/2016

TICANASE
(fluticasone)

• Commonly used for:

  Allergies

• Formulary (ACA-compliant plans)

  Commercial group/individual: NF

  Medicare: NF

• What changed/notes

  Not added to formulary

  Est. annual cost: $454,100

• Effective date

  07/01/2016

VISTOGARD
(uridine triacetate)

• Commonly used for:

  Emergency treatment of fluorouracil or capecitabine overdose

• Formulary (ACA-compliant plans)

  Commercial group/individual: Pref. specialty

  Medicare: Tier 5

• What changed/notes

  QL: 20 packets per 5 days

  Est. annual cost: $75,000

• Effective date

  07/01/2016

VRAYLAR
(cariprazine)

• Commonly used for:

  Schizophrenia/ bipolar disorder

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. brand

  Medicare: Tier 5

• What changed/notes

  ST: Must first try one of olanzapine, quetiapine, risperidone or ziprasidone for 28 days

  QL: Limited to 30 tablets in 30 days

  Est. annual cost: $12,240

• Effective date

  07/01/2016

XELJANZ XR
(tofacitinib)

• Commonly used for:

  Rheumatoid arthritis

• Formulary (ACA-compliant plans)

  Commercial group/individual: Non-pref. specialty

  Medicare: Tier 5

• What changed/notes

  PA required

  Est. annual cost: $38,000

• Effective date

  07/01/2016

XURIDEN
(uridine triacetate)

• Commonly used for:

  Hereditary orotic aciduria

• Formulary (ACA-compliant plans)

  Commercial group/individual: Not covered

  Medicare: Not covered

• What changed/notes

  Not added to formulary

  Est. cost: $22,500 per month

• Effective date

  07/01/2016

ZEMBRACE SYMTOUCH
(sumatriptan)

• Commonly used for:

  Migraine

• Formulary (ACA-compliant plans)

  Commercial group/individual: NF

  Medicare: Tier 5

• What changed/notes

  Not added to formulary

  Est. annual cost: N/A

• Effective date

  07/01/2016

ZEPATIER
(elbasvir and grazoprevir)

• Commonly used for:

  Hepatitis C

• Formulary (ACA-compliant plans)

  Commercial group/individual: Pref. specialty

  Medicare: Tier 5

• What changed/notes

  PA required

  Est. cost: $54,600 per 12 weeks

• Effective date

  06/10/2016

ZECUITY
(sumatriptan)

• Commonly used for:

  Migraine

• Formulary (ACA-compliant plans)

  Commercial group/individual: NF

  Medicare: No change

• What changed/notes

  Removing from formulary

  Est. annual cost: N/A

• Effective date

  07/01/2016

The P&T Committee reviewed the medical criteria for 23 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:

GAZYVA IBRANCE XALKORI ZOHYDRO ER

No changes were made to the following prior authorization requirements:

ERWINAZE FARYDAK JUXTAPID KADCYLA KORLYM KYNAMRO LAZANDA MAKENA NPLATE ORENITRAM ER

OSPHENA OTEZLA POMALYST PROLIA PROMACTA RAVICTI SANCUSO SEROSTIM VIMIZIA