July 1, 2021 commercial formulary changes

In January and July of each year, the Priority Health Pharmacy and Therapeutics committee makes changes to the commercial formulary to ensure our members have access to safe, effective and affordable drugs.

This year we've made more than 65 positive formulary changes, including 41 new drugs and changing 18 current drugs.

Effective Jul. 1, 2021, 17 changes will go into effect that will either remove a drug from the formulary, increase the tier the drug is in, or add step therapy or prior authorization.

These changes will impact 359 members.

Commercial formulary changes impacting 10+ members

Drug Common use Change type Anticipated severity Covered alternatives Members impacted
Descovy Human Immunodeficiency Virus Remove from formulary High emtricitabine-tenofovir (generic truvada – on formulary 07/01/2021) 148
Naproxen DR Pain/inflammation Remove from formulary Medium Regular release naproxen, ibuprofen, meloxicam 87
Propafenone ER Cardiac arrhythmias Increase tier Medium Propafenone immediate release, flecainide, amiodarone 34
Topiramate ER sprinkle capsules Seizures/migraines Add step therapy Medium Topiramate tablets, topiramate immediate release sprinkle capsules (requires step therapy with topitamate tablets) 31
Udenyca (medical drug) Glaucoma Tier increase Medium Latanoprost eye drops, timolol eye drops 11
Veltassa Hyperkalemia Add step therapy Medium Sodium polystyrene sulfonate, kionex, lokelma 10

Commercial formulary changes impacting <5

Drug Common use Change type Anticipated severity Covered alternatives Members impacted
Prednisolone solution (20mg/5ml only) Allergic reactions, endocrine disorders, various others Remove from formulary Low- other strengths still available Prednisolone oral solution 15mg/5ml, prednisolone sodium phosphate oral solution 6.7mg (5 base)/5ml, 15mg/5ml, or 25mg/5ml 4
Ziextenzo (Medical Drug) Neutropenia (low white blood cell count) Remove from formulary Low – other biosimilars still available Neulasta, Fulphila, or Nyvepria 4
Chlorzoxazone -brand and generic - (375mg and 750mg) Muscle relaxer Remove from formulary Low - other strengths still available Chlorzoxazone 500mg, cyclobenzaprine, methocarbamol 3
Alinia (oral suspension only) Diarrhea due to Giardia lambia or Cyryptosporidium parvum Tier increase Medium Metronidazole, vancomycin IV (reconstituted and taken by mouth), Firvanq 2
Oxandrolone (traditional only) Promotion of weight gain, offset protein catabolism due to prolonged corticosteroid use, bone pain from osteoporosis Tier increase Medium Megestrol acetate 1
Cromolyn nebulizer solution Asthma Remove from formulary Medium Arnuity, Flovent, levalbuterol tartrate HFA 1
Levorphanol Pain Remove from formulary High Morphine ER, oxycontin ER 1
Tolazamide (500mg only) Hyperglycemia Tier increase Low tolazamide 250mg, glimepiride, glipizide 0
Risedronate (30mg only) Osteoporosis Tier increase, addition of step therapy Low Alendronate, risedronate 5mg, 35mg, DR 35 mg, 150mg, or ibandronate 0
Methyltestosterone Cancer Add authorization and increase tier Low Injectable testosterone for primary hypogonadism 0

How we're communicating to members

Commercial members impacted by changes will receive a letter advising them of how their drug coverage will be changing and what steps they can take prior to Jul. 1, 2021. The letters also include a list of alternative medications that may be options for them.

What do providers need to do?

Providers may proactively reach out to members whose drug is being removed from the formulary, with an alternative treatment or prescription.  Members may also reach out to their provider to ask about alternative treatment options.

Learn more

Our June 10 Virtual Office Advisory will cover these changes. Join us to ask questions and learn more.