Commercial formulary changes coming July 1, 2020

Update: As of Jun. 9, 2020, the Priority Health pharmacy department made the decision not to move forward with the proposed changes (outlined below) to Ozempic and Victoza for the Commercial Traditional formulary. Learn more about this update. 

In July and January 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.

So far in 2020, we’ve added 45 new drugs to the formulary. We’ve also made positive changes (reduced tier or removal of authorization requirement) on 11 drugs, which helps make them more affordable to our members.

On July 1, 2020, we’ll have 28 drug changes that either remove a drug from the formulary or increase the tier the drug is in. These changes impact approximately 3,420 unique members.

Changes to diabetes medications

Of the members impacted, 51% (1,728) are impacted by a change to a diabetes medication.

To mitigate the member and provider impact of these changes, we’ll be proactively entering authorizations for impacted members. Providers will need to work with their patients prior to July 1, 2020 to write a prescription for the new medication.

For example: If a member is taking Ozempic or Victoza, which will have a tier increase and require step therapy through Trulicity effective July 1, 2020, the pharmacy team will proactively enter an authorization for Trulicity for that member. The provider will not have to go through the prior authorization process, eliminating a significant barrier for this transition. The member will still need to work with their provider to get a new prescription for Trulicity.

Drug class Drug Change to Traditional formulary Change to Optimized formulary
  • Ozempic
  • Victoza

Increase tier, add step therapy through Trulicity

Current users can change to Trulicity immediately (no new prior authorization required)

Increase tier, update prior authorization to require use of Trulicity prior to approval

Current users can change to Trulicity immediately (no new prior authorization required)

  • Farziga
  • Jardiance
  • Glyxambi
  • Invokana
  • Xigduo XR
  • Synjardy XR
  • Qtern
  • Synjardy
  • Invokamet
  • Steglujan
  • Invokamet XR
N/A (no changes)

Tier increase; update prior authorization to require steglatro or segluromet (preferred drugs in class)

Current users can change to steglatro or segluromet immediately (no new prior authorization required)

  • Symlinpen 60
  • Symlinpen 120
Tier increase Tier increase

Other formulary changes

Of the members impacted, 37% (1,256) are impacted by changes to the following three drugs.

Drug Common use Change type
Budesonide Asthma, bronchospasm prophylaxis Tier increase
Dotti Secondary symptoms of menopause Tier increase
Latuda Schizophrenia, bipolar depression Tier increase

How we’re communicating to our members

Members who are impacted by any changes to the formulary receive a letter advising them of how their drug coverage will be changing and what steps they can take prior to July 1, 2020. The letters also include a list of alternative medications that may be options for them.

Learn more

Our May 21 Virtual Office Advisory webinar will cover these changes. Join us to ask questions and learn more