Formulary changes coming July 1, 2022

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

Commercial and Individual formulary changes effective July 1, 2022

This year we’ve made more than 80 enhancements to the commercial formulary, including 49 new drugs added to the formulary and changes to 34 current drugs.

Effective July 1, 2022, 55 drug changes will go into effect that will either remove a drug from the formulary, increase the drug tier, add step therapy and/or add prior authorization. These changes will impact 556 members.

Additionally, diabetes coverage for GLP-1 drugs will limit optimized members to one month supply and some may also experience higher cost share due to tier increases. For members with a traditional plan, GLP-1 drug coverage will now require a diabetes diagnosis. These changes will impact 361 optimized members and 752 traditional members.

Formulary changes impacting 1 to 50+ members

Drug	Common Use	Change Type	Preferred Alternatives	Anticipated Severity	Members Impacted
Alvesco inhaler	Asthma	Prior Authorization Required	Arnuity/Flovent/Qvar	Medium	1
Ambien	Insomnia	Prior Authorization Required	Zolpidem	High	1
Amiodarone 400mg	Ventricular Fibrillation	Remove from formulary	Amiodraone 200mg tablets	Medium	22
Aplenzin	Depression	Prior Authorization Required	Bupropion ER tablet/bupropion tablet/bupropion SR tablet	Medium	1
Beconase AQ Nasal Spray	Nasal Allergies	Prior Authorization Required	Amiodarone 200mg tablets	Medium	1
Breo Ellipta	Asthma/COPD	Prior Authorization Required	Dulera/ Symbicort/ Wixela/fluticasone-salmeterol inhaler	High	13
Carisoprodol	Muscle Relaxer	Prior Authorization Required	Cyclobenzaprine/methocarbamol/tizanidine/baclofen	High	10
Chlorzoxazone 500mg	Muscle Relaxer	Tier Increase (1/1b to 3)	Baclofen/cyclobenzaprine	Medium	71
Clobetasol Foam	Topical Inflammatory Conditions	Prior Authorization Required	Clobetasol ointment/Clobetasol cream/Clobetasol gel/Clobetasol solution	Medium	4
Cyclosporine capsules (unmodified)	Anti-rejection for organ transplant	Tier Increase (1/1b to 3)	Cyclosporine, modified	High	14
Dexilant	GERD	Prior Authorization Required	Iansoprazole/Omeprazole/Nexium 24hr 20mg delayed-release tablet (OTC)/Pantoprazole/Rabeprazole	High	3
Epiduo Forte Gel	Acne	Prior Authorization Required	Adapalene- benzoyle peroxide gel 0.1-205%	Low	1
Fluoxetine tablet	Depression	Prior Authorization Required	Fluoxetine capsule	High	5
Genotropin	Human growth hormone replacement	Remove from fomulary	Norditropin	High	9
Horizant	Restless legs syndrome	Prior Authorization Required	Gabapentin/Ropinirole/Pramipexole	Medium	1
Indocin Suspension	Pain/Inflammation	Prior Authorization Required	Indomethacin capsules	Medium	1
Invokamet	Type 2 Diabetes	Step Therapy Required	Synjardy, Xigduo, Jardiance or Farxiga	Medium	1
Invokana	Type 2 Diabetes	Step Therapy Requied	Jardiance, Farxiga, Synjardy or Xigduo	Medium	15
Keppra	Seizures	Prior Authorization Required	Levetiracetam	High	1
Levothyroxine capsule	Hypothyroidism	Prior Authorization Required	Levothyroxine tablet/Levoxyl/Unithroid	Medium	1
Livalo	Hypercholesterolemia	Prior Authorization Required	Pravastatin/Rosuvastatin/Atorvastatin/Lovastatin/Simvastatin	High	24
Mesalamine DR 1.2gm tablets	Ulcerative Colitis	Tier Increase (1 to 3)	N/A	Medium	1
Minocycline extended-release tablet	Acne	Prior Authorization Required	Minocycline/Doxycycline	Low	1
Olanzapine-Fluoxetine capsule	Depression	Prior Authorization Required	Olanzapine/Fluoxetine	Medium	2
Omnaris nasal spray	Nasal allergies	Prior Authorization Required	Fluticasone nasal spray/ Flunisolide nasal spray/ Mometasone nasal spray/ Triamcinolone nasal spray	Medium	1
Oracea	Acne	Prior Authorization Required	Minocycline/Doxycycline	Medium	1
Oxandrolone	Anabolic Steroid	Tier Increase (2 to 3)	None	Low	2
Potassium Chloride 10% Solution	Hypokalemia	Tier Increase (1/1b to 3)	Potassium Chloride tablets/capsules	Medium	32
Pulmicort	Asthma	Prior Authorization Required	Arnuity/Flovent/Qvar	Medium	1
Pyridostigmine extended-release tablet	Myasthenia gravis	Prior Authorization Required	Pyridostigmine tablet	Medium	2
Qbrexza	Pulmonary axillary hyperdidrosis	Prior Authorization Required	Drysol/Glycopyrrolate/Propranolol	Medium	1
Qnasl Nasal Spray	Nasal allergies	Prior Authorization Required	Fluticasone nasal spray/ Flunisolide nasal spray/ Mometasone nasal spray/ Triamcinolone nasal spray	Medium	10
Ranexa	Chronic angina	Prior Authorization Required	Ranolazine ER tablet	High	1
Rasuvo	Rheumatoid Arthritis	Prior Authorization Required	Methotrexate injection	Medium	1
Retin A Microspheres Pump and Gel (including generic)	Acne	Remove from formulary	Tretinoin gel/Tretinoin cream/Adapalene cream	Low	4
Rhopressa	Glaucoma	Prior Authorization Required	Dorzolamide/Timolol	Medium	1
Siklos	Sickle Cell Disease	Remove from fomulary	Hydroxyurea 500mg	Low	1
Sucralfate Suspension	Ulcers	Tier Increase (1/1b to 2)	Sucralfate tablets	High	226
Sumatriptan-Naproxen tablet	Migraines	Prior Authorization Required	Sumatriptan/Naproxen	Medium	1
Synthroid	Hypothyroidism	Prior Authorization Required	Levothyroxine tablet/Levoxyl/Unithroid	High	1
Tegretol	Seizures	Prior Authorization Required	Carbamazepine	High	1
Testosterone 1.62% packet	Hypogonadism	Prior Authorization Required	Testosterone 1.62% gel pump	Medium	2
Testosterone 2% gel pump	Hypogonadism	Prior Authorization Required	Testosterone 1.62% gel pump, Testosterone 1% gel	Medium	1
Testosterone Solution Pump	Hypogonadism	Prior Authorization Required	Testosterone 1.62% gel pump, Testosterone 1% gel	Medium	3
Tetracycline	Acne	Tier Increase (1/1a to 3)	Doxycycline/Minocycline	Low	10
Tirosint Capsule	Hypothyroidism	Prior Authorization Required	Levothyroxine tablet/Levoxyl/Unithroid	Medium	13
Tresiba	Diabetes	Prior Authorization Required	Lantus/Toujeo	High	8
Trileptal	Seizures	Prior Authorization Required	Oxcarbazepine	High	2
Trokendi	Seizures	Prior Authorization Required	Topiramate	High	2
Tudorza	Chronic Obstructive Pulmonary Disease	Prior Authorization Required	Incruse Ellipta/Spriva	Medium	1
Vardenafil*	Erectile Dysfunction	Remove from formulary	Sildenafil/Tadalafil	Medium	19
Vyzulta	Glaucoma	Prior Authorization Required	Bimatoprost/Lantanoprost	Medium	1
Wellbutrin	Depression	Prior Authorization Required	Bupropion ER tablet/bupropion tablet/bupropion SR tablet	High	2
Zetonna	Allergic Rhinitis	Prior Authorization Required	Fluticasone nasal spray/ Flunisolide nasal spray/ Mometasone nasal spray/ Triamcinolone nasal spray	Medium	1

*Sexual dysfunction rider required

GLP-1 class changes impacting 0-50+ members

Drug	Common Use	Change Type	Preferred Alternatives	Anticipated Severity	Members Impacted
Trulicity-Traditional	Diabetes	No Prior authorization required if diagnosis for Type 2 Diabetes on file	N/A	Low	204
Trulicity-Optimized	Diabetes	None-Prior Authorization already required	N/A	None	0
Bydureon- Traditional	Diabetes	No Prior authorization required if diagnosis for Type 2 Diabetes on file	Trulicity	Low	2
Bydureon-Optimized	Diabetes	No Prior authorization required if diagnosis for Type 2 Diabetes on file	Trulicity	Low	11
Byetta-Traditional	Diabetes	No Prior authorization required if diagnosis for Type 2 Diabetes on file	Trulicity	None	0
Byetta-Optimized	Diabetes	Tier Increase (3 to 5)	Trulicity	None	0
Ozempic- Traditional	Diabetes	No Prior authorization required if diagnosis for Type 2 Diabetes on file	Trulicity	Low	470
Ozempic- Optimized	Diabetes	Tier Increase (3 to 5)	Trulicity	High	253
Victoza- Traditional	Diabetes	No Prior authorization required if diagnosis for Type 2 Diabetes on file	Trulicity	Low	78
Victoza- Optimized	Diabetes	Tier Increase (3 to 5)	Trulicity	Low	59
Adlyxin- Traditional	Diabetes	No Prior authorization required if diagnosis for Type 2 Diabetes on file	Trulicity	None	0
Adlyxin- Optimized	Diabetes	Tier Increase (3 to 5)	Trulicity	None	0

How we're communicating to members

Impacted members will receive a letter advising them of their drug coverage changes and what steps they can take prior to July 1, 2022. The letters will include options for covered alternatives and if they are impacted by GLP-1 changes, diagnosis requirements will be outlined for continuation of their medication.

What do you need to do?

You can proactively reach out to your patients impacted by these changes by referring to the member impact list your provider performance specialist shared with you and offering alternative treatment options. Your patients may also reach out to you to discuss alternative medications or how to submit a proper diagnosis to us.

Learn more

These changes will be reviewed at our June 9 Virtual Office Advisory. Join us to ask questions and learn more.