Update to July 1 commercial formulary changes

Earlier this year, we communicated July 1, 2020 changes to our commercial formularies (traditional and optimized).

We've made the decision not to move forward with the July 1 formulary change previously planned for diabetes medications Ozempic and Victoza, for our Traditional formulary. This change would have increased the tier and added step therapy through Trulicity for both drugs.

All changes planned for the Optimized formulary will still be implemented on July 1, 2020.

Background

The cost of drugs used to treat diabetes is on the rise. In the most recent 12-month period, GLP-1 receptor antagonist drug spend has increased 40% in the Priority Health commercial population, on top of a 30% increase in 2019.

The Priority Health pharmacy department and the Pharmacy and Therapeutics (P&T) committee worked to address this concern by recommending a formulary change in the GLP-1 receptor antagonist class that would move Ozempic and Victoza to Tier 3 (non-preferred brand) with a step through Trulicity first. The decision was made because clinical efficacy and safety data among the GLP-1 options is similar, but the net cost of Trulicity is nearly $1,000 less per year after all negotiated discounts.

Although the change was anticipated to go into effect July 1 for both the commercial Optimized and traditional formularies, the change is being placed on hold for the Traditional formulary and will be re-evaluated for 2021.

Many of our members have already switched to Trulicity, and we continue to encourage our providers to prescribe Trulicity as the most cost-effective option.