Commercial and Medicare formulary changes coming Jan. 1, 2020
Effective Jan. 1, 2020, we’re making updates to our Medicare and commercial formularies.
Commercial formulary updates
In January and July of each year, the Priority Health Pharmacy and Therapeutics committee makes changes to our commercial formulary to ensure our members have access to safe, effective and affordable drugs.
So far in 2019, we’ve added 72 new drugs to the commercial formulary. We’ve also reduced the tier or removed step therapy or prior authorization on 28 drugs.
On Jan. 1, 2020, 128 formulary changes will either remove a drug from the formulary or increase the tier. These changes impact 4,225 members. Of those, approximately 70% are impacted by the following 10 drug changes:
| Drug name | Change type | Covered alternatives |
|---|---|---|
| Tretinoin 0.05% cream, 0.05% gel and 0.1% cream |
Tier increase |
Tretinoin 0.025% cream/gel and 0.1% gel, OTC products |
| Mesalamine DR 400mg, 800mg and 1.2gm |
Tier increase |
Mesalamine 4gm enema, Apriso, Lialda |
| Timolol Maleate 0.05% (generic Istalol only) | Remove from formulary | Timolol maleate (non-generic Istalol products), Timolol gel-forming eye drops |
| Pulmicort Flexhaler | Remove from formulary | Flovent, Arnuity, Qvar |
| Bydureon | Tier increase, add step therapy | Trulicity, Ozempic, Victoza |
| Myrbetriq | Tier increase | Oxybutynin IR/ER, Trospium IR, Tolterodine |
| Mupirocin calcium 2% cream | Remove from formulary | Mupirocin calcium 2% ointment |
| Creon | Tier increase | Zenpep, Pancreaze |
| Calcipotriene cream | Tier increase | Calcipotriene solution or ointment |
| Mesalamine 1000mg | Tier increase | Mesalalmine 4gm enema, Apriso, Lialda |
Medicare formulary updates
Effective Jan. 1, 2020, 96 drugs will be removed from the Medicare formulary, impacting 3,620 members. Many drugs are being removed because they are brands that now have generics on the market. Approximately 56% of members are impacted from the following 5 drug changes:
| Drug name |
Change type | Covered alternatives |
|---|---|---|
| Lyrica | Remove from formulary | pregabalin capsule (generic Lyrica) |
| Brimonidine Tartrate 0.15% | Remove from formulary | Brimonidine 0.2% |
| Basaglar Kwikpen | Remove from formulary | Lantus, Toujeo |
| Tresiba Flextouch | Remove from formulary | Lantus, Toujeo |
| Doxycycline Monohydrate 100mg tablets | Remove from formulary | Doxycycline Monohydrate 100mg capsules |
How we're communicating to members
Members impacted by any changes to our commercial or Medicare formularies will receive a letter by Dec. 1, 2020, explaining how their drug coverage will change and the steps they should take prior to Jan. 1, 2020. The letters also include a list of alternative medicines that may be options for them.
Learn more
Our Nov. 13, 2019 Virtual Office Advisory webinar will cover commercial and Medicare formulary changes coming Jan. 1, 2020. Register for the webinar so you can learn more or ask questions.