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.