Changes in TREMFYA coverage coming Apr. 1, 2025

Beginning Apr. 1, 2025, TREMFYA® will no longer be covered under the medical or pharmacy benefit for our commercial group and individual members.

How will this impact your patients?

Your patients currently being treated with, or who’ve been approved for, TREMFYA will remain covered and won’t be affected by this change. In July, TREMFYA will move from a tier 4 to a tier 5 drug for these patients and will be removed from the SaveOnSP drug list for those eligible to participate in the SaveOnSP program.

Patients looking to start treatment with TREMFYA should consider a formulary alternative or will be responsible for the full cost of the medication after April 1.

Formulary alternatives include:

•  Simlandi® and adalimumab-adaz (with prior authorization requirements)
• Hadlima™ and adalimumab-adbm (with prior authorization requirements)
• Renflexis® (site of service requirements apply)
• Inflectra® (site of service requirements apply)
• Xeljanz® (with prior authorization requirements)

What’s TREMFYA?

TREMFYA is a prescription drug used to treat adults with psoriatic arthritis, active ulcerative colitis and plaque psoriasis.

Potential changes coming for ustekinumab and Stelara® biosimilars

As the biosimilars market continues to grow, our pharmacy team is evaluating our coverage of Stelara and Stelara biosimilars. Keep an eye out for more information in the coming weeks.

Why the change?

As the market changes, we’re committed to assessing and updating our formularies to ensure our members have access to the most affordable and effective therapies. We appreciate you working alongside us to support medication adherence and help patients get the care they need.