Formulary Updates: August 2020 P&T Committee Meeting
Horizon BCBSNJ’s Pharmacy and Therapeutics (P&T) Committee meets quarterly to review new drugs, drug classes, clinical indications, therapeutic advantages, chemical entities and safety information to help ensure that our formularies encourage the use of safe, effective and affordable drugs by our members.
The tables below outline changes determined for our Commercial and Medicare Formularies at the P&T Committee meeting held in August 2020.
In the past, notices about P&T Committee determinations have been included in our quarterly Blue Review newsletter. Going forward these updates will be posted under News & Legal Notices.
COMMERCIAL FORMULARY
Below are the changes determined for our Commercial Formulary at the August 2020 P&T Committee meeting.
MOVED FROM NON-PREFERRED TO PREFERRED STATUS
Brand Name |
Generic Name |
Prior Authorization (Y/N) |
Valtoco® |
diazepam nasal spray |
N |
AyvakitTM |
avapritinib |
Y |
Tazverik® |
tazemetostat |
Y |
RE-EVALUATED AND ADDED TO THE PREFERRED STATUS
Brand Name |
Generic Name |
Prior Authorization (Y/N) |
Repatha® |
evolocumab |
Y |
Baqsimi® |
glucagon nasal powder |
N |
Dovato® |
dolutegravir and lamivudine |
N |
Soliqua® |
insulin glargine and lixisenatide injection |
Y |
Xultophy® |
insulin degludec and liraglutide injection |
Y |
RE-EVALUATED AND ADDED TO THE NON-PREFERRED STATUS
Brand Name |
Generic Name |
Prior Authorization (Y/N) |
Onglyza® |
saxagliptin |
Y |
Kombiglyze® XR |
saxagliptin and metformin |
N |
Omnipod DASH® |
insulin management system |
Y |
REVIEWED AND REMIAINING IN in NON-PREFERRED STATUS
Brand Name |
Generic Name |
Prior Authorization (Y/N) |
UbrelvyTM |
ubrogepant |
Y |
NurtecTM ODT |
rimegepant |
Y |
Revyow® |
lasmiditan |
Y |
Secuado® |
asenapine |
Y |
Caplyta® |
lumateperone |
Y |
Gloperba® |
colchicine oral solution |
Y |
Talicia® |
omeprazole magnesium, amoxicillin, and rifabutin |
N |
ZerviateTM |
cetirizine ophthalmic solution |
Y |
Jatenzo® |
testosterone undecanoate |
Y |
Riomet ERTM |
metformin HCL ER oral suspension |
Y |
Palforzia® allergen powder |
peanut (Arachis hypogaea) powder |
Y |
MEDICARE FORMULARY
Below are the changes determined for our Medicare Formulary at the August 2020 P&T Committee meeting.
ADDED TO THE MEDICARE FORMULARY
Brand Name |
Generic Name |
Prior Authorization (Y/N) |
Fintepla® |
fenfluramine |
Y |
Tivicay® |
dolutegravir |
N |
Darzalex FasproTM |
daratumumab-hyaluronidase-fihj |
Y |
PhesgoTM |
pertuzumab-trastuzumab-hyaluronidase-zzxf |
Y |
RukobiaTM |
fostemsavir tromethamine |
N |
TabrectaTM |
capmatinib |
Y |
ZepzelcaTM |
lurbinectedin |
Y |
Pemazyre® |
pemigatinib |
Y |
RetevmoTM |
selpercatinib |
Y |
TrodelvyTM |
sacituzumab govitecan-hziy |
Y |
QinlockTM |
ripretinib |
Y |
NOT COVERED IN THE MEDICARE FORMULARY
Brand Name |
Generic Name |
Prior Authorization (Y/N) |
OrtikosTM |
budesonide |
n/a |
Dayvigo® |
lemborexant |
n/a |
Zeposia® |
ozanimod |
n/a |
EvrysdiTM |
risdiplam |
n/a |
LicartTM |
diclofenac epolamine patch |
n/a |
Ferriprox® Twice-A-Day |
deferiprone |
n/a |
DojolviTM |
triheptanoin |
n/a |
AvsolaTM |
infliximab-axxq |
n/a |
Twirla® |
levonorgestrel-ethinyl estradiol patch |
n/a |
LyumjevTM |
insulin lispro-aabc |
n/a |
OriahnnTM |
elagolix-estradiol-norethindrone |
n/a |
Fensolvi® |
leuprolide |
n/a |
Mycapssa® |
octreotide |
n/a |
Bynfezia PenTM |
octreotide |
n/a |
NexlizetTM |
bempedoic acid-ezetimibe |
n/a |
Breztri AerosphereTM |
budesonide-glycopyrrolate-formoterol |
n/a |
PhexxiTM |
lactic acid-citric acid-potassium bitartrate gel |
n/a |
KynmobiTM |
apomorphine |
n/a |
ZilxiTM |
minocycline micronized |
n/a |
HelidacTM |
metronidazole-tetracycline w/bismuth subsalicylate |
n/a |
Formulary information is available online
- Review our Commercial Formulary
- Review our Medicare Formulary
- Review the Federal Employee Program® (FEP®) Formulary
This notice includes prescription brand name drugs that are registered marks or trademarks of pharmaceutical manufacturers that are not affiliated with either Horizon Blue Cross Blue Shield