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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

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

Published on: January 11, 2021, 01:47 a.m. ET
Last updated on: January 7, 2021, 05:46 a.m. ET