Formulary Updates: Q1 2021
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 meetings held in the first quarter of 2021.
COMMERCIAL FORMULARY
Moved to Preferred Status from Non-Preferred Status
|
Brand Name |
Generic Name |
Prior Authorization (Y/N) |
|
Kynmobi™ |
apomorphine hydrochloride |
Y |
|
Tivicay PD® |
dolutegravir |
N |
|
Breztri Aerosphere™ |
budesonide, glycopyrrolate, and formoterol fumarate |
Y |
Added to Non-Preferred Status following re-evaluation
|
Brand Name |
Generic Name |
Prior Authorization (Y/N) |
|
Apokyn® |
apomorphine hydrochloride soln |
N |
Remaining in Non-Preferred Status following review
|
Brand Name |
Generic Name |
Prior Authorization (Y/N) |
|
Zilxi™ |
minocycline |
Y |
|
Upneeq® |
oxymetazoline hydrochloride |
N |
|
Twirla® |
levonorgestrel and ethinyl estradiol |
N |
|
Mycapssa |
octreotide |
Y |
|
Lyumjev™ |
insulin lispro-aabc |
Y |
|
Semglee™ |
insulin glargine |
N |
|
Bafiertam™ |
monomethyl fumarate |
Y |
|
Kesimpta® |
ofatumumab |
Y |
|
Nexletol® |
bempedoic acid |
Y |
|
Nexlizet™ |
bempedoic acid and ezetimibe |
Y |
|
Rukobia® |
fostemsavir |
Y |
|
Fintepla® |
fenfluramine |
Y |
|
Inqovi® |
decitabine and cedazuridine |
Y |
|
Koselugo™ |
selumetinib |
Y |
|
Dojolvi® |
triheptanoin |
Y |
|
Evrysdi™ |
risdiplam |
Y |
|
Enspryng™ |
satralizumab-mwge |
Y |
|
Pemazyre® |
pemigatinib |
Y |
MEDICARE FORMULARY
Added to the Medicare formulary
|
Brand Name |
Generic Name |
Prior Authorization (Y/N) |
|
Vaxelis™ |
diphtheria and tetanus toxoids and acellular pertussis, inactivated poliovirus, Haemophilus b conjugate and hepatitis B vaccine |
N |
|
Zokinvy™ |
lonafarnib |
Y |
|
Riabni™ |
rituximab-arx |
Y |
Not covered in the Medicare formulary
|
Brand Name |
Generic Name |
Prior Authorization (Y/N) |
|
Oxlumo™ |
lumasiran |
n/a |
|
Qdolo™ |
tramadol oral solution |
n/a |
|
Reltone™ |
urosodiol |
n/a |
|
Eysuvis™ |
loteprednol ophthalmic |
n/a |
|
Sutab® |
sodium sulfate, magnesium sulfate, and potassium chloride |
n/a |
|
Thyquidity™ |
levothyroxine |
n/a |
|
Winlevi® |
clascoterone cream |
n/a |
|
Orladeyo™ |
Berotralstat |
n/a |
|
Gemtesa® |
vibegron |
n/a |
|
Nyvepria™ |
pegfilgratim-apgf |
n/a |
Formulary information is available
- Review our Commercial formulary
- Review our Medicare formulary
- Review the Federal Employee Program® (FEP®) formulary
This document contains prescription brand name drugs that are registered marks or trademarks of pharmaceutical manufacturers that are not affiliated with either Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross Blue Shield Association.