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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

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.

Published on: March 29, 2021, 02:31 a.m. ET
Last updated on: March 25, 2021, 07:15 a.m. ET