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Formulary Updates: Q2 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)

Gavreto™

pralsetinib

Y

Kesimpta®

ofatumumab

Y

Lynparza®

olaparib

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)

Hemady™

dexamethasone

Y

Bonsity™

teriparatide

Y

Cystadrops®

cysteamine ophthalmic solution

Y

Conjupri®

levamlodipine

Y

Qdolo™

tramadol hydrochloride oral solution

Y

Gimoti™

metoclopramide nasal spray

Y

Alkindi Sprinkle®

hydrocortisone

Y

Phexxi™

lactic acid, citric acid, and potassium bitartrate vaginal gel

N

Annovera®

segesterone acetate and ethinyl estradiol vaginal system

N

Impeklo™

clobetasol lotion

Y

Zypitamag™

pitavastatin magnesium

Y

Xywav™

calcium, magnesium, potassium, and sodium oxybates

Y

Cequa™

cyclosporine

Y

Lampit®

nifurtimox

N

Onureg®

azacitidine

Y

Ongentys®

opicapone

Y

Orladeyo™

berotralstat

Y

MEDICARE FORMULARY

Added to the Medicare formulary

Brand Name

Generic Name

Prior Authorization (Y/N)

Cosela™

trilaciclib

Y

Drizalma Sprinkle 20 mg, 30 mg, 40 mg, 60 mg

duloxetine delayed-release capsule

N

Not covered in the Medicare formulary

Brand Name

Generic Name

Prior Authorization (Y/N)

Evkeeza™

evinacumab

n/a

Verquvo™

vericiguat

n/a

Plegridy IM®

peginterferon beta-1a

n/a

Bronchitol®

mannitol

n/a

Lupkynis™

voclosporin

n/a

Vesicare LS™

solifenacin

n/a

Amondys 45™

casimersen

n/a

Klisyri®

tirbanibulin

n/a

Roszet™

ezetimibe/rosuvastatin

n/a

Ponvory™

ponesimod

n/a

Zegalogue®

dasiglucagon

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: July 13, 2021, 06:07 a.m. ET
Last updated on: July 13, 2021, 08:22 a.m. ET