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Formulary Updates: Q2 2022

Horizon’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 second quarter of 2022.

COMMERCIAL FORMULARY

Added to Non-Preferred Status following re-evaluation

Brand Name Generic Name Prior Authorization (Y/N)
Descovy® emtricitabine/tenofovir N

Moved to Preferred Status from Non-Preferred Status

Brand Name Generic Name Prior Authorization (Y/N)
Xarelto 1mg/mL solution® rivaroxban N

Remaining in Non-Preferred Status following review

Brand Name Generic Name Prior Authorization (Y/N)
Tarpeyo™ budesonide Y
Vuity™ pilocarpine hydrochloride Y
Besremi® ropeginterferon alfa-2b-njft Y
Livtencity™ maribavir Y
Scemblix® asciminib Y
Tavneos® avacopan Y
Livmarli® maralixibat Y
Qulipta™ atogepant Y
Opzelura™ ruxolitinib Y
Lybalvi® olanzapine/samidorphan Y
Winlevi® clascoterone Y
Tyrvaya™ varenicline solution Y

MEDICARE FORMULARY

Added to the Medicare Formulary

Brand Name Generic Name Prior Authorization (Y/N)
Prehevbrio™ hepatitis B vaccine n/a

Not covered in the Medicare Formulary

Brand Name Generic Name Prior Authorization (Y/N)
Adbry™ tralokinumab n/a
Cibinqo™ abrocitinib n/a
Tarpeyo™ budesonide n/a
Tezspire™ tezepelumab-ekko n/a
Dartisla glycopyrrolate n/a
Twyneo® tretinoin/benzoyl peroxide n/a
Seglentis® celecoxib and tramadol hydrochloride n/a
Pyrukynd® mitapivat n/a
Ibsrela® tenapanor n/a
Releuko™ filgrastim-ayow 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: June 6, 2022, 12:29 p.m. ET
Last updated on: June 6, 2022, 11:17 a.m. ET