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Formulary Updates: Q3 2021

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 third quarter of 2021.

COMMERCIAL FORMULARY

Moved to Preferred Status from Non-Preferred Status

Brand Name Generic Name Prior Authorization (Y/N)
Orgovyx™ relugolix Y
Tepmetko® tepotinib Y
Ukoniq® umbralisib Y
Fotivda® tivozanib Y

Added to Preferred Status following re-evaluation

Brand Name Generic Name Prior Authorization (Y/N)
Forteo® teriparatide injection N
Movantik® naloxegol Y

Added to Non-Preferred Status following re-evaluation

Brand Name Generic Name Prior Authorization (Y/N)
Mitigare® Colchicine N

Remaining in Non-Preferred Status following review

Brand Name Generic Name Prior Authorization (Y/N)
Zokinvy® lonafarnib Y
Klisyri® tirbanibulin Y
Imcivree™ setmelanotide Y
Hetlioz LQ® tasimelteon oral suspension Y
Gemtesa® vibegron Y
Verquvo® vericiguat Y
Lupkynis™ voclosporin Y
Eysuvis® loteprednol etabonate Y
Ponvory™ ponesimod Y
Bronchitol® mannitol N
Sutab® sodium sulfate, magnesium sulfate, and potassium chloride Y
Xolair® calcium, magnesium, potassium, and sodium oxybates Y

MEDICARE FORMULARY

Added to the Medicare Formulary

Brand Name Generic Name Prior Authorization (Y/N)
Kloxxado™ naloxone N

Not covered in the Medicare Formulary

Brand Name Generic Name Prior Authorization (Y/N)
Norgesic Forte orphenadrine-ASA-caffeine n/a
Brexafemme ibrexafungerp n/a
Aduhelm™ aducanumab n/a
Nextstellis® drospirenone and estetrol (E4) n/a
Myfembree® relugolix, estradiol, noerethindrone n/a
Kerendia® finerenone n/a
Azstarys™ serdexmehylphenidate/dexmethylphenidate 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: September 27, 2021, 05:24 a.m. ET
Last updated on: September 22, 2021, 09:59 a.m. ET