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Formulary Updates: Q4 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 fourth quarter of 2021.

COMMERCIAL FORMULARY

Moved to Preferred Status from Non-Preferred Status

Brand Name Generic Name Prior Authorization (Y/N)
Lumakras™ sotorasib Y

Added to Preferred Status following re-evaluation

Brand Name Generic Name Prior Authorization (Y/N)
Ajovy® fremanezumab Y
Semglee® insulin glargine-yfgn N
Dupixent® dupilumab Y
Fasenra® benralizumab Y
Xolair® omalizumab Y
Nucala® mepolizumab Y

Added to Non-Preferred Status following re-evaluation

Brand Name Generic Name Prior Authorization (Y/N)
Lantus® insulin glargine N

Remaining in Non-Preferred Status following review

Brand Name Generic Name Prior Authorization (Y/N)
Vesicare® solifenacin succinate Y
Thyquidity™ levothyroxine sodium Y
Myfembree® relugolix, estradiol, and norethindrone acetate Y
Roszet® rosuvastatin and ezetimibe Y
Accrufer® ferric maltol Y
Brexafemme® ibrexafungerp Y
Empaveli™ pegcetacoplan Y
Truseltiq™ infigratinib Y
Qelbree® viloxazine Y
Wegovy™ semaglutide Y
Zegalogue® dasiglucagon N

MEDICARE FORMULARY

Added to the Medicare Formulary

Brand Name Generic Name Prior Authorization (Y/N)
Ticovac™ tick-borne encephalitis vaccine N

Not covered in the Medicare Formulary

Brand Name Generic Name Prior Authorization (Y/N)
Uptravi® selexipag n/a
Nexviazyme® avalglucosidase alfa-ngpt n/a
Saphnelo™ anifrolumab-fnia n/a
Bylvay™ odevixibat n/a
Rezurock™ belumosudil n/a
Tivdak™ tisotumab vedotin-tftv n/a
Trudhesa™ dihydroergotamine mesylate n/a
Qulipta™ atogepant n/a
Skytrofa™ lonapegsomatropin-tcgd n/a
Livmarli™ maralixibat oral solution n/a
Opzelura™ Ruxolitinib n/a
Loreev XR® lorazepam ER 24 hr sprinkle cap 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: December 13, 2021, 02:59 a.m. ET
Last updated on: December 8, 2021, 03:03 a.m. ET