Commercial and Medicare formulary changes coming Jan. 1, 2020

Effective Jan. 1, 2020, we’re making updates to our Medicare and commercial formularies.

Commercial formulary updates

In January and July of each year, the Priority Health Pharmacy and Therapeutics committee makes changes to our commercial formulary to ensure our members have access to safe, effective and affordable drugs.

So far in 2019, we’ve added 72 new drugs to the commercial formulary. We’ve also reduced the tier or removed step therapy or prior authorization on 28 drugs.

On Jan. 1, 2020, 128 formulary changes will either remove a drug from the formulary or increase the tier. These changes impact 4,225 members. Of those, approximately 70% are impacted by the following 10 drug changes:

 Drug name Change type Covered alternatives
Tretinoin 0.05% cream, 0.05% gel and 0.1% cream  

Tier increase

Tretinoin 0.025% cream/gel and 0.1% gel, OTC products
 Mesalamine DR 400mg, 800mg and 1.2gm  

Tier increase

Mesalamine 4gm enema, Apriso, Lialda
Timolol Maleate 0.05% (generic Istalol only) Remove from formulary Timolol maleate (non-generic Istalol products), Timolol gel-forming eye drops
Pulmicort Flexhaler Remove from formulary  Flovent, Arnuity, Qvar
Bydureon Tier increase, add step therapy  Trulicity, Ozempic, Victoza
Myrbetriq Tier increase Oxybutynin IR/ER, Trospium IR, Tolterodine
Mupirocin calcium 2% cream  Remove from formularyMupirocin calcium 2% ointment
Creon Tier increase  Zenpep, Pancreaze
Calcipotriene cream Tier increase  Calcipotriene solution or ointment
Mesalamine 1000mg Tier increase  Mesalalmine 4gm enema, Apriso, Lialda

Medicare formulary updates

Effective Jan. 1, 2020, 96 drugs will be removed from the Medicare formulary, impacting 3,620 members. Many drugs are being removed because they are brands that now have generics on the market. Approximately 56% of members are impacted from the following 5 drug changes:

Drug name
Change type  Covered alternatives
Lyrica Remove from formulary  pregabalin capsule (generic Lyrica)
Brimonidine Tartrate 0.15% Remove from formulary  Brimonidine 0.2%
Basaglar Kwikpen Remove from formulary  Lantus, Toujeo
Tresiba Flextouch Remove from formulary  Lantus, Toujeo
Doxycycline Monohydrate 100mg tablets Remove from formulary  Doxycycline Monohydrate 100mg capsules

How we're communicating to members

Members impacted by any changes to our commercial or Medicare formularies will receive a letter by Dec. 1, 2020, explaining how their drug coverage will change and the steps they should take prior to Jan. 1, 2020. The letters also include a list of alternative medicines that may be options for them.

Learn more

Our Nov. 13, 2019 Virtual Office Advisory webinar will cover commercial and Medicare formulary changes coming Jan. 1, 2020. Register for the webinar so you can learn more or ask questions.