In July and January of each year, the Priority Health Pharmacy and Therapeutics committee makes changes to the commercial formulary to ensure our members have access to safe, effective and affordable drugs.
So far in 2020, we’ve added 45 new drugs to the formulary. We’ve also made positive changes (reduced tier or removal of authorization requirement) on 11 drugs, which helps make them more affordable to our members.
On July 1, 2020, we’ll have 28 drug changes that either remove a drug from the formulary or increase the tier the drug is in. These changes impact approximately 3,420 unique members.
Changes to diabetes medications
Of the members impacted, 51% (1,728) are impacted by a change to a diabetes medication.
To mitigate the member and provider impact of these changes, we’ll be proactively entering authorizations for the preferred product for impacted members.
For example: If a member is taking Ozempic or Victoza, which will have a tier increase and require step therapy through Trulicity effective July 1, 2020, the pharmacy team will proactively enter an authorization for Trulicity for that member. The provider will not have to go through the prior authorization process, eliminating a significant barrier for this transition. The member will still need to work with their provider to get a new prescription for Trulicity.
Changes to diabetes medications are outlined in the table, below.
Changes to diabetes medications - July 2020
Other formulary changes
Of the members impacted, 37% (1,256) are impacted by changes to the following three drugs:
How we’re communicating to our members
Members who are impacted by changes to the formulary receive a letter advising them of how their drug coverage will be changing and what steps they should take prior to July 1, 2020. The letters also include a list of alternative medications that may be options for them.
Our May 21 Virtual Office Advisory webinar will cover these changes. Join us to ask questions and learn more.