{"id":14612,"date":"2022-11-15T13:28:23","date_gmt":"2022-11-15T13:28:23","guid":{"rendered":"https:\/\/www.ppmco.org\/?page_id=14612"},"modified":"2026-04-02T20:57:17","modified_gmt":"2026-04-02T20:57:17","slug":"cambios-en-el-formulario","status":"publish","type":"page","link":"https:\/\/www.ppmco.org\/es\/beneficios-del-plan\/medicamentos-recetados\/cambios-en-el-formulario\/","title":{"rendered":"Cambios en el formulario"},"content":{"rendered":"<div id=\"block_13ec6104be640f67547a9a823c233750\" class=\"wpfox-page-header standard has-cta\" style=\"\">\r\n\t<div class=\"wrapper banner\">\r\n\t\t<div class=\"bg-glow\"><\/div>\r\n\t\t\t\t<div class=\"text-block\">\r\n\t\t\t\n\n<h2 class=\"wp-block-heading page-title has-h-3-font-size\">Beneficios<\/h2>\n\n\n\n<h1 class=\"wp-block-heading has-h-1-font-size\">Cambios en el formulario de Priority Partners<\/h1>\n\n\r\n\t\t<\/div>\r\n\t\t<div class='fgimage'><img loading=\"lazy\" decoding=\"async\" width=\"633\" height=\"799\" src=\"https:\/\/www.ppmco.org\/wp-content\/uploads\/2022\/07\/fg-prescription.png\" class=\"attachment-large size-large\" alt=\"\" srcset=\"https:\/\/www.ppmco.org\/wp-content\/uploads\/2022\/07\/fg-prescription.png 633w, https:\/\/www.ppmco.org\/wp-content\/uploads\/2022\/07\/fg-prescription-238x300.png 238w\" sizes=\"auto, (max-width: 633px) 100vw, 633px\" \/><\/div>\t<\/div>\r\n\t\n\t\t<div class='cta-bar page-header-jumpmenu'>\n\t\t\t<form class='desktop'>\n\t\t\t\t<label>Encuentre atenci\u00f3n ahora:<\/label>\n\t\t\t\t<div class='prepend'>Necesito<\/div>\n\t\t\t\t<select class='jumpmenu'>\n\t\t\t\t\t<option value='https:\/\/pp.healthtrioconnect.com\/public-app\/consumer\/provdir\/entry.page' data-target='_blank'>un m\u00e9dico<\/option><option value='https:\/\/www.caremark.com\/' data-target='_blank'>una farmacia<\/option><option value='https:\/\/www.ppmco.org\/es\/find-care-now\/denatl-care\/' data-target=''>atenci\u00f3n dental<\/option><option value='https:\/\/superiorvision.com\/members\/' data-target='_blank'>atenci\u00f3n de la visi\u00f3n<\/option><option value='https:\/\/pp.healthtrioconnect.com\/public-app\/consumer\/provdir\/search.page?lat=&#038;long=&#038;searchString=&#038;sortType=NAMEASC&#038;provType=H&#038;addressState=md&#038;providerSpecialty=hospital&#038;myAddress=&#038;myCity=&#038;myState=md&#038;myZip=&#038;distance=25&#038;ageId=&#038;sexId=&#038;conditionId=&#038;xsesschk=undefined' data-target='_blank'>un hospital<\/option>\n\t\t\t\t<\/select>\n\t\t\t\t<a class='btn'>Va<\/a>\n\t\t\t<\/form>\n\t\t\t<div class='mobile'>\n\t\t\t\t\n\t\t\t\t\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\n<div class=\"wp-block-group is-style-section-padding is-layout-flow wp-block-group-is-layout-flow\">\n<h2 class=\"wp-block-heading has-text-align-center has-purple-color has-text-color\">Cambios en el formulario de 2026<\/h2>\n\n\n\n<p class=\"has-text-align-center is-style-default has-intro-font-size\">El cuadro que aparece a continuaci\u00f3n describe todos los cambios en nuestro formulario desde que se imprimi\u00f3 la lista del formulario por \u00faltima vez el 04\/01\/2026.<\/p>\n\n\n\n<figure class=\"wp-block-table is-style-stripes col-1-5 col-2-3 col-3-2 col-4-2 col-3-center col-4-center\"><table><thead><tr><th>Nombre del medicamento<\/th><th>Descripci\u00f3n del cambio*<\/th><th>Monto del copago<\/th><th>Fecha de vigencia<br>de cambio<\/th><\/tr><\/thead><tbody><tr><td>Hernexeos (zongertinib)<\/td><td>Agregado de AP con LC<\/td><td>$1<\/td><td>04\/01\/2026<\/td><\/tr><tr><td>Modeyso (dordaviprone)<\/td><td>Agregado de AP con LC<\/td><td>$1<\/td><td>04\/01\/2026<\/td><\/tr><tr><td>Ensacove (ensartinib)<\/td><td>Agregado de AP con LC<\/td><td>$1<\/td><td>04\/01\/2026<\/td><\/tr><tr><td>Ibtrozi (taletrectinib)<\/td><td>Agregado de AP con LC<\/td><td>$1<\/td><td>04\/01\/2026<\/td><\/tr><tr><td>Novolog Mix 70\/30 vial, and Novologix Mix FlexPen<\/td><td>Agregado de AP con LC<\/td><td>$1<\/td><td>04\/01\/2026<\/td><\/tr><\/tbody><\/table><\/figure>\n<\/div>\n\n\n\n<p>*LC = l\u00edmite de cantidad, AP = autorizaci\u00f3n previa, TE = tratamiento escalonado, FF = fuera de formulario, N\/A = no aplicable<\/p>\n\n\n\n<div style=\"height:3em\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<div id=\"block_cccd700deb92178f747331a9b2430448\" class=\"wpfox-text-image-section default-padding circle\">\r\n\t<div class=\"wrapper has-teal-background-color\">\r\n\t\t<div class=\"row row-text-image image-right\">\r\n\t\t\t<div class=\"col col-text\">\r\n\t\t\t\t\n\n<h4 class=\"wp-block-heading has-h-4-featured-font-size\">Recursos para Afiliados<\/h4>\n\n\n\n<h2 class=\"wp-block-heading has-h-2-featured-font-size\">Se pueden enviar por correo las versiones en papel de todos los formularios para miembros<\/h2>\n\n\n\n<p class=\"is-style-default has-intro-font-size\">Todos los documentos est\u00e1n disponibles en papel <strong>sin cargo<\/strong>. Para solicitar una copia en papel, llame a <strong>Atenci\u00f3n al Cliente<\/strong> al:<\/p>\n\n\n\n<div class=\"wp-block-buttons is-style-margin-top-10 is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-phone-icon-no-tab\"><a class=\"wp-block-button__link has-white-color has-gold-background-color has-text-color has-background wp-element-button\" href=\"tel:800-654-9728\">800-654-9728<\/a><\/div>\n<\/div>\n\n\n\n<p class=\"is-style-default margin-top-0\">De lunes a viernes, de 8 a.m. to 5 p.m.<\/p>\n\n\r\n\t\t\t<\/div>\r\n\t\t\t<div class=\"col col-image\">\r\n\t\t\t\t\r\n\t\t\r\n\t\t\t<div class='image-wrapper'>\r\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"1024\" src=\"https:\/\/www.ppmco.org\/wp-content\/uploads\/2022\/07\/help-1024x1024.jpg\" class=\"attachment-large size-large\" alt=\"\" srcset=\"https:\/\/www.ppmco.org\/wp-content\/uploads\/2022\/07\/help-1024x1024.jpg 1024w, https:\/\/www.ppmco.org\/wp-content\/uploads\/2022\/07\/help-300x300.jpg 300w, https:\/\/www.ppmco.org\/wp-content\/uploads\/2022\/07\/help-150x150.jpg 150w, https:\/\/www.ppmco.org\/wp-content\/uploads\/2022\/07\/help-768x768.jpg 768w, https:\/\/www.ppmco.org\/wp-content\/uploads\/2022\/07\/help-1536x1536.jpg 1536w, https:\/\/www.ppmco.org\/wp-content\/uploads\/2022\/07\/help.jpg 1920w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/>\r\n\t\t\t<\/div>\r\n\t\t\r\n\t\t\r\n\t\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t<\/div>\r\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Se describen los cambios realizados en el formulario desde la \u00faltima vez que se imprimi\u00f3.<\/p>\n","protected":false},"author":7,"featured_media":0,"parent":12723,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"14922,99912256,12167,14926,99912663,14924","_relevanssi_noindex_reason":"","inline_featured_image":false,"footnotes":""},"class_list":["post-14612","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - 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