2021 Priority Partners Formulary Changes
The table below outlines all the changes to our formulary since the formulary list was last printed on 01/01/2021.
| Drug Name | Description of Change* | Copay Amount | Effective Date of Change |
|---|---|---|---|
| Palforzia (Peanut allergen oral immunotherapy powder) | Addition to formulary with PA | $3 | 01/01/2021 |
| Qinlock (ripretinib) | Addition to formulary with PA | $3 | 01/01/2021 |
| Retevmo (selpercatinib) | Addition to formulary with PA | $3 | 01/01/2021 |
| Inqovi (decitabine-cedazuridine) | Addition to formulary with PA | $3 | 01/01/2021 |
| Semglee (insulin glargine) | Addition of QL (20 pens per 25 days; 6 vials per 25 days) | $3 | 01/01/2021 |
| Oxycodone-acetaminophen oral solution | Formulary Deletion | N/A | 01/01/2021 |
| Onureg (azacitidine) | Addition to formulary with PA | $3 | 04/01/2021 |
| Gavreto (pralsetinib) | Addition to formulary with PA | $3 | 04/01/2021 |
| Dificid oral suspension (fidaxomicin) | Addition to formulary with PA | $3 | 04/01/2021 |
| Orgovyx (relugolix) | Addition to formulary with PA | $3 | 04/01/2021 |
| Rybelsus (oral semaglutide) | Addition to formulary with ST | $3 | 04/01/2021 |
| Rosuvastatin (generic for Crestor) | Addition to formulary | $1 | 04/01/2021 |
| Tepmetko (tepotinib) | Addition to formulary with PA | $3 | 07/01/2021 |
| Ukoniq (umbralisib) | Addition to formulary with PA | $3 | 07/01/2021 |
| Incruse Ellipta (umeclidinium) | Addition to formulary | $3 | 07/01/2021 |
| Cefadroxil suspension 250mg/5mL and 500mg/5mL | Addition to formulary | $1 | 07/01/2021 |
| Spiriva Respimat and Spiriva HandiHaler (tiotropium) | Formulary Deletion | N/A | 07/01/2021 |
| Synjardy and Synjardy XR (empagliflozin-metformin) | Formulary Deletion | N/A | 07/01/2021 |
*QL = Quantity Limit, PA = Prior Authorization, ST = Step Therapy, NF = Non Formulary, N/A = Not Applicable