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 |
*QL = Quantity Limit, PA = Prior Authorization, ST = Step Therapy, NF = Non Formulary, N/A = Not Applicable