Pending changes to the approved drug list
From time to time, we add drugs to or remove them from the approved drug list (formulary). We also may change their tier, which determines how much you pay for them. We make these changes based on the scientific evidence we have of their value in helping people get well and stay healthy.
If you are taking a drug that is being removed
If we remove drugs from the approved drug list during the year, we'll notify you of the change at least 60 days before the date that the change becomes effective. The exceptions to this 60-day notice are when the FDA decides a drug is not safe, or if a drug manufacturer removes the drug from the market.
You may ask Priority Health to make an exception for you. We must make a decision within 72 hours of your request. Contact Customer Service to make these requests.
Learn more about asking for an exception.
Current and pending changes to the approved drug list
- Drugs in ALL CAPS are brand names; generic drugs appear in lower case.
- Jump down to Changes to/removals from the approved drug list
- View the drugs Medicare does not cover and changes to their drug coverage
KEY:
- PA = Prior authorization needed
- QL = Quantity limits apply
- ST = Step therapy (trying other drugs first) is required
- LA = Limited availability (available only at certain pharmacies)
Additions to the approved drug list:
| Drug name | Effective date | Tier | Category |
|---|---|---|---|
| salsalate* | 01/01/2010 | 1 | Anti-Inflammatory Agents/Nonsteroidal Anti-inflammatory Drugs |
| EFFIENT | 01/01/2010 | 2 | Blood Products/Modifiers/ Volume Expanders/Platelet Aggregation Inhibitors |
| EXTAVIA | 01/01/2010 | 4, ST |
Immunological Agents/ Immunomodulators |
| ILARIS** | 01/01/2010 | 4, PA | Immunological Agents/Immunomodulators |
| INTUNIV | 01/01/2010 | 3, ST | Central Nervous System Agents/Non-amphetamines, ADHD |
| ONGLYZA | 01/01/2010 | 2, ST | Blood Glucose Regulators/Antidiabetic Agents |
| ONSOLIS | 01/01/2010 | 3, PA | Analgesics/Opioid Analgesics |
| SABRIL | 01/01/2010 | 4 | Anticonvulsants/Sodium Channel Inhibitors |
| SAPHRIS | 01/01/2010 | 3, ST | Antipsychotics/Atypicals |
| STELARA** | 01/01/2010 | 4, PA | Immunological Agents/Immune Suppressants |
| TYVASO | 01/01/2010 | 4, PA | Respiratory Tract Agents/Pulmonary Antihypertensives |
| ZIPSOR | 01/01/2010 | 3, ST |
Anti-Inflammatory Agents/Nonsteroidal Anti-inflammatory Drugs |
| MULTAQ | 01/01/2010 | 2 | Cardiovascular Agents/Antiarrhythmics |
| NITRO-BID | 01/01/2010 | 2 | Cardiovascular Agents/Vasodilators |
| nisoldipine* | 01/01/2010 | 1 | Cardiovascular Agents/Calcium Channel Blocking Agents |
Changes to/removals from approved drug list:
| Drug name | Effective date | Tier | Category | Formulary alternative | Tier | Reason |
|---|---|---|---|---|---|---|
| nefazodone hcl* |
01/01/2010 | 3 |
Antidepressants | n/a |
1 |
Previously listed as brand, now generic |
| VALTREX | 01/01/2010 | 2, ST | Antivirals | n/a | 2 | Removed Step Therapy |
| fexofenadine hcl* | 03/01/2010 | 1, ST | Antihistamines | n/a | 1 | Removed Step Therapy |
| XOPENEX HFA | 03/01/2010 | 3, ST | Bronchodilators, Sympathomimetic | n/a | 3 | Removed Step Therapy |
*We provide coverage of this prescription drug in the coverage gap under our PriorityMedicare Plus plan. Please refer to your Evidence of Coverage for more information about this coverage.
**This prescription drug may be covered under our medical benefit. For more information, call Customer Service toll-free at 888 389-6648, 8:00 a.m. to 9:00 p.m. Eastern time, 7 days a week. TTY/TDD users should call toll-free 888 551-6761.
Updated: February 01, 2010