1 de julio de 2021 formulary changes – Net Results Plus update
The information below is effective 1 de julio de 2021 and applies to all commercial employer groups that are assigned to the Net Results Plus formulary. All changes to this list are the result of a comprehensive review of relevant clinical information by the Prime Therapeutics National Pharmacy and Therapeutics Committee.
Brand name drugs available with generic equivalents (Excluded from coverage)
For application across all commercial formularies, the following brand name drugs are now available with generic equivalents, and as a result the brand name will be excluded from coverage effective 1 de julio de 2021. The generic equivalent will continue to be covered.
Alinia Hycodan Taytulla
Atripla Kuvan Timoptic Ocudose
Banzel Monurol Timoptic-XE
Bethkis Sklice Tytkerb
Brand name and generic drugs with available alternatives (Excluded from coverage)
The following generic and brand name drugs with preferred alternatives will be excluded from coverage effective 1 de julio de 2021. Requests for coverage will require documented medical necessity.
Calcipotriene/betamethasone Dipropionate doxepin hydrochloride
The following products have been moved to a higher copay tier effective 1 de julio de 2021. These changes generally involve a change to the next higher copay tier. There are some products that will have a change of more than one higher tier change related to formulary design – these products are designated with an asterisk.
HYDROCORTISONE BUTYRATE* PROLATE* PYRAZINAMIDE*
The following products will require prior authorization (medical necessity) review before coverage is allowed, effective 1 de julio de 2021.
The following products will have quantity limits per dispensing, effective 1 de julio de 2021.
ELIQUIS 5mg MEPERIDINE 50mg/5ml
MEPERIDINE 100mg MEPERIDINE 50mg/5ml