Formulary changes for commercial group and individual members coming July 1
In January and July of each year, the Priority Health Pharmacy and Therapeutics committee make changes to the commercial group and individual formularies to ensure our members have access to safe, effective and affordable drugs.
Commercial group and individual formulary changes take effect on July 1, 2024
Beginning July 1, 2024, 13 drugs will be removed from our commercial group formulary and 1 drug will be added to our site-of-service policy. These changes will impact 95 of our commercial group and individual members.
Commercial group and individual formulary changes
| Drug name | Common use | What's changing | Preferred alternative | Member impact |
| Afinitor, Afinitor Disperz | Oncology | Removed from formulary | Everolimus | Group: 4 |
| Iressa | Oncology | Removed from formulary | Generic gefitinib, available at tier 4 | 0 |
| Tarceva | Oncology | Removed from formulary | Erlotinib, available at tier 4 | 0 |
| Sutent | Oncology | Removed from formulary | Sunitinib, available at tier 4 | 0 |
| Targretin | Oncology | Removed from formulary | Bexarotene, available at tier 4 | Group: 1 |
| Temodar | Oncology | Removed from formulary | Temozolomide, available at tier 4 | 0 |
| Tykerb | Oncology | Removed from formulary | Lapatinib, available at tier 4 | 0 |
| Votrient | Oncology | Removed from formulary | Pazopanib tablets, available at tier 4 | Group: 1 |
| Xeloda | Oncology | Removed from formulary | Capecitabine, available at tier 4 | 0 |
| Aubagio | Multiple Sclerosis | Removed from formulary | Teriflunomide tablets | Group: 16 Individual: 4 |
| Gilenya | Multiple Sclerosis | Removed from formulary | Fingolimod tablets |
Group: 24 |
| Tecfidera | Multiple Sclerosis | Removed from formulary | Dimethyl fumarate tablets | Group: 7 Individual: 4 |
| Azelastine/fluticasone, Dymista nasal spray | Allergies | Removed from formulary | Now available over the counter |
Group: 23 |
SaveOnSP program changes
24 drug changes will go into effect that will either remove or add a specialty drug at the $0 out of pocket cost through the SaveOnSP program. These changes will impact 103 members.
If the removed drugs from the SaveOnSP list are included in the formulary, the drugs will no longer be eligible for the $0 out of pocket cost but may be covered through the members’ cost share plan. No alternatives will be offered for removed drugs.
Members are encouraged to contact the SaveOnSP team with questions. The complete SaveOnSP drug list is available as an attachment on the Approved Drug List.
SaveOnSP drug list changes
| Drug name | Member impact |
| Removed from the SaveOnSP drug list | |
| Glatiramer Acetate | Group: 24 |
| Granix | 0 |
| Yusimry | 0 |
| Votrient | 0 |
| Added to the SaveOnSP drug list | |
| Camzyos | Group: 1 |
| Ogsiveo | 0 |
| Tracleer | Group: 1 |
| Ojjaara | Group: 1 |
| Adempas | Group: 4 |
| Omnitrope | Group: 14 |
| Akeega | 0 |
| Opsumit | Group: 2 |
| Altuviiio | Group: 1 |
| Signifor | 0 |
| Bimzelx | Group: 4 |
| Sucraid | Group: 4 |
| Cimzia | Group: 6 |
| Truqap | Group: 35 |
| Fruzaqla | Group: 1 |
| Tyvaso | Group: 2 |
| Lytgobi | 0 |
| Uptravi | 0 |
| Nourianz | 0 |
| Welireg | Group: 1 |