Formulary Update for October 2019
Posted on September 27, 2019
Health New England’s formularies can be accessed on healthnewengland.org using the “Find A Drug” tool at the top of the page.
The online formularies are updated throughout the year as changes are made. We have three formularies, one for each line of business – Commercial, Medicare Advantage and BeHealthy Partnership/Medicaid. Each formulary includes the tier assignment for each drug and any drug-specific medication management requirements, including quantity limitations, step therapy requirements and prior authorization requirements.
Most recently, the following medications have been reviewed for our Commercial and BeHealthy Partnership/Medicaid line of business:
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Brand Name: |
Aemcolo | Generic Name: | Rifamycin |
|
Brand Name: |
Arakoda | Generic Name: |
Tafenoquine |
| Brand Name: | Arikayce | Generic Name: |
Amikacin |
|
Brand Name: |
Bryhali lotion | Generic Name: |
Halobetasol |
|
Brand Name: |
Copiktra | Generic Name: |
Duvelisib |
|
Brand Name: |
Epidiolex | Generic Name: |
Cannabidol |
|
Brand Name: |
Galafold | Generic Name: |
Migalastat |
|
Brand Name: |
Orilissa | Generic Name: |
Elagolix |
|
Brand Name: |
Sympazan | Generic Name: |
Clobazam |
|
Brand Name: |
Tavalisse | Generic Name: |
Fostamatinib |
|
Brand Name: |
Testopel | Generic Name: |
Testosterone |
| Brand Name: | Tibsovo | Generic Name: |
Ivosidenib |
|
Brand Name: |
Xelpros | Generic Name: |
Latanoprost |
| Brand Name: | Vizimpro | Generic Name: |
Dacomitinib |
| Brand Name: | Yutiq | Generic Name: |
Fluocinolone |
Prescription Drug Coverage- BeHealthy Partnership
Step Therapy Drug changes effective January 1, 2020:
For BeHealthy Partnership to cover the Step Therapy drugs listed here, you first must try the corresponding First Line drugs. If BeHealthy Partnership has paid a claim for the First Line drug within the previous 180 or 360 days (depending on the First Line drug), then you are eligible for coverage of the Step Therapy drug. The use of samples does not satisfy the requirements of documented usage of a First Line drug or medical necessity for a Step Therapy drug. If it is Medically Necessary for you to use a Step Therapy drug before trying a First Line drug, then your doctor can contact BeHealthy Partnership to request a medical review. All new Step Therapy requirements apply only to new prescriptions.
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You must try: |
First Line Drugs-must try 2: |
· Darifenacin · Solifenacin · Tolterodine ER · Trospium |
|
Before BeHealthy Partnership will cover: |
Step Therapy Drug(s): |
· Myrbetriq · Toviaz |
|
You must try: |
First Line Drug(s): |
· Dapsone 5% |
| Before BeHealthy Partnership will cover: | Step Therapy Drug(s): |
· Aczone 7.5% |
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Quantity Limit Additions Starting January 1, 2020, BeHealthy Partnership will add Quantity Limits to the drugs below. |
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Drug Name |
Quantity Limit per 30-day supply (unless otherwise specified) |
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· Aripiprazole solution |
300 ML | ||||
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· Azelaic acid · Clobetasol aerosol |
50 grams |
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| · Calcipotriene/betamethasone ointment
· Clobetasol cream · Hydrocortisone valerate ointment |
60 grams |
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| · Clobetasol shampoo
· Pramosone lotion |
118 ML |
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· Ranolazine ER · Synjardy/Synjardy XR 12.5mg |
60 tablets | ||||
| · Synjardy/Synjardy XR all other strengths |
30 tablets |
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New Prior Authorizations (PA) Effective January 1, 2020 |
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