{"id":4892,"date":"2019-09-27T17:54:36","date_gmt":"2019-09-27T17:54:36","guid":{"rendered":"http:\/\/hnetalk.com\/provider\/?p=4892"},"modified":"2019-09-27T17:57:26","modified_gmt":"2019-09-27T17:57:26","slug":"formulary-update-for-october-2019","status":"publish","type":"post","link":"http:\/\/hnetalk.com\/provider\/formulary-update-for-october-2019\/","title":{"rendered":"Formulary Update for October 2019"},"content":{"rendered":"

Health New England\u2019s formularies can be accessed on healthnewengland.org <\/strong><\/a>using the \u201cFind A Drug\u201d tool at the top of the page.<\/p>\n

The online formularies are updated throughout the year as changes are made. We have three formularies, one for each line of business \u2013 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.<\/p>\n

Most recently, the following medications have been reviewed for our Commercial and BeHealthy Partnership\/Medicaid line of business:<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Brand Name:<\/em><\/strong><\/p>\n<\/td>\n

Aemcolo<\/td>\nGeneric Name:<\/em><\/strong><\/td>\nRifamycin<\/td>\n<\/tr>\n
\n

Brand Name:<\/em><\/strong><\/p>\n<\/td>\n

Arakoda<\/td>\nGeneric Name:<\/em><\/strong><\/td>\n\n

Tafenoquine<\/p>\n<\/td>\n<\/tr>\n

Brand Name:<\/em><\/strong><\/td>\nArikayce<\/td>\nGeneric Name:<\/em><\/strong><\/td>\n\n

Amikacin<\/p>\n<\/td>\n<\/tr>\n

\n

Brand Name:<\/em><\/strong><\/p>\n<\/td>\n

Bryhali lotion<\/td>\nGeneric Name:<\/em><\/strong><\/td>\n\n

Halobetasol<\/p>\n<\/td>\n<\/tr>\n

\n

Brand Name:<\/em><\/strong><\/p>\n<\/td>\n

Copiktra<\/td>\nGeneric Name:<\/em><\/strong><\/td>\n\n

Duvelisib<\/p>\n<\/td>\n<\/tr>\n

\n

Brand Name:<\/em><\/strong><\/p>\n<\/td>\n

Epidiolex<\/td>\nGeneric Name:<\/em><\/strong><\/td>\n\n

Cannabidol<\/p>\n<\/td>\n<\/tr>\n

\n

Brand Name:<\/em><\/strong><\/p>\n<\/td>\n

Galafold<\/td>\nGeneric Name:<\/em><\/strong><\/td>\n\n

Migalastat<\/p>\n<\/td>\n<\/tr>\n

\n

Brand Name:<\/em><\/strong><\/p>\n<\/td>\n

Orilissa<\/td>\nGeneric Name:<\/em><\/strong><\/td>\n\n

Elagolix<\/p>\n<\/td>\n<\/tr>\n

\n

Brand Name:<\/em><\/strong><\/p>\n<\/td>\n

Sympazan<\/td>\nGeneric Name:<\/em><\/strong><\/td>\n\n

Clobazam<\/p>\n<\/td>\n<\/tr>\n

\n

Brand Name: <\/em><\/strong><\/p>\n<\/td>\n

Tavalisse<\/td>\nGeneric Name:<\/em><\/strong><\/td>\n\n

Fostamatinib<\/p>\n<\/td>\n<\/tr>\n

\n

Brand Name:<\/em><\/strong><\/p>\n<\/td>\n

Testopel<\/td>\nGeneric Name: <\/em><\/strong><\/td>\n\n

Testosterone<\/p>\n<\/td>\n<\/tr>\n

Brand Name:<\/em><\/strong><\/td>\nTibsovo<\/td>\nGeneric Name:<\/em><\/strong><\/td>\n\n

Ivosidenib<\/p>\n<\/td>\n<\/tr>\n

\n

Brand Name:<\/em><\/strong><\/p>\n<\/td>\n

Xelpros<\/td>\nGeneric Name:<\/em><\/strong><\/td>\n\n

Latanoprost<\/p>\n<\/td>\n<\/tr>\n

Brand Name:<\/em><\/strong><\/td>\nVizimpro<\/td>\nGeneric Name:<\/em><\/strong><\/td>\n\n

Dacomitinib<\/p>\n<\/td>\n<\/tr>\n

Brand Name: <\/em><\/strong><\/td>\nYutiq<\/td>\nGeneric Name:<\/em><\/strong><\/td>\n\n

Fluocinolone<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Prescription Drug Coverage- BeHealthy Partnership<\/h3>\n

Step Therapy Drug changes effective January 1, 2020:<\/strong>
\nFor 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.\u00a0If 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.\u00a0All new Step Therapy requirements apply only to new prescriptions.<\/p>\n\n\n\n\n\n\n
\n

You must try:<\/strong><\/p>\n<\/td>\n

First Line Drugs-must try 2:<\/td>\n\n

\u00b7\u00a0 Darifenacin<\/p>\n

\u00b7\u00a0 Solifenacin<\/p>\n

\u00b7\u00a0 Tolterodine ER<\/p>\n

\u00b7\u00a0 Trospium<\/p>\n<\/td>\n<\/tr>\n

\n

Before BeHealthy Partnership will cover:<\/strong><\/p>\n<\/td>\n

\n

Step Therapy Drug(s):<\/p>\n<\/td>\n

\n

\u00b7\u00a0 Myrbetriq<\/p>\n

\u00b7\u00a0 Toviaz<\/p>\n<\/td>\n<\/tr>\n

\n

You must try:<\/strong><\/p>\n<\/td>\n

\n

First Line Drug(s):<\/p>\n<\/td>\n

\n

\u00b7 Dapsone 5%<\/p>\n<\/td>\n<\/tr>\n

Before BeHealthy Partnership will cover:\u00a0 \u00a0<\/strong><\/td>\nStep Therapy Drug(s):<\/td>\n\n

\u00b7 Aczone 7.5%<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n\n\n\n\n\n\n\n\n
\n

Quantity Limit Additions<\/strong><\/p>\n

Starting January 1, 2020, BeHealthy Partnership will add Quantity Limits to the drugs below.<\/p>\n<\/td>\n<\/tr>\n

\n

Drug Name<\/p>\n<\/td>\n

\n

Quantity Limit per 30-day supply<\/p>\n

(unless otherwise specified)<\/p>\n<\/td>\n<\/tr>\n

\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Aripiprazole solution<\/p>\n<\/td>\n

300 ML<\/td>\n<\/tr>\n
\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Azelaic acid<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Clobetasol aerosol<\/p>\n<\/td>\n

\n

50 grams<\/p>\n<\/td>\n<\/tr>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Calcipotriene\/betamethasone ointment<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Clobetasol cream<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Hydrocortisone valerate ointment<\/td>\n

\n

60 grams<\/p>\n<\/td>\n<\/tr>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Clobetasol shampoo<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pramosone lotion<\/td>\n

\n

118 ML<\/p>\n<\/td>\n<\/tr>\n

\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ranolazine ER<\/p>\n

\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Synjardy\/Synjardy XR 12.5mg<\/p>\n<\/td>\n

60 tablets<\/td>\n<\/tr>\n
\u00b7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Synjardy\/Synjardy XR all other strengths<\/td>\n\n

30 tablets<\/p>\n<\/td>\n<\/tr>\n

\n\n\n\n\n\n\n
\n

Effective January 1, 2020, The Following Medications Will Require Prior Authorization<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

\u00b7\u00a0\u00a0Fiasp<\/strong><\/p>\n

\u00b7\u00a0\u00a0Sabril<\/strong><\/p>\n<\/td>\n

\n

Prior Auth thru Optum<\/em><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/td>\n<\/tr>\n

\n

New Prior Authorizations (PA) Effective January 1, 2020<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n
    \n
  • \u00a0<\/strong>Betimol. Alternative is timolol<\/em><\/strong><\/li>\n
  • Duloxetine 40mg. Alternative is duloxetine 20mg<\/em><\/strong><\/li>\n
  • Fluoroplex cream. Alternative is fluorouracil 5%<\/em><\/strong><\/li>\n
  • Fosamax D. Alternative is alendronate <\/em><\/strong><\/li>\n
  • Picato. Alternative is fluorouracil 5%<\/em><\/strong><\/li>\n
  • Synalar ointment kit. Alternative is fluocinolone<\/em><\/strong><\/li>\n
  • Trianex. Alternative is triamcinolone<\/em><\/strong><\/li>\n
  • Xolegel gel. Alternative is ketoconazole<\/em><\/strong><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

     <\/p>\n

     <\/p>\n","protected":false},"excerpt":{"rendered":"

    Health New England\u2019s formularies can be accessed on healthnewengland.org using the \u201cFind A Drug\u201d 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 \u2013 Commercial, Medicare Advantage and BeHealthy Partnership\/Medicaid. Each formulary includes the tier […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[],"class_list":["post-4892","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p6ZZHB-1gU","_links":{"self":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/4892","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/comments?post=4892"}],"version-history":[{"count":1,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/4892\/revisions"}],"predecessor-version":[{"id":4893,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/posts\/4892\/revisions\/4893"}],"wp:attachment":[{"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/media?parent=4892"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/categories?post=4892"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/hnetalk.com\/provider\/wp-json\/wp\/v2\/tags?post=4892"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}