AmeriHealth HMO, Inc., AmeriHealth Insurance Company of New Jersey, and AmeriHealth Administrators will make changes to its Select Drug Program® Formulary and Value Formulary. The changes are effective April 1, 2023, and will include:
Glucagon-like Peptide 1 (GLP-1) Receptor Agonists for treating diabetes
- Effective April 1, 2023, GLP-1 Receptor Agonist agents indicated for the treatment of type 2 diabetes will require a prior authorization on Select Drug Program Formulary and Value Formulary.
- Existing users will not experience impact until August 1, 2023. Formulary update letters will be sent to impacted members and their providers in May 2023.
Clinical information about Glucagon-like Peptide 1 (GLP-1) Receptor Agonists for treating diabetes
Type 2 diabetes mellitus is the most common form of diabetes. It occurs when the pancreas cannot make enough insulin to keep blood sugar at normal levels and cells are resistant to insulin.
Glucagon-like peptide 1 (GLP-1) Receptor Agonists are a class of medications indicated as adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. They help to manage blood sugar by:
- Slowing stomach emptying
- Increasing insulin production
- Reducing sugar released from the liver
Examples of GLP-1 Receptor Agonists include but are not limited to: Trulicity® (duraglutide), Bydureon® and Byetta® (exenatide), Ozempic® and Rybelsus® (semaglutide), Mounjaro™ (tirzepatide), and Victoza® (liraglutide).
Wegovy® (semaglutide) and Saxenda® (liraglutide) are FDA approved as pharmacologic treatments for obesity or can be prescribed to overweight patients with comorbidities.
- Although same active ingredient, dose and brand-name differ when used for weight management.
To ensure appropriate use of GLP-1 Receptor Agonist agents for members with type 2 diabetes, AmeriHealth is updating formulary management of this class of drugs.
To review the formulary changes that go into effect April 1, 2023, please visit:
- AmeriHealth Pennsylvania:
You can review the full formularies on our AmeriHealth New Jersey or AmeriHealth Pennsylvania websites where you can download a PDF or search for a specific formulary drug.
To view Select Drug Formulary information for your patients who carry an AmeriHealth Administrators ID card, please click here.
For more on pharmacy policies and programs, visit the AmeriHealth New Jersey or AmeriHealth Pennsylvania websites.