​Effective January 1, 2023, changes will be made affecting the Premium Formulary drug program.

The Premium Formulary is managed by an independent pharmacy benefits management (PBM) company. It includes all therapeutic categories and provides physicians with prescribing options. The formulary is reviewed biannually to add new drugs and to remove brand-name drugs when a generic equivalent becomes available.

Formulary key updates

• Diabetic glucose meters and test strips — Contour^® glucometers and test strips will move to a preferred status. Lifescan OneTouch^® glucometers and test strips will move to an excluded status. Members are eligible to receive a new meter at no cost to them. Details on how to redeem their new Contour^® meter will be sent to current users.
• Enbrel^® will move to a preferred status, expanding options within the Tumor Necrosis Factor (TNF) Inhibitors class and adding value for plans and members.
• Select non‑preferred ADHD medications, such as Quilichew ER^®, Mydayis^®, Zenzedi^®, and Daytrana^®, will move to an excluded status to promote use of new generics and preferred brand alternatives.
• Toviaz^®, Combigan^®, and Esbriet^® — New generic launches. Generics for these products to be added to the generic tier and brand name products will move to an excluded status.
• Antineoplastic agents, Rubraca^® and Talzenna^®, will move to an excluded status. Covered alternatives include Lynparza^® and Zejula.

Utilization Management

• Utilization management strategies for select drugs in categories such as antipsychotics and erectile dysfunction agents, among others, will be enhanced with new or revised quantity limits and/or prior authorization (PA) edits.
• GLP‑1 agonists — Existing Step Therapy (ST) protocol will be retired, and a new PA requirement will be added to help manage off‑label use for weight loss.
• Antiviral agents — A new PA will be required for Prevymis^TM to better manage this costly product.
• Enzyme replacement — A new PA will be required for Buphenyl^®​ to better manage this costly product.
• ADHD ST protocol — To be updated to require trial of three generics/preferred brands. Currently, it only requires trial of two generics/preferred brands.
  

Health Care Reform (HCR) list

• Male condoms to be added to the HCR list and available to member at $0 cost-share effective December 30, 2022, in accordance with recommendations from the United States Preventive Services Task Force (USPSTF). 
• Aspirin 325mg used for primary prevention of cardiovascular disease (CVD) and colorectal cancer (CRC) will be removed from the HCR List in accordance with USPSTF recommendations.

For more information on the Premium Formulary, visit the AmeriHealth Administrators website.​​