Effective July 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 gene ric equivalent becomes available.
Formulary – key updates
- Humira® biosimilars – up to 3 biosimilars will be added to the formulary in 2023 at parity with Humira starting with Amgen's AmjevitaTM. By adding these at parity, it increases member and provider accessibility and choice.
- Gilenya®, Buphenyl® tablet/powder – new generic launches; generics for these products to be added to Generic tier and brand-name products will move to an Excluded status.
- Depakote® DR tab 125mg, 250mg will move to an Excluded status. Covered alternative(s) include: divalproex sodium dr tab.
- Arimidex® 1mg will move to an Excluded status. Covered alternative(s) include: anastrozole tab.
- Plaquenil® 200mg 1mg will move to an Excluded status. Covered alternative(s) include: hydroxychloroquine tab.
- New inclusions to high-cost generics exclusion list include drugs such as: candesartan/HCTZ, telmisatan/HCTZ, olopatadine spray 0.6%, fesoterodine ER tabs, and methylphenidate patches.
Utilization Management – key updates
Utilization Management (UM) strategies for select drugs in categories such as Targeted Immune Modulators (TIMS) among others will be enhanced with new or revised Quantity Limit (QL) and/or Prior Authorization (PA) edits.
- Targeted Immune Modulators – QLs will be added to 19 TIMS drugs across various therapeutic classes. This includes drugs such as Humira®, Taltz®, SkyriziTM, Otezla®, and Orencia®, among others.
- Acyclovir ointment – new QL of 30 grams per 28 days.
- Venlafaxine ER capsules – new QL being added (varies per strength).
Please refer to the UM updates flyer for details on exact QLs.
For more information on the Premium Formulary, visit the Independence Blue Cross and Independence Administrators websites.