Formulary Updates for Commercial, Marketplace, and Medicaid Formularies
New Drugs (recently FDA approved, prior authorization required, Tier 3, non-formulary for MVP Medicaid).
Please note that on April 1, 2023, the pharmacy benefit for New York State (NYS) Medicaid Managed Care and Health Recovery Plan (HARP) Members will transition to the NYS Medicaid fee-for-service (FFS) Pharmacy Program called NYRX. Physician administered medications under the Medicaid Member’s medical benefit remain the responsibility of MVP.
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New Chemical Entities |
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|---|---|
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Drug Name |
Indication |
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Fabhalta® (iptacopan) |
The treatment of paroxysmal nocturnal hemoglobinuria in adults |
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Casgevy™ (exagamglogene autotemcel) |
The treatment of sickle cell disease in patients aged 12 years and older with recurrent vaso-occlusive crises |
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Lyfgenia™ (lovotibeglogene autotemcel) |
The treatment of sickle cell disease in patients ages 12 years and older with a history of vaso-occlusive events |
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New Chemical Entities |
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|---|---|
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Drug Name |
Indication |
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Wainua™ (eplontersen) |
The treatment of polyneuropathy of hereditary transthyretin-mediated amyloidosis in adults |
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Zilbrysq® (zilucoplan) |
The treatment of generalized myasthenia gravis in adults who are anti-acetylcholine receptor antibody positive |
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Agamree® (vamorolone) |
The treatment of Duchenne muscular dystrophy in patients ages 2 years and older |
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Rivfloza™ pre-filled syringes |
The lowering of urinary oxalate levels in patients ages 9 years and older with primary hyperoxaluria type 1 and relatively preserved kidney function |
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Rivfloza™ vials |
The lowering of urinary oxalate levels in patients ages 9 years and older with primary hyperoxaluria type 1 and relatively preserved kidney function |
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Vevye® 0.1% (cyclosporine) |
The treatment of the signs and symptoms of dry eye disease |
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Idose TR® (travoprost) |
The reduction of intraocular pressure in patients with ocular hypertension or open-angle glaucoma |
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New Combinations/Formulations |
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|---|---|
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Drug Name |
Indication |
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Zoryve foam® (roflumilast) |
The treatment of seborrheic dermatitis in patients ages 9 years and older |
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Iwilfin™ (eflornithine) |
The reduction in risk of relapse in patients with high-risk neuroblastoma who have demonstrated at least a partial response to prior multiagent, multimodality therapy including anti-GD2 immunotherapy |
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Eohilia™ (budesonide oral suspension) |
Indicated for 12 weeks of treatment in adult and pediatric patients 11 years of age and older with eosinophilic esophagitis (EoE) |
Drugs Removed from Prior Authorization- Commercial and Exchange
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Drug Name |
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Airsupra |
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Olpruva |
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Rezzayo |
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Xacduro |
Drug Exclusion
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Drug Name |
|---|
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Vevye 0.1% |
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Zoryve foam |
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Impefa |
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Iyuzeh |
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Miebo |
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Ngenla |
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Suflave |
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Xdemvy |
New Generics
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Brand Name |
Generic Name |
|---|---|
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Farxiga |
Dapagliflozin |
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Xigduo XR |
Dapagliflozin-Metformin |
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Prolensa |
Bromfenac ophthalmic solution |
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Indocin |
Indomethacin suspension |
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Korlym |
Mifepristone |
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Gralise |
Gabapentin ER |
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Emflaza |
Deflazacort |
Miscellaneous Updates
Commercial, Market Place, Self-Funded
- Asmanex HFA added to the Commercial, Market Place, and Self-Funded formularies for Members 10 years and younger
- Generic Flovent (fluticasone HFA and fluticasone diskus) moved from Tier 2 to Tier 1 for the Market Place Formulary
Policy Updates
Review other articles in this issue regarding formulary, pharmacy policy, and medical policy updates.