Pharmacy
Pharmacy Formulary and Prior Authorization Changes for January 2025
November 14, 2024
Beginning January 2025, some drugs will experience a formulary drug list change. Read about the formulary drug list changes.
How we’re notifying impacted members
- Members received a letter in the mail in November 2024 notifying them of the change.
- Members’ providers were notified of the change in our October 2024 Provider News.
If you have any questions about these formulary and prior authorization changes, please contact your Premera representative.
Also, beginning January 2025, the following drugs will require a new prior authorization:
Condition:
Drugs Requiring a New Prior Authorization:
Preferred Alternatives:
Asthma
- Airsupra (albuterol-budesonide)
- Brand Albuterol HFA
- Brand Levalbuterol HFA
- ProAir Respiclick (albuterol)
- Ventolin HFA (albuterol)
- Xopenex HFA (levalbuterol)
- Generic albuterol HFA
Cancer
- Avastin (bevacizumab)
- Mvasi (bevacizumab-awwb)
- Zirabev (bevacizumab-bvzr)
- Herceptin (trastuzumab)
- Herceptin Hylecta (trastuzumab-hyaluronidase-oysk)
- Kanjinti (trastuzumab-anns)
- Trazimera (trastuzumab-qyyp)
- Rituxan (rituximab)
- Ruxience (rituximab-pvvr)
- Truxima (rituximab-abbs)
Fertility Support
- Fyremadel (ganirelix)
- Brand ganirelix
- Generic ganirelix
- Generic cetrorelix
- Cetrotide (cetrorelix)
Inflammatory Diseases
- Hyrimoz (adalimumab-adaz)
- Adalimumab-adaz
- Adalimumab-adbm
- Adalimumab-ryvk
- Cyltezo (adalimumab-adbm)
- Humira (adalimumab) (AbbVie)*
- Simlandi (adalimumab-ryvk)
- Avsola (infliximab-axxq)
- Inflectra (infliximab-dyyb)
- Brand Infliximab
- Remicade (infliximab)
Rare Diseases
- Glassia (alpha1-proteinase inhibitor)
- Aralast (alpha1-proteinase inhibitor)
- Prolastin-C (alpha1-proteinase inhibitor)
- Zemaira (alpha1-proteinase inhibitor)
- Remodulin (treprostinil)
- Generic treprostinil
- Rystiggo (rozanolixizumab-noli)
- Soliris (eculizumab)
- Ultomiris (ravulizumab-cwvz)
- Vyvgart (efgartigimod alfa-fcab)
- Vyvgart Hytrulo (efgartigimod-hyaluronidase-qvfc)