BCBSRI pharmacy program individual market formulary update July 1, 2021
The information below is effective July 1, 2021 and applies only to the individual market segment including through the state’s healthcare exchange (Healthsource RI). Prime Therapeutics offers the Net Results Formulary, which is used to support individual market products. This 5-tier formulary is developed and maintained with a comprehensive review of relevant clinical information by the Prime Therapeutics National Pharmacy and Therapeutics Committee and includes local review by the BCBSRI Pharmacy and Therapeutics Committee.
Excluded from coverage
As part of the formulary updates, the following drug products will be excluded from the prescription drug list, effective July 1, 2021.
Amantadine Hyrdrochloride Imipramine Pamoate Proair Respiclick
Clindamycin/Benzoyl Perodxide Kombiglyze XR Tavaborole
Cyclobenzaprine Hydrochloride Minocycline Hydrochloride Temazepam
Diclofenac Sodium Onglyza Tretinoin
Diclofenac Sodium ER Praluent Trexall
The following drug products are now available with generic equivalents and will be excluded from coverage effective July 1, 2021. The generic equivalent product will continue to be covered.
Alinia Ferriprox Proair HFA
Atripla Kerydin Sklics
Banzel Kuvan Tytkerb
Cost share changes
The following products will require a higher out-of-pocket cost share, effective July 1, 2021.
Hydrocortisone Butyrate Tyblume
The following drug will now require prior authorization for coverage, effective July 1, 2021.