Priority Health - July 1 Formulary Change for Diabetes Meds Not Occuring

June 16, 2020

On May 1, 2020, PH sent a communication about July 1 changes to our commercial formularies (Traditional and Optimized).

Priority Health has made the decision not to move forward with the July 1 formulary change previously planned for diabetes medications Ozempic and Victoza, for our Traditional formulary. This change would have increased the tier and added step therapy through Trulicity for both drugs.

All changes planned for the Optimized formulary will still be implemented on July 1.

 

Background

The cost of drugs used to treat diabetes is on the rise. In the most recent 12-month period, GLP-1 receptor antagonist drug spend has increased 40% in the Priority Health commercial population, on top of a 30% increase in 2019.

The Priority Health pharmacy department and the Pharmacy and Therapeutics (P&T) committee worked to address this concern by recommending a formulary change in the GLP-1 receptor antagonist class that would move Ozempic and Victoza to Tier 3 (non-preferred brand) with a step through Trulicity first. The decision was made because clinical efficacy and safety data among the GLP-1 options is similar, but the net cost of Trulicity is nearly $1,000 less per year after all negotiated discounts.

Although the change was anticipated to go into effect July 1 for both the commercial Optimized and Traditional formularies, the change is being placed on hold for the Traditional formulary and will be re-evaluated for 2021.

Many of our members have already switched to Trulicity, and we continue to encourage our providers to prescribe Trulicity as the most cost-effective option.

 

How do I know what type of formulary a patient has (Optimized vs. Traditional)?

Our commercial plans have two formularies: Optimized and Traditional. Our Optimized formulary is the formulary for all small groups and is available as a rider for large groups. Patients will our Optimized formulary will have “Optimized Rx: Yes” on the back of their membership card. 

 

Learn more about drug price transparency

If you’d like more information related to drug price transparency and encouraging lower cost options, we’re here to help. Recognizing drug prices are challenging to understand because of discounts that occur along the supply chain, we’ve launched several awareness campaigns and can offer reporting to help you choose wisely. 

While Priority Health can support you in any drug area of interest, our specific areas of focus includes diabetes, inflammatory biologics and dermatology drugs—categories that contribute to the top five drivers of overall pharmacy cost.