FLASH: P&T June Meeting Updates

All Plans

Cardiology

 New Drug Reviews / Policies

 Tryvio (aprocitentan)—May be used in patients whose blood pressure is not adequately controlled on other antihypertensive medications

• • Formulary placement recommendations
    • Commercial—Non-Formulary
    • Medicare—Non-Formulary
  • Tryngolza (olezarsen)—Adjunct to diet to reduce triglycerides in adults with familial chylomicronemia syndrome
    • Formulary placement recommendations
      • Commercial—Non-Formulary
      • Medicare—Non-Formulary
    • Attruby (acoramidis)—Treatment of the cardiomyopathy of wild-type or variant transthyretin-mediated amyloidosis in adults to reduce cardiovascular death and cardiovascular-related hospitalization
      • Formulary placement recommendations
        • Commercial—Non-Preferred Specialty Pharmacy with PA and MDL (#60/30days)
        • Medicare—Non-Formulary

Endocrinology

 New Drug Reviews / Policies

 Yorvipath (palopegteriparatide)—Treatment of hypoparathyroidism in adults. Limitations of use: Not studied for acute postsurgical hypoparathyroidism; titration scheme was only evaluated in adults who first achieved an albumin-corrected serum calcium of ≥7.8 mg/dL (≥1.95 mmol/L) using calcium and active vitamin D treatment.

• • Formulary placement recommendations
    • Commercial—Non-Formulary
    • Medicare—Non-Formulary
  • Crenessity (crinecerfont)—Adjunctive treatment to glucocorticoid replacement to control androgens in adults and pediatric patients ≥4 years of age with classic congenital adrenal hyperplasia
    • Formulary placement recommendations
      • Commercial—Non-Formulary
      • Medicare—Non-Formulary

Pulmonology

 New Drug Reviews / Policies

 Ohtuvayre (ensifentrine)—Maintenance treatment of chronic obstructive pulmonary disease in adults.

• • Formulary placement recommendations
    • Commercial—Non-Formulary
    • Medicare—Medicare Part B (Non-Formulary Part D)
  • Alyftrek (vanzacaftor, tezacaftor, deutivacaftor)—Treatment of cystic fibrosis (CF) in patients ≥6 years of age who have at least one F508del mutation or another responsive mutation in the CF transmembrane conductance regulator (CFTR) gene
    • Formulary placement recommendations
      • Commercial—Non-Preferred Specialty Pharmacy with PA
      • Medicare—Non-Formulary

Commercial

Cardiology

Criteria Changes

 Vyndaqel/Vyndamax

• • Added step through Atrruby and exclusion criteria
• Amvuttra
  • Added ATTR-CM indication criteria

Pulmonology

 Criteria Changes

 Trikafta

• • Added liver function requirement given new boxed warning
• Dupixent
  • Added criteria for urticaria
• Nucala
  • Added criteria for Chronic Obstructive Pulmonary Disease
• Fasenra
  • Added coverage criteria for eosinophilic granulomatosis with polyangiitis

 Miscellaneous Policy Updates

•  Rinvoq
  • Created policy with criteria for Giant Cell Arteritis (GCA)

• Tocilizumab Products – Medical Benefit
  • Added Rinvoq trial for GCA indication
• Zoryve
  • Added coverage criteria for psoriasis for foam preparation
• Behavioral Health Medications
  • Removed PA on desvenlafaxine, duloxetine, lurasidone, Trintellix, and vilazodone
• Absorica
  • Removed PA from Claravis, Amnesteen, Myorisan, Zenatane, Accutane, and generic isotretinoin

Policies to Retire

 Azelaic Acid

• Fish Oil – Lovaza and Vascepa
• Tazorac
• Topical Ivermectin Cream

Quantity Limit and Managed Dose Limit Updates

The P&T Committee meets bimonthly, and formulary changes and criteria changes can occur during the meetings. Negative formulary changes are generally made effective on 1/1 and 7/1, while positive formulary changes are effective immediately to better serve our members and providers. Upcoming negative formulary and criteria changes can be found online at the following website: HealthAlliance.org/Documents/960/2022. Drug coverage and policies in the following categories will be reviewed during the remainder of 2025 and changes may be made:

• September (Final Meeting): Neurology, Psychiatry, Pain, Ophthalmology, Urology, Rare Diseases.