{"id":14611,"date":"2022-11-15T13:28:23","date_gmt":"2022-11-15T13:28:23","guid":{"rendered":"https:\/\/ppmco.foxtrotdev.com\/?page_id=14611"},"modified":"2026-07-01T19:02:16","modified_gmt":"2026-07-01T19:02:16","slug":"formulary-changes","status":"publish","type":"page","link":"https:\/\/ppmco.foxtrotdev.com\/?page_id=14611","title":{"rendered":"Formulary Changes"},"content":{"rendered":"<div id=\"block_9551eafee15aa4c9461ff03c58157089\" class=\"wpfox-page-header standard has-cta\" style=\"\">\r\n\t<div class=\"wrapper banner\">\r\n\t\t<div class=\"bg-glow\"><\/div>\r\n\t\t\t\t<div class=\"text-block\">\r\n\t\t\t\n\n<h2 class=\"wp-block-heading page-title has-h-3-font-size\">Plan Benefits<\/h2>\n\n\n\n<h1 class=\"wp-block-heading has-h-1-font-size\">Priority Partners Formulary Changes<\/h1>\n\n\r\n\t\t<\/div>\r\n\t\t<div class='fgimage'><img loading=\"lazy\" decoding=\"async\" width=\"633\" height=\"799\" src=\"https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/fg-prescription.png\" class=\"attachment-large size-large\" alt=\"Smiling man with arms crossed\" srcset=\"https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/fg-prescription.png 633w, https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/fg-prescription-238x300.png 238w\" sizes=\"auto, (max-width: 633px) 100vw, 633px\" \/><\/div>\t<\/div>\r\n\t\n\t\t<div class='cta-bar page-header-jumpmenu'>\n\t\t\t<form class='desktop'>\n\t\t\t\t<label>Find care now:<\/label>\n\t\t\t\t<div class='prepend'>I need<\/div>\n\t\t\t\t<select class='jumpmenu'>\n\t\t\t\t\t<option value='https:\/\/pp.healthtrioconnect.com\/public-app\/consumer\/provdir\/entry.page' data-target='_blank'>a doctor<\/option><option value='https:\/\/www.caremark.com\/' data-target='_blank'>a pharmacy<\/option><option value='https:\/\/ppmco.foxtrotdev.com\/plan-benefits\/dental-care\/' data-target=''>a dentist<\/option><option value='https:\/\/superiorvision.com\/members\/' data-target='_blank'>vision care<\/option><option value='https:\/\/pp.healthtrioconnect.com\/public-app\/consumer\/provdir\/search.page?lat=&#038;long=&#038;searchString=&#038;sortType=NAMEASC&#038;provType=H&#038;addressState=md&#038;providerSpecialty=hospital&#038;myAddress=&#038;myCity=&#038;myState=md&#038;myZip=&#038;distance=25&#038;ageId=&#038;sexId=&#038;conditionId=&#038;xsesschk=undefined' data-target='_blank'>a hospital<\/option>\n\t\t\t\t<\/select>\n\t\t\t\t<a class='btn'>Go<\/a>\n\t\t\t<\/form>\n\t\t\t<div class='mobile'>\n\t\t\t\t<label>Find care now<\/label>\n\t\t\t\t<a class='btn' href='https:\/\/ppmco.foxtrotdev.com\/find-care-now\/' target=''>Go<\/a>\n\t\t\t<\/div>\n\t\t<\/div>\n\t<\/div>\n\n\n<div class=\"wp-block-group is-style-section-padding is-layout-flow wp-block-group-is-layout-flow\">\n<h2 class=\"wp-block-heading has-text-align-center has-purple-color has-text-color\">2026 Formulary Changes<\/h2>\n\n\n\n<p class=\"has-text-align-center is-style-default has-intro-font-size wp-block-paragraph\">The table below outlines all the changes to our formulary since the formulary list was last printed on 07\/01\/2026.<\/p>\n\n\n\n<div style=\"height:25px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n\n<figure class=\"wp-block-table is-style-stripes col-1-5 col-2-3 col-3-2 col-4-2 col-3-center col-4-center\"><table><thead><tr><th>Drug Name<\/th><th>Description of Change*<\/th><th>Copay Amount<\/th><th>Effective Date<br>of Change<\/th><\/tr><\/thead><tbody><tr><td>Hernexeos (zongertinib)<\/td><td>Addition to formulary with PA<\/td><td>$1<\/td><td>04\/01\/2026<\/td><\/tr><tr><td>Modeyso (dordaviprone)<\/td><td>Addition to formulary with PA<\/td><td>$1<\/td><td>04\/01\/2026<\/td><\/tr><tr><td>Ensacove (ensartinib)<\/td><td>Addition to formulary with PA<\/td><td>$1<\/td><td>04\/01\/2026<\/td><\/tr><tr><td>Ibtrozi (taletrectinib)<\/td><td>Addition to formulary with PA<\/td><td>$1<\/td><td>04\/01\/2026<\/td><\/tr><tr><td>Novolog Mix 70\/30 vial, and Novologix Mix FlexPen<\/td><td>Addition to formulary with PA<\/td><td>$1<\/td><td>04\/01\/2026<\/td><\/tr><tr><td>Inluriyo (imlunestrant) <\/td><td>Addition to formulary with PA<\/td><td>$1<\/td><td>07\/01\/2026<\/td><\/tr><tr><td>Komzifti (ziftomenib)<\/td><td>Addition to formulary with PA<\/td><td>$1<\/td><td>07\/01\/2026<\/td><\/tr><tr><td>Hyrnuo (sevabertinib)<\/td><td>Addition to formulary with PA<\/td><td>$1<\/td><td>07\/01\/2026<\/td><\/tr><tr><td>Fiasp (insulin aspart) 100-unit vial and FlexTouch<\/td><td>Addition to formulary with QL<\/td><td>$1<\/td><td>07\/01\/2026<\/td><\/tr><tr><td>umeclidinium-vilanterol (generic of Anoro Ellipta)<\/td><td>ST removal<\/td><td>$1<\/td><td>07\/01\/2026<\/td><\/tr><tr><td>lubiprostone (generic Amitiza)<\/td><td>PA removal; Addition of QL<\/td><td>$1<\/td><td>07\/01\/2026<\/td><\/tr><\/tbody><\/table><\/figure>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">*QL = Quantity Limit, PA = Prior Authorization, ST = Step Therapy, NF = Non Formulary, N\/A = Not Applicable<\/p>\n\n\n\n<div style=\"height:3em\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n\n<div id=\"block_ee24d6438f0452c0703b8f4476d23c15\" class=\"wpfox-text-image-section default-padding circle\">\r\n\t<div class=\"wrapper has-teal-background-color\">\r\n\t\t<div class=\"row row-text-image image-right\">\r\n\t\t\t<div class=\"col col-text\">\r\n\t\t\t\t\n\n<h4 class=\"wp-block-heading has-h-4-featured-font-size\">Member Resources<\/h4>\n\n\n\n<h2 class=\"wp-block-heading has-h-2-featured-font-size\">Member Documents Can Be Mailed to You.<\/h2>\n\n\n\n<p class=\"is-style-default has-intro-font-size wp-block-paragraph\">All documents are available in <strong>paper form without charge<\/strong>. To request a paper copy, please call <strong>Customer Service<\/strong> at:<\/p>\n\n\n\n<div class=\"wp-block-buttons is-style-margin-top-10 is-layout-flex wp-block-buttons-is-layout-flex\">\n<div class=\"wp-block-button is-style-phone-icon-no-tab\"><a class=\"wp-block-button__link has-white-color has-gold-background-color has-text-color has-background wp-element-button\" href=\"tel:800-654-9728\">800-654-9728<\/a><\/div>\n<\/div>\n\n\n\n<p class=\"is-style-default margin-top-0 wp-block-paragraph\">Monday through Friday, 8 a.m. to 5 p.m.<\/p>\n\n\r\n\t\t\t<\/div>\r\n\t\t\t<div class=\"col col-image\">\r\n\t\t\t\t\r\n\t\t\r\n\t\t\t<div class='image-wrapper'>\r\n\t\t\t\t<img loading=\"lazy\" decoding=\"async\" width=\"1024\" height=\"1024\" src=\"https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/help-1024x1024.jpg\" class=\"attachment-large size-large\" alt=\"Woman waving during a video call\" srcset=\"https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/help-1024x1024.jpg 1024w, https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/help-300x300.jpg 300w, https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/help-150x150.jpg 150w, https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/help-768x768.jpg 768w, https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/help-1536x1536.jpg 1536w, https:\/\/ppmco.foxtrotdev.com\/wp-content\/uploads\/2022\/07\/help.jpg 1920w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/>\r\n\t\t\t<\/div>\r\n\t\t\r\n\t\t\r\n\t\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t<\/div>\r\n<\/div>","protected":false},"excerpt":{"rendered":"<p>Outlined changes made to the formulary since it was last printed.<\/p>\n","protected":false},"author":7,"featured_media":0,"parent":226,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"formulary changes, copay, copayment change, addition of PA, addition to formulary","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"9691,11566,11346,10974,11561,14131","_relevanssi_noindex_reason":"","inline_featured_image":false,"footnotes":""},"class_list":["post-14611","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.2 - 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