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Formulary Updates: Q1 2023

Horizon's Pharmacy and Therapeutics (P&T) Committee meets quarterly to review new drugs, drug classes, clinical indications, therapeutic advantages, chemical entities and safety information to help ensure that our formularies encourage the use of safe, effective and affordable drugs by our members.

The tables below outline changes determined for our Commercial and Medicare Formularies at the P&T Committee meetings held in the first quarter of 2023.


Added to Non-Preferred Status following evaluation
Brand Name Generic Name Prior Authorization (Y/N)
Pheburane® sodium phenylbutyrate Y
Hyftor™ sirolimus Y
Moved from Non-Preferred Status to Non-Formulary Status
Brand Name Generic Name Prior Authorization (Y/N)
Ravicti® glycerol phenylbutyrate Y
Remaining in Non-Formulary Status following review
Brand Name Generic Name Prior Authorization (Y/N)
Vivjoa® oteseconazole Y
Ztalmy® ganaxolone Y
Auvelity™ dextromethorphan with bupropion Y
Epsolay® benzoyl peroxide Y
Radicava ORS® edaravone Y
Tlando® testosterone undeconate Y
Entadfi™ finasteride and tadalafil Y
Zoryve® roflumilast Y
Aspruzyo Sprinkle™ ranolazine Y
Adlarity® Donepezil Y
Tadliq® Tadalafil Y
Ryaltris® olopatadine with mometasone Y


Added to the Medicare Formulary
Brand Name Generic Name Prior Authorization (Y/N)
Elahere™ Mirvetuximab Soravtansine-Gynx Y
Tecvayli™ Teclistamab Y
Jynneos® Smallpox and mpox vaccine N
Imjudo® Tremelimumab-actl Y
Noxafil® PowderMix kit Posaconazole delayed release susp packet Y
Not covered in the Medicare Formulary
Brand Name Generic Name Prior Authorization (Y/N)
Furoscix® SQ furosemide n/a
Tascenso ODT® Fingolimod n/a
Stimufend® Pegfiltrastim-fpgk n/a
Pedmark® Sodiumthiosulfate n/a
Relyvrio™ Sodium phenylbutyrate/taurusodiol n/a
Xelstrym™ Dextroamphetamine transdermal system n/a

Formulary information is available

This document contains prescription brand name drugs that are registered marks or trademarks of pharmaceutical manufacturers that are not affiliated with either Horizon Blue Cross Blue Shield of New Jersey or the Blue Cross Blue Shield Association.

Published on: March 20, 2023, 14:36 p.m. ET
Last updated on: March 13, 2023, 14:38 p.m. ET