Plan Benefits
Priority Partners Formulary Changes
2025 Formulary Changes
The table below outlines all the changes to our formulary since the formulary list was last printed on 01/01/2025.
| Drug Name | Description of Change* | Copay Amount | Effective Date of Change |
|---|---|---|---|
| Alogliptin tablets | Copayment Change | $1 | 01/01/2025 |
| Alogliptin-metformin tablets | Copayment Change | $1 | 01/01/2025 |
| Fluticasone-salmeterol (generic of Airduo Respiclick) | Copayment Change | $1 | 01/01/2025 |
| levalbuterol inhaler | Copayment Change | $1 | 01/01/2025 |
| Basaglar KwikPen | Copayment Change | $1 | 01/01/2025 |
| Admelog SoloStar and vial | Copayment Change | $1 | 01/01/2025 |
| Dexcom G6 and G7 products | Copayment Change | $1 | 01/01/2025 |
| Freestyle Libre, Libre 2, and Libre 3 products | Copayment Change | $1 | 01/01/2025 |
| Omnipod products | Copayment Change | $1 | 01/01/2025 |
| Androderm (testosterone transdermal) | Addition to formulary | $1 | 01/01/2025 |
| Jatenzo (testosterone undecanoate) | Addition to formulary | $1 | 01/01/2025 |
| Dapagliflozin (generic formulation of Farxiga) | Addition to formulary | $1 | 01/01/2025 |
| Priftin (rifapentine tablet) | Addition to formulary | $1 | 01/01/2025 |
| Opill (OTC norgestrel tablet) | Addition to formulary | $1 | 01/01/2025 |
| Ojemda (tovorafenib) | Addition to formulary with PA | $1 | 01/01/2025 |
| Lazcluze (lazertinib) | Addition to formulary with PA | $1 | 01/01/2025 |
| Voranigo (vorasidenib) | Addition to formulary with PA | $1 | 01/01/2025 |
| Pregnyl (chorionic gonadotropin) injection | Addition of PA | $1 | 01/01/2025 |
| Novarel (chorionic gonadotropin) injection | Addition of PA | $1 | 01/01/2025 |
| Generic Chorionic gonadotropin injection | Addition of PA | $1 | 01/01/2025 |
| Ovidrel (choriogonadotropin alfa) injection | Addition of PA | $1 | 01/01/2025 |
| Follistim AQ (follitropin beta) injection | Addition of PA | $1 | 01/01/2025 |
| Gonal-F (follitropin alfa) injection | Addition of PA | $1 | 01/01/2025 |
| Gonal-F-RFF (follitropin alfa/beta) injection | Addition of PA | $1 | 01/01/2025 |
| Gonal-F-RFF Redi-Ject (follitropin alfa/beta) injection | Addition of PA | $1 | 01/01/2025 |
| Ganirelix acetate injection, Fyremadel Injection (ganirelix acetate) | Addition of PA | $1 | 01/01/2025 |
| Cetrorelix acetate injection (generic of Cetrotide) | Addition of PA | $1 | 01/01/2025 |
| Menopur (menotropins) injection | Addition of PA | $1 | 01/01/2025 |
*QL = Quantity Limit, PA = Prior Authorization, ST = Step Therapy, NF = Non Formulary, N/A = Not Applicable
Member Resources
Member Documents Can Be Mailed to You.
All documents are available in paper form without charge. To request a paper copy, please call Customer Service at:
Monday through Friday, 8 a.m. to 5 p.m.
