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The table below outlines all the changes to our formulary since the formulary list was last printed on 01/01/2020.
|Drug Name||Description of Change*||Copay Amount||Effective Date of Change|
|Xospata||Addition to formulary with PA||$3||01/01/2020|
|Balversa||Addition to formulary with PA||$3||01/01/2020|
|Piqray||Addition to formulary with PA||$3||01/01/2020|
|Xpovio||Addition to formulary with PA||$3||01/01/2020|
|Nesina (alogliptin)||Available at $0 copay||$0||03/01/2020|
|Kazano (alogliptin/metformin)||Available at $0 copay||$0||03/01/2020|
|Onglyza (saxagliptin)||Formulary Deletion||N/A||03/01/2020|
|Januvia (sitagliptin)||Formulary Deletion||N/A||03/01/2020|
|Kombiglyze XR (saxagliptin/metformin)||Formulary Deletion||N/A||03/01/2020|
|Janumet, Janumet XR (sitagliptin/metformin)||Formulary Deletion||N/A||03/01/2020|
|Nourianz||Addition to formulary||$3||04/01/2020|
|Vumerity||Addition to formulary with PA||$3||04/01/2020|
|Chloroquine**||QL added (10days supply/60days); N/A to FDA approved diagnosis||$1||04/01/2020|
|Hydroxychloroquine**||QL added (10days supply/60days N/A to FDA approved diagnosis||$1||04/01/2020|
|Kaletra (Lopinavir-ritonavir)**||QL added (10days supply/60days); N/A to FDA approved diagnosis||$3||04/01/2020|
|Ulesfia (benzyl alcohol)||Formulary Deletion||N/A||07/01/2020|
|Ranitidine syrup, tablets, and OTC products||Formulary Deletion||N/A||07/01/2020|
|Videx (didanosine) solution||Formulary Deletion||N/A||07/01/2020|
|Rescriptor (delavirdine)||Formulary Deletion||N/A||07/01/2020|
|Ayvakit (avapritinib)||Addition to formulary with PA||$3||07/01/2020|
|Tazverik (tazemetostat)||Addition to formulary with PA||$3||07/01/2020|
|Pemazyre (pemigatinib)||Addition to formulary with PA||$3||07/01/2020|
|Koselugo (selumetinib)||Addition to formulary with PA||$3||07/01/2020|
|Tukysa (tucatinib)||Addition to formulary with PA||$3||07/01/2020|
*QL = Quantity Limit, PA = Prior Authorization, ST = Step Therapy, NF= Non Formulary
**In light of the COVID-19 Public Health Emergency, to help ensure appropriate access to needed medications, Quantity limit was added to certain medications on a temporary basis. Priority Partners will continue to evaluate as needed.