Pharmacy Benefits Advisory Committee (PBAC) Updates

Updated 4/1/2024

Pharmacy Benefits Advisory Committee (PBAC) Updates

The Pharmacy Benefits Advisory Committee (PBAC), consisting of clinical subject matter experts within Michigan Medicine and the University of Michigan, meets regularly to review and approve changes to the Prescription Drug Plan formulary. Check the formulary for up to date formulary status. Formulary status is subject to change. Here are the latest updates.

May 2024

Effective May 1, 2024, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Brand Products Added to Formulary

  • Eohilia – Tier 3, PA, QL
  • Fabhalta – Tier 2, specialty, PA, QL
  • Truqap – Tier 2, specialty, PA, QL, split fill
  • Xphozah – Tier 3, specialty, LDD, PA, QL

April 2024

Effective April 1, 2024, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Brand Products Added to Formulary

  • Bimzelx – Tier 3, specialty, PA, QL
  • Bosulif 50 mg and 100 mg capsules – Tier 2, specialty, PA, QL
  • Sunlenca tablet – Tier 2, specialty, QL
  • Velsipity – Tier 3, specialty, PA, QL
  • Zilbrysq – Tier 3, specialty, LDD, PA, QL

March 2024

Effective March 1, 2024, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Brand Products Added to Formulary

  • Augtyro – Tier 2, specialty, PA, QL
  • Fruzaqla – Tier 2, specialty, PA, QL
  • Ogsiveo – Tier 2, specialty, PA, QL, split fill
  • Rozlytrek pellet – Tier 2, specialty, PA, QL
  • Xalkori pellet – Tier 2, specialty, PA, QL
  • Zenpep Dr 60,000 unit capsule – Tier 2, MMN, AL, QL
  • Zoryve 0.3% foam – Tier 3, MMN, PA, QL
  • Zurzuvae – Tier 2, specialty, LDD, PA, QL

January 2024

Effective Jan. 1, 2024, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Brand Products Added to Formulary

  • Akeega – Tier 2, specialty, SCN, PA, QL
  • Jesduvroq – Tier 3, PA, QL
  • Paxlovid – Tier 2, AL, QL, pharmacy attestation required

Coverage Updates

  • Advair HFA – Moved to tier 2
  • Alogliptin/alogliptin-metformin – Moved to non-formulary
  • Amphetamine 5 mg and 10 mg tablet (Evekeo) – Moved to tier 1, AL, QL
  • Breo Ellipta – Moved to tier 2, removed ST
  • Cephalexin 250 mg and 500 mg tablets – Moved to excluded (capsules of same strength still covered)
  • Colchicine 0.6 mg capsule – Moved to excluded
  • Cosentyx – Moved to tier 2
  • Dulera – Moved to tier 2
  • Dyanavel XR – Moved to non-formulary, QL
  • Janumet/Janumet XR – Moved to tier 2
  • Jornay PM – Moved to tier 3, PA, QL
  • Nitrofurantoin 25 mg/5 mL oral suspension – Added AL, QL
  • Praluent – Moved to tier 3
  • Roflumilast (Daliresp) – Removed PA
  • Trelegy Ellipta – Moved to tier 2, removed ST
  • Zejula 100 mg tablet – Moved to tier 2, specialty, SCN, PA, QL
  • Lantus brand – Moved to tier 0
  • Novolog brand – Moved to tier 0
  • Humalog brand – Moved to tier 0
  • Levemir brand – Moved to tier 0
  • Tirzepatide (Mounjaro) – Moved to tier 2
  • Fremanezumab (Ajovy) – Moved to tier 2
  • Lasmiditan succinate (Reyvow) – Moved to tier 2
  • Risankizumab (Skyrizi) – Moved to tier 3
  • Upadacitinib (Rinvoq) – Moved to tier 3

November 2023

Effective Nov. 1, 2023, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Brand Products Added to Formulary

  • Momelotinib 100, 150, 200 mg tablets (Ojjaara) – Tier 2, specialty, PA, QL
  • Palovarotene 1, 1.5, 2.5, 5, 10 mg capsules (Sohonos) – Tier 2, LDD, PA
  • Quizartinib 17.7 mg and 26.5 mg tablets (Vanflyta) – Tier 2, specialty, PA, QL
  • Adalimumab-adbm CF – Tier 2, specialty, PA, QL
  • Adalimumab-fkjp – Tier 2, specialty, PA, QL
  • Isavuconazonium 74.5 mg capsule (Cresemba) – Tier 2, MMN, PA, QL
  • Lithium 8 mEq/5 mL oral solution – Tier 1, AL
  • Fluticasone furoate-vilanterol trifenatate 50-25 mcg inhalers (Breo Ellipta) – Tier 3, ST, QL

Other Coverage Updates

Teriparatide 620 mcg/2.48 ml – Moved to tier 0

October 2023

Effective Oct. 1, 2023, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Brand Products Added to Formulary

  • Ritlecitinib 50 mg capsule (Litfulo) – Tier 2, LDD, PA, QL
  • Lotilaner 0.25% ophthalmic solution (Xdemvy) – Tier 2, PA, QL
  • Somatrogon-ghla 24 mg and 60 mg/1.2 mL pens (Ngenla) – Tier 3, specialty, PA
  • Zavegepant 10 mg nasal spray (Zavzpret) – Tier 3, MMN, PA, QL
  • Talazoparib 0.1 mg and 0.35 mg capsules (Talzenna) – Tier 3, specialty, PA, QL
  • Posaconazole 300 mg powder mix oral suspension (Noxafil) – Tier 2, PA
  • Methoxy polyethylene glycol-epoetin beta 120 mcg/0.3 mL syringe (Mircera) – Tier 2, specialty, PA
  • Peg 3350/sodium sulfate, chloride/potassium chlor/magnesium powder (Suflave) – Tier 3
  • Latanoprost 0.005% PF eye drop (Iyuzeh) – Tier 3, ST
  • Nalmefene 2.7 mg nasal spray (Opvee) – Tier 2, QL
  • Respiratory syncytial virus (RSV) vaccine (Arexvy and Abrysvo) – Tier 0, AL, QL

Other Coverage Updates

  • Dabigatran – Moved to tier 0
  • Edoxaban (Savaysa) – Moved to non-formulary
  • Serdexmethylphenidate-dexmethylphenidate capsule (Azstarys) – Updated PA requirements
  • Talazoparib 0.5 mg capsule (Talzenna) – Moved to excluded (0.25 mg capsules to be used instead)
  • Theophylline 300 mg and 400 mg ER capsules (Theo 24) – Added ST

August 2023

Effective Aug. 1, 2023, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Brand Products Added to Formulary

  • Zavegepant nasal spray (Zavzpret) – Tier 3, MMN, PA, QL
  • Fecal microbiota spores capsule (Vowst) – Tier 2, specialty, PA, QL
  • Perfluorohexyloctane 100% eye drops (Miebo) – Tier 3, PA, QL (max 30 days per first fill)
  • Niraparib 200 and 300 mg tablets (Zejula) – Tier 2, specialty, PA, QL
  • Ozanimod 0.23, 0.46, and 0.92 mg starter kits (Zeposia starter kit 28-day) – Tier 3, specialty, PA, QL
  • Voxelotor 300 mg tablets (Oxybryta) – Tier 2, LDD, specialty, PA, QL
  • Deutetrabenazine ER tablets (Austedo XR) – Tier 2, specialty, PA, QL
  • Tolmetin sodium 600 mg tablets – Tier 1, QL

New Generics Added to Formulary

  • Darunavir 600 mg and 800 mg tablets (generic for Prezista)

Other Coverage Updates

  • Niraparib 100 mg capsules – Reduced QL
  • Tolmetin sodium 200 mg tablets – Added QL
  • Levothyroxine capsules (Tirosint) – Added QL
  • Sodium phenylbutyrate products – Added QL

  • Odevixibat (Bylvay) – Updated PA requirements (see criteria document)

  • Linaclotide 72 mcg capsule (Linzess) – Updated PA requirements (see criteria document)
  • Propranolol 80 mg XL capsule (InnoPran XL/Inderal XL) – Moved to excluded
  • Indomethacin 50 mg suppository (Indocin) – Moved to tier 3, MMN, added PA, added QL

July 2023

Effective July 1, 2023, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Brand Products Added to Formulary

  • Sodium Oxybate ER Packets (Lumryz) – Tier 3, LDD, PA, QL
  • Fezolinetant tablets (Veozah) – Tier 2, PA, QL
  • Somapacitan pens (Sogroya) – Tier 3, PA, QL
  • Elexacaftor-tezacaftor-ivacaftor 80-40-60 mg/59.5 mg and 100-50-75 mg/75 mg packets (Trikafta) – Tier 2, specialty, PA, QL
  • Ivacaftor 5.8 mg and 13.4 mg granule packets (Kalydeco) – Tier 2, specialty, PA, QL
  • Dabrafenib 10 mg oral tablet for suspension (Tafinlar) – Tier 2, specialty, PA, QL
  • Trametinib 0.05 mg/mL oral solution (Mekinist) – Tier 2, specialty, PA, QL

New Generics Added to Formulary

  • Naftifine 2% gel (generic for Naftin)
  • Budesonide 2 mg rectal foam (generic for Uceris)
  • Methsuximide 300 mg capsule (generic for Celontin)

Other Coverage Updates

  • Naltrexone/Bupropion (Contrave) – Removed PA requirement for coverage
  • Phentermine/Topiramate (Qsymia) – Removed PA requirement for coverage
  • Solriamfetol tablets (Sunosi) – Moved to Tier 2, updated PA requirements (see criteria document)
  • Pitolisant tablets (Wakix) – Updated PA requirements (see criteria document)
  • Sodium Oxybate products – Updated PA requirements (see criteria document)
  • Mometasone nasal spray – Moved to excluded
  • Upadacitinib tablets (Rinvoq) – Updated PA requirements (see criteria document)

May 2023

Effective May 1, 2023, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Brand Products Added to Formulary

  • Sparsentan tablets (Filspari) – Tier 2, specialty, LDD, PA, QL

  • Omaveloxolone capsules (Skyclarys) – Tier 2, specialty, LDD, PA, QL

  • Trofinetide 200 mg/mL oral solution (Daybue) – Tier 2, specialty, LDD, PA, QL

  • Leniolisib 70 mg tablet (Joenja) – Tier 2, specialty, LDD, PA, QL

  • Olutasidenib 150 mg capsule (Rezlidhia) – Tier 2, specialty, PA, QL

  • Insulin glargine-aglr KwikPen (Rezvoglar) – Tier 0

  • Levofloxacin 1.5% eye drops – Tier 1

New Generics Added to Formulary

  • Lurasidone 20, 40, 60, 80, 120 mg tablet (generic for Latuda)
  • Nitisinone 20 mg capsule (generic for Orfadin)

Other Coverage Updates

  • Rifaximin 550 mg tablet (Xifaxan) – Moved to Michigan Medicine closed network (must fill at Michigan Medicine), effective Sept. 1, 2023 – Added PA
  • Topical tretinoin products – Added age limit requiring PA if >39 years of age
  • CGRP inhibitor products – Updated PA requirements (see criteria document)
  • Latuda tablets – Removed step therapy requirements

April 2023

Effective April 1, 2023, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Brand Products Added to Formulary

  • Apalutamide 240 mg tablets (Erleada) – Tier 2, specialty, PA, QL

  • Pexidartinib hydrochloride 125 mg capsules (Turalio) – Tier 2, LDD, specialty, PA, QL

  • Sotorasib 320 mg tablets (Lumakras) – Tier 2, specialty, PA, split fill, QL

  • Lanadelumab-flyo 150 mg/ml syringe (Takhzyro) – Tier 2, LDD, specialty, PA, QL

Other Coverage Updates

  • Sodium picosulfate/magnesium oxide/citric acid solution (Clenpiq) – Moved to Non-Formulary and added QL

March 2023

Effective March 1, 2023, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Brand Products Added to Formulary

  • Adalimumab-atto 40 mg autoinjector (Amjevita) – Tier 2, specialty, PA, QL

  • Tezepelumab-ekko pens (Teszspire) – Tier 2, specialty, PA, QL

  • Pirtobrutinib tablets (Jaypirca) – Tier 2, specialty, PA, QL

  • Elacestrant hydrochloride tablets (Orserdu) – Tier 2, specialty, LDD, PA, QL

New Generics Added to Formulary

  • Tafluprost 0.0015% eye drop (generic for Zioptan)
  • Diclofenac 50 mg powder packet (generic for Cambia)
  • Minocycline 105 mg and 135 mg ER tablet (generic for Minolira)
  • Brimonidine 0.33% gel pump (generic for Mirvaso)
  • Tasimelteon 20 mg capsule (generic for Hetlioz)
  • Dichlorphenamide 50 mg tablet (generic for Keveyis)
  • Estradiol 50 mg/5 mL IM injection (generic for Delestrogen)

Other Coverage Updates

  • Beclomethasone Dipropionate inhaler (QVAR Redihaler) – Moved to Tier 2
  • Fluticasone Furoate inhaler (Arnuity Ellipta) – Moved to Tier 2
  • Ciclesonide HFA inhaler (Alvesco) – Added PA
  • Mometasone (Asmanex Twisthaler and Asmanex HFA) – Added PA
  • Zileuton tablet (Zyflo) – Moved to non-formulary
  • Tezepelumab-ekko syringes (Teszspire) – Moved to Tier 2, specialty, PA, QL

February 2023

Effective Feb. 1, 2023, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Drug Products and Biosimilars Added to Formulary

  • Adagrasib 200 mg tablets (Krazati) – Tier 2, PA, QL, split fill

December 2022

Effective Dec. 1, 2022, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Drug Products and Biosimilars Added to Formulary

  • Dextroamphetamine 4.5, 9, 13.5, 18 mg/9-hour patch (Xelstrym) – Tier 3, PA, QL
  • Dextromethorphan-bupropion 45-105 mg tablet (Auvelity) – non-formulary, QL
  • Futibatinib 4 mg tablet (Lytgobi) – Tier 2, specialty, PA, QL
  • Pegfilgrastim-pbbk 6 mg/0.6 mL syringe (Fylnetra) – Tier 2, specialty, QL
  • Furosemide 80 mg/10 mL subcutaneous injection on-body kit (Furoscix) – Tier 3, LDD, PA, QL

New Generics Added to Formulary

  • Roflumilast 250 and 500 mcg tablet (generic for Daliresp)

November 2022

New Drug Products and Biosimilars Added to Formulary

Effective Nov. 1, 2022, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

  • Deucravacitinib 6 mg tablet (Sotyktu) – Tier 3, specialty, PA, QL
  • Edaravone oral suspension (Radicava ORS) – Tier 2, LDD, PA, QL
  • Ibrutinib 70 mg/mL oral suspension (Imbruvica) – Tier 2, specialty, PA, QL
  • Lumacaftor-ivacaftor 75-94 mg granule packet (Orkambi) – Tier 2, specialty, PA, QL
  • Tadalafil 20 mg/5 mL oral suspension (Tadliq) – Tier 3, specialty, PA, QL
  • Clindamycin phosphate 2% vaginal gel (Xaciato) – non-formulary, QL

New Generics Added to Formulary

  • Fingolimod 0.5 mg capsule (generic for Gilenya)
  • Orlistat 120 mg capsule (generic for Xenical)
  • Icosapent ethyl 500 mg capsule (generic for Vascepa)
  • Timolol maleate 0.25% PF eye drop (generic for Timoptic Ocudose)
  • Tazarotene 0.05% and 0.1% gel (generic for Tazorac)
  • Estradiol 0.1% (0.25 mg), (0.5 mg), (0.75 mg), (1 mg) and (1.25 mg) gel packet (generic for Divigel)

October 2022

New Drug Products Added to Formulary

Effective Oct. 1, the following changes will be made to the Prescription Drug Plan's formulary. Review the formulary. 

  • Oteseconazole 150 mg capsules (Vivjoa) – Tier 3, PA, QL
  • Sirolimus 0.2% gel (Hyftor) – Tier 2, LDD, PA, QL
  • Roflumilast 0.3% cream (Zoryve) – Tier 3, specialty, PA, QL
  • Filgrastim-ayow (Releuko) – Tier 2, specialty, QL
  • Tenapanor 50 mg tablets (Ibsrela) – Tier 3, PA, QL (2 per day)

New Generics Added to Formulary

  • Sodium sulfate-potassium sulfate-magnesium sulfate solution (generic for Suprep)
  • Lenalidomide 2.5 mg and 20 mg capsule (generic for Revlimid)

August 2022

New Drug Products Added to Formulary

Effective Aug. 1, 2022, the following changes will be made to the Prescription Drug Plan's formulary. Review the formulary. 

  • Tirzepatide injection (Mounjaro) – Tier 3, ST, QL, AL (≥ 18 years)
  • Tapinarof 1% cream (Vtama) – Tier 3, specialty, PA, QL
  • Ranolazine ER 500 mg and 1,000 mg granule packet (Aspruzyo sprinkle) – Tier 3, AL (≤ 10 years), QL
  • Treprostinil 16 mcg, 32 mcg, 48 mcg, and 64 mcg dry powder inhaler (Tyvaso DPI) – Tier 3, LDD, PA, QL
  • Measles, mumps and rubella vaccine live/pf (Priorix) – Tier 0, QL

New Generics and Biosimilars Added to Formulary

  • Dabigatran 75 mg and 100 mg capsule (generic for Pradaxa)

  • Vilazodone 10 mg, 20 mg, 40 mg tablet (generic for Viibryd)

  • Lacosamide 10 mg/mL solution (generic for Vimpat)

  • Bexarotene 1% gel (generic for Targretin)

  • Mesalamine ER 500 mg capsule (generic for Pentasa)

  • Sorafenib 200 mg tablet (generic for Nexavar)

  • Methylphenidate 10 mg, 15 mg, 20 mg, and 30 mg/9-hour patch (generic for Daytrana)

June 2022

New Drug Products Added to Formulary

Effective June 1, 2022, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

  • Ganaxolone (Ztalmy) – Tier 2, LDD, PA, QL
  • Mavacamten (Camzyos) – Tier 3, specialty, PA, QL
  • Testosterone undecanoate 112.5 mg capsules (Tlando) Tier 3, PA, QL
  • Amlodipine besylate 1 mg/mL oral solution (Norliqva) – Tier 3, AL

New Generics and Biosimilars Added to Formulary

  • Nalmefene HCl 2mg/2mL vial (generic for Revex)

  • Apomorphine 30 mg/3 mL cartridge (generic for Apokyn)
  • Hydralazine hydrochloride and isosorbide dinitrate 20-37.5 tablet (generic for BiDil)
  • Pirfenidone 257 mg and 801 mg tablet (generic for Esbriet)
  • Baclofen 5 mg/5 mL oral solution (generic for Ozobax)