Reason for change. Recently approved. Recently approved. Recently approved. Recently approved. Recently updated. Recently approved.

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Irene Blair
6 years ago
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1 2017 Formulary Change Notice Please note these changes to your 2017 List of Covered Drugs Drug name (medication) Rubraca Aprepitant Onivyde Oseltamivir Restasis Xiidra Daptomycin Selzentry Linzess Butalb/APAP/caff , Desvenlafaxine ER Nature of the change Reason for change Formulary Alternative alternative Notes Lynparza 5 NM 1-1 Emend Tarceva 5 NM 1-6 Relenza Xiidra Restasis Cubicin Tivicay Amitiza codeine sertraline Last :

2 Ilaris Veltassa Durezol Ilevro Bavencio Busulfan Tazarotene 0.1% cream Austedo Lartruvo Ezetimibe/simvastatin Fluticasone/salmeterol Zejula Synjardy Synjardy XR reduction reduction reduction Arcalyst 5 NM 3-17 SPS Nevanac Nevanac carboplatin Iressa tretinoin Xenazine docetaxel atorvastatin Advair docetaxel Nesina Nesina Last :

3 Glyxambi Tymlos Imfinzi Rydapt Kisqali Femara Co-Pack Ocrevus Ocaliva Octagam Atomoxetine Imfinzi Olopatadine Rubraca Xadago added Nesina Prolia adriamycin cytarabine Ibrance Copaxone 5 NM, QL 5-26 ursodiol Prosol 3 PA 6-9 methylphenidate doxorubicin Patanol paclitaxel carbidopa-levodopa Last :

4 Alunbrig Tymlos Rituxan Hycela Dupixent Siliq Sevelamer Carbonate Otezla Xultophy Soliqua Kevzara Ingrezza Idhifa Subsys Avastatin Prolia doxorubicin tretinoin Enbrel Renagel Humira Byetta Victoza Humira Xenazine Rydapt Fentanyl 2 PA 9-15 Last :

5 Besponsa Vigabatrin Nerlynx Vyxeos Trimipramine Verzenio Glatiramer Acetate Aliqopa Fosamprenavir Calcium Triptodur Shingrix Vosevi Tremfya daunorubicin lamotrigine Herceptin daunorubicin sertraline Herceptin Aubagio 5 PA,QL daunorubicin Atripla Lupron Depot Zostavax Harvoni 5 PA Humira 5 PA Last :

6 Mavyret Calquence Carvedilol ER Qtern Verzenio Shingrix Carvedilol ER Juluca Harvoni 5 PA Rituxan 5 PA atenolol Nesina Ibrance 5 PA Zostavax atenolol Atripla 5 NM Blue Cross Blue Shield of Arizona Advantage is an HMO plan with a Medicare contract. Enrollment in Blue Cross Blue Shield of Arizona Advantage depends on contract renewal. You can ask BCBSAZ Advantage to make an exception to our coverage rules. There are several types of exceptions that you can ask us to make. You can ask us to cover a drug even if it is not on our formulary. If, this drug will be covered at a pre-determined cost-sharing level, and you would not be able to ask us to provide the drug at a lower cost-sharing level. You can ask us to cover a formulary drug at a lower cost-sharing level. For example a drug is covered in 4; you can ask us to cover it at the cost-sharing amount that applies to drugs in 3 instead. This would lower the amount you must pay for your drug. You can ask us to waive coverage restrictions or limits on your drug. For example, for certain drugs, BCBSAZ Advantage limits the amount of the drug that we will cover. If Last :

7 your drug has a quantity limit, you can ask us to waive the limit and cover a greater amount. For more recent information or other questions, please contact BCBSAZ Advantage at 1-(800) or, for TTY users, 711, October 1-February 14, 7 days a week, 8 a.m.-8 p.m. (February 15-September 30, Monday Friday, 8 a.m.- 8 p.m.), or visit Last :

2018 Medicare Part D Formulary Change

2018 Medicare Part D Formulary Change We may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, or add prior authorizations, quantity limits and/or step therapy