Effective January 1, 2021, FutureScripts, our pharmacy benefits manager, will make its standard biannual changes to its Premium Formulary, as well as changes regarding albuterol HFA rescue inhalers.
The Premium Formulary is a restricted formulary managed by FutureScripts and is available to commercial members in Pennsylvania. This formulary includes all therapeutic categories and provides physicians with prescribing options. In addition, the formulary is reviewed biannually to add new drugs and to remove brand-name drugs when a generic equivalent becomes available. When you prescribe a formulary medication, plan participants receive the drug for a lower copayment. If you prescribe a drug not on the formulary, the plan participants' out-of-pocket cost will be greater. Prescribing generic drugs allows plan participants to always pay the lowest copayment. The use of the formulary does not prohibit you from prescribing an uncovered medication. You are able to prescribe any covered medication, regardless of whether the drug is on the formulary or not. However, a formulary exception is needed for drugs that have been excluded from the formulary.
Albuterol HFA rescue inhalers
Albuterol HFA inhalers are indicated for the treatment or prevention of bronchospasm in patients with reversible obstructive airway disease, including asthma and chronic obstructive pulmonary disease (COPD).
Effective January 1, 2021, FutureScripts is making a change to the Premium Formulary and moving to a generic only albuterol HFA rescue inhaler strategy. All branded albuterol HFA products such as Proair®, Proventil®, and Ventolin® as well as their authorized brand alternatives (ABAs) will be moving to an excluded status on the Premium Formulary. Additionally, Levalbuterol HFA and Xopenex® HFA will also be moving to an excluded status. Generic albuterol HFA will continue to be available on the Premium Formulary at the generic tier. All recent albuterol HFA shortages have been resolved and no additional shortages are anticipated at this time.
Providers, as well as their patients, who are affected by this change will be notified by mail. We recognize you are best qualified to choose the most appropriate treatment for your patients and encourage you to discuss switching patients, where appropriate, to the preferred products to avoid any disruption in their therapies.
Note: The term “authorized brand alternative" or ABA is most commonly used to describe an approved brand name drug that is marketed without the brand name on its label. Other than the fact that it does not have the brand name on its label, it is the exact same drug product as the branded product. Unlike a standard generic drug, the ABA is not approved by the U.S. Food and Drug Administration as a generic drug. Accordingly, for cost sharing purposes, ABAs are treated as brand name drugs.
Please review the changes and exclusion lists that go into effect January 1, 2021. For additional information on the Premium Formulary, visit the AmeriHealth Pennsylvania Premium Formulary website.
To view Premium Formulary information for your patients who carry an AmeriHealth Administrators ID card, visit the AmeriHealth Administrators website.