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2022 Formulary Change Notification

December 1, 2021

On January 1, 2022, some drugs will no longer be covered on our Medicare Part D formulary. To assist our providers, we have included the list below of the most commonly prescribed drugs being removed along with the drug's 2022 formulary alternative(s). Please refer to the list to identify the appropriate options for your patients.

Product Name Formulary Alternative

BYDUREON PEN (product discontinued)

BYDUREON BCISE AUTO INJ

AURYXIA

CALCIUM ACETATE (PHOS BINDER) CAP/TAB, SEVELAMER CARBONATE

TRULANCE

LINZESS CAP, LUBIPROSTONE CAP

BRINZOLAMIDE OPHTH SUSP 1%

AZOPT, DORZOLAMIDE

If you determine that it is necessary for your patient to continue to receive the non-formulary drug in 2022, you will need to submit a Coverage Determination request on or after November 1, 2021.

Request forms are located on our website on the Coverage Determinations and Redeterminations for Drugs page www.wellcare.com/medicare or you can call to request authorization.

If you have any questions, please contact Medicare Pharmacy Services at 1-855-538-0454.

This update applies to: All Network Providers

State(s): MAPD

AL, AR, AZ, CA, CT, FL, GA, HI, IL, KY, LA, MA, ME, MI, MO, MS, NC, NH, NJ, NY, OH, RI, SC, TN, TX, VT, WA

Line of Business: Medicare Part D

Member Services: 1-833-444-9088: AL, AR, AZ, CT, FL, IL, KY, LA, MA, ME, MI, MO, MS, NC, NH, NJ, NY, RI, TN, TX, VT, WA

CA: 1-866-999-3945

GA, IL, MI, OH, SC: 1-866-892-8340

HI: 1-877-457-7621

Prior Authorization: 1-855-538-0454

 

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Last Updated On: 12/7/2021
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