Medicare Provider Update: 2021 Formulary Changes for Medicare Part D-DSNP
Date: 11/04/20
Fort Lauderdale, Florida
On Jan. 1, 2021, some drugs will no longer be covered on our Medicare/Medicare-Medicaid formulary(ies). To assist providers, the list below includes the most commonly prescribed drugs being removed along with the drug’s 2021 formulary alternative(s). Please refer to the list to identify the appropriate options for your patients.
Product Name | Formulary Alternative |
Cimetidine | Famotidine, Nizatidine |
Fluticasone Propionate/Salmeterol Diskus, Wixela Inhub | Advair, Symbicort, Breo Ellipta, Trelegy Ellipta |
Glyburide | Glipizide, Glimepiride |
| Humalog Mix, Humalog Mix Kwikpen | Novolog Mix 70/30, Novolog 70/30 Flexpen |
Humalog, Humalog Kwikpen | Novolog INJ, Novolog Flexpen, Fiasp, Fiasp Flextouch |
| Humulin 70/30, Humulin 70/30 Kwikpen | Novolin INJ 70/30, Novolin 70/30 Flexpen (Note: brand RELION not covered) |
Humulin N, Humulin N Kwikpen | Novolin N INJ U-100, Novolin N Flexpen (Note: brand RELION not covered) |
Humulin R | Novolin R, Novolin R Flexpen (Note: brand RELION not covered) |
Indomethacin | Ibuprofen, Meloxicam, Naproxen |
Invokana | Jardiance, Farxiga |
Lantus, Lantus Solostar | Basaglar, Levemir, Tresiba |
Omega-3-Acid Ethyl Esters | Vascepa |
Premarin Crm, Premarin Tabs | Estradiol |
Proair HFA, Proair Respiclick | Ventolin HFA, Albuterol HFA |
| Spiriva Handihaler, Spiriva Respimat | Incruse Ellipta, Trelegy Ellipta |
Stiolto Respimat | Anoro Ellipta, Bevespi Aerosphere, Trelegy Ellipta |
Testosterone Gel 1.62%, Testosterone Soln 30 MG/ACT | Testosterone Gel 1%, Testosterone Gel Pump 1% |
| Toujeo Solostar, Toujeo Max Solostar | Basaglar, Levemir, Tresiba |
Travatan Z | Travoprost, Latanoprost Sol 0.005%, Lumigan Sol 0.01%, Rhopressa Sol 0.02% |
Vesicare | Solifenacin |
If you determine that it is necessary for your patient to continue to receive the non-formulary drug in 2021, you will need to submit a Coverage Determination request on or after Dec. 1, 2020.
Request forms are located on our Allwell website on the Coverage Determinations and Redeterminations for Drugs page, or you can call 1-800-867-6564 to request authorization.
If you have any questions, please contact Medicare Pharmacy Services at 1-800-867-6564.