Effective 1/1/2021: Allwell Formulary and Prescription Alternative Updates
Date: 02/04/21
As of January 1, 2021, some drugs are no longer covered on the Allwell from Superior HealthPlan formulary. To assist providers, the list below contains the most commonly prescribed drugs that were removed from the formulary, along with the drug’s 2021 formulary alternative(s). Please refer to the list to identify the appropriate options for members.
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 it is determined to be necessary for the member to continue the non-formulary drug in 2021, a Drug Coverage Determination Form must be submitted after December 1, 2020. These forms are located on Allwell's Coverage Determinations and Redeterminations for Drugs webpage. You may also call Allwell’s Prior Authorization department at 1-800-867-6564 to request authorization.
Additional Information
For any questions, please contact Envolve Pharmacy Solutions at 1-800-867-6564.