Pharmacy Formulary and Medical Policy Changes for July 2025
Beginning July 2025, some drugs will have a formulary drug list change. You can view drug list changes here.
Also, starting July 2025, the following drugs will require prior authorization:
Condition
Drugs requiring a new prior authorization
Preferred alternatives
Cancer
Nyvepria (pegfilgrastim-apgf)
- Fulphila (pegfilgrastim-jmdb)
- Udenyca (pegfilgrastim-cbqv)
- Udenyca On-body (pegfilgrastim-cbqv)
Inflammatory diseases
Humira (adalimumab)
- Adalimumab-adaz
- Adalimumab-adbm
- Adalimumab-ryvk
- Cyltezo (adalimumab-adbm)
- Simlandi (adalimumab-ryvk)
New prescriptions: Prescriptions dispensed on or after July 2025, will need a new prior authorization. For members currently taking Humira, we are doing additional provider outreach to transition members to a preferred alternative.
Current prescriptions: If there’s no alternative medication for a member currently taking one of these prescriptions, submit a prior authorization and ensure all conditions are met. Members who receive an approved prior authorization may have higher out-of-pocket costs than a preferred alternative drug, depending on their health plan.
Communication: Letters to impacted members will be mailed this month encouraging them to contact their provider.
Contact: If you have questions, call the pharmacy services team at 888-261-1756, Monday through Friday, 7:30 a.m. to 6 p.m. Pacific Time.