11/1/2021
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Posted by Provider Relations
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.
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Product Name
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Formulary Alternative
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BYDUREON PEN (product discontinued)
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BYDUREON BCISE AUTO INJ
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AURYXIA
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CALCIUM ACETATE (PHOS BINDER) CAP/TAB, SEVELAMER CARBONATE
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TRULANCE
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LINZESS CAP, LUBIPROSTONE CAP
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BRINZOLAMIDE OPHTH SUSP 1%
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AZOPT, DORZOLAMIDE
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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.fideliscare.org/WellcareMedicare/Prescription-Drug-Information or you can call to request authorization.
If you have any questions, please contact Provider Services at 1-888-FIDELIS.