CommercialJuly 22, 2025
July formulary deletions
Drug name | Advanced drug list | Guided drug list | Complete open drug list | Focused drug list | Effective date |
ACCRUFER | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
ACCU‑CHEK STRIP, GLUCOMETER, & SUPPLIES | Tier 2 (No Change) | NF ‑> Tier 2 | Tier 2 (No Change) | Tier 2 (No Change) | 7/1/25 |
ADALIMUMAB‑ADBM | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | F ‑> NF | 7/1/25 |
ADTHYZA | Tier 3 ‑> NF | NF (No Change) | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
ARMOUR THYROID | Tier 3 ‑> NF | NF (No Change) | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
CALCIPOTRIENE AER 0.005% (Brand) | Tier 1 ‑> Tier 3 | Tier 1 (No Change) | Tier 1 ‑> Tier 3 | Tier 1 ‑> Tier 3 | 7/1/25 |
CYLTEZO | NF (No Change) | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
CYTOMEL | Tier 3 ‑> NF | NF (No Change) | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
DUROLANE | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
EUFLEXXA | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
FREESTYLE STRIPS, GLUCOMETER, & SUPPLIES | NF ‑> Tier 2 | Tier 2 (No Change) | Tier 3 ‑> Tier 2 | NF ‑> Tier 2 | 7/1/25 |
GEL‑ONE | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
GELSYN‑3 | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
HYALGAN | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
HYMOVIS | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
IYUZEH | Tier 3 (No Change) | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
MONOVISC | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | F ‑> NF | 7/1/25 |
NIVA THYROID | Tier 3 ‑> NF | NF (No Change) | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
NP THYROID | Tier 1 ‑> NF | Tier 1 ‑> NF | Tier 1 ‑> Tier 3 | Tier 1 ‑> NF | 7/1/25 |
NUVARING | Tier 3 ‑> NF | Tier 1 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
NUVARING (generic) | Tier 1 (No Change) | NF ‑> Tier 1 | Tier 1 (No Change) | Tier 1 (No Change) | 7/1/25 |
OCALIVA | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
ONETOUCH TEST STRIP, GLUCOMETER, & SUPPLIES | Tier 2 ‑> NF | Tier 2 ‑> NF | Tier 2 ‑> Tier 3 | Tier 2 ‑> NF | 7/1/25 |
ORTHOVISC | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | F ‑> NF | 7/1/25 |
RHOFADE | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
SELARSDI | NF ‑> Tier 3 | NF ‑> Tier 3 | Tier 3 (No Change) | NF ‑> F | 7/1/25 |
SIMLANDI | NF ‑> Tier 3 | NF ‑> Tier 3 | Tier 3 (No Change) | NF ‑> F | 7/1/25 |
SODIUM OXYBATE | Tier 3 (No Change) | Tier 3 (No Change) | Tier 3 (No Change) | NF ‑> F | 7/1/25 |
SUPARTZ FX | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
SYNTHROID | Tier 3 ‑> NF | NF (No Change) | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
SYNOJOYNT | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
SYNVISC | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | F ‑> NF | 7/1/25 |
SYNVISC ONE | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | F ‑> NF | 7/1/25 |
TERIPARATIDE (Brand) | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | F ‑> NF | 7/1/25 |
THYROID | Tier 3 ‑> NF | NF (No Change) | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
TIROSINT/TIROSINT ‑SOL | Tier 3 ‑> NF | NF (No Change) | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
TRILURON | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
VISCO‑3 | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
VYVANSE | Tier 2 ‑> NF | NF (No Change) | Tier 2 ‑> Tier 3 | Tier 2 ‑> NF | 7/1/25 |
XYREM | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | NF (No Change) | 7/1/25 |
ZORYVE CRE 0.3% | Tier 3 ‑> NF | Tier 3 ‑> NF | Tier 3 (No Change) | Tier 3 ‑> NF | 7/1/25 |
*Members should refer to their member handbook for benefit details regarding applicable copayments or coinsurance.
Note: This is a summary of July 1, 2025, changes only. There may be additional positive changes to our Commercial formularies to be effective July 1, 2025.
Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MULTI-BCBS-CM-086610-25 CPN86144
PUBLICATIONS: August 2025 Provider Newsletter
To view this article online:
Visit https://providernews.anthem.com/nevada/articles/july-formulary-deletions-26108
Or scan this QR code with your phone