Products & Programs PharmacyMedicaidMarch 4, 2025

Quarterly pharmacy formulary change notice

The formulary changes in the table below were reviewed and approved at our fourth quarter 2024 Pharmacy and Therapeutics Committee meeting.

Effective March 1, 2025, the changes outlined below apply to all Anthem members.

Effective for all patients on March 1, 2025

Therapeutic class

Drug

Revised status

Potential alternatives

DERMATOLOGICALS

COSENTYX 300MG SENSOREADY PEN

COSENTYX 150MG SENSOREADY PEN

COSENTYX 150MG/ML INJECTION

COSENTYX 300MG INJECTION

COSENTYX 75MG/0.5ML INJECTION

COSENTYX 125MG/5ML INJECTION

COSENTYX UNO 300MG/2ML INJECTION

NON‑PREFERRED

SELARSDI INJECTION

(PA REQUIRED)

INTERLEUKIN ANTAGONISTS

SELARSDI INJECTION

PREFERRED WITH PA

N/A

PHOSPHODIESTERASE 4 (PDE4) INHIBITORS

OTEZLA STARTER KIT

OTEZLA 10/20MG TABLET

OTEZLA 30MG TABLET

NON‑PREFERRED

SELARSDI INJECTION

(PA REQUIRED

SOLUBLE TUMOR NECROSIS FACTOR RECEPTOR AGENTS

ENBREL MINI 50MG/ML INJECTION

ENBREL SURECLICK 50MG/ML INJECTION

ENBREL 25MG/ML INJECTION

ENBREL 50MG/ML INJECTION

NON‑PREFERRED

SELARSDI INJECTION

(PA REQUIRED

What action do I need to take?

Please review these changes and work with your Anthem patients to transition them to formulary alternatives. If preferred formulary alternatives are not clinically appropriate for specific patients, you will need to obtain preapproval to continue coverage beyond the effective date.

What if I need assistance?

If, for medical reasons, your Anthem patient cannot be converted to a formulary alternative, call our Pharmacy department at 844‑396‑2330 and follow the voice prompts for pharmacy preapproval. You can find the Preferred Drug List on our care provider partners website at https://providers.anthem.com/nv.

If you need assistance with any other item, contact your local Provider Relations representative or contact Provider Services at 844‑396‑2330.

Anthem Blue Cross and Blue Shield Healthcare Solutions is the trade name of Community Care Health Plan of Nevada, Inc. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

NVBCBS-CD-078422-25

PUBLICATIONS: April 2025 Provider Newsletter