Anthem Blue Cross and Blue Shield | 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 Anthem Health Plans of Virginia, Inc. Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc., serving all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123, are independent licensees 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
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