Update: Vyvanse Formulary Update Effective January 1, 2022

Effective January 1, 2022, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) has removed Vyvanse from coverage on the Essential Formulary. Other commercial formularies (Enhanced and Net Results) will continue to maintain the same utilization management requirements on this medication.

This change does not impact Medicare, State Health Plan (SHP) members, Federal Employee Program (FEP) members, or groups that do not use Blue Cross NC for their pharmacy benefits.

Formulary Notes

All formulary changes are reviewed by an independent committee of physicians and pharmacists practicing within North Carolina. This includes representation from psychiatric and family medicine specialties.

Non comprehensive list of alternatives in these classes and their tier on the Essential Formulary:

• Amphetamine- Dextroamphetamine (generic Adderall XR) – Tier 2
• Methylphenidate Hcl ER (generic Concerta) – Tier 2
• Methylphenidate LA (generic Ritalin LA) – Tier 2
• Dexmethylphenidate ER (generic Focalin XR) - Tier 2
• Dextroamphetamine ER (generic Dexedrine) - Tier 4

Prior to being removed from the Essential Formulary, Vyvanse was a Tier 3 medication.

A coverage exception can be granted in the rare circumstance that a member’s specific clinical situation makes the alternatives inappropriate for their health.  More information concerning these requests can be found here.

The non-formulary drug criteria can be found at this link.

Member impact

The formulary update impacted commercial groups and individual ACA members on the Essential Formulary on January 1, 2022.  ACA group members will be impacted upon renewal.

Member notification of this change was sent in mid-November and by updates to the shopper formulary publication once the Open Enrollment Period began.

Members switching to one of the most common alternatives will likely see a decrease in out-of-pocket costs due to moving to a lower tier drug.

If you have questions, please call our Provider Blue Line at 1-800-214-4844 for assistance.