2025 Medicare Formulary Changes and Alternate Drugs
Date: 12/02/24
2025 Formulary Changes
On January 1, 2025, some drugs will no longer be covered on our Medicare Part D Plan formulary(ies). To assist our providers, we have included the list below of the most commonly prescribed drugs being removed along with the drug’s 2025 formulary alternative(s). Please refer to the list to identify the appropriate options for your patients.
Product Name | Formulary Alternative(s) |
|---|---|
Basaglar KwikPen | Insulin Glargine-yfgn |
Gemtesa | Tolterodine, Solifenacin, Oxybutynin, Myrbetriq |
Fiasp | Insulin Aspart |
Pulmicort Flexhaler | Arnuity Ellipta |
Levalbuterol HFA | Albuterol Sulfate HFA, Ventolin HFA |
Emgality | Aimovig* |
Silodosin | Tamsulosin, Alfuzosin ER, Finasteride, Dutasteride |
Veltassa | Sodium Polystyrene Sulfonate, Lokelma |
Fesoterodine ER | Tolterodine, Solifenacin, Oxybutynin, Myrbetriq |
Xeljanz, Xeljanz XR | Yuflyma*, Cyltezo 40 mg/0.8mL*, Humira*, Enbrel*, Rinvoq*, Skyrizi*, Stelara* |
Forteo | Teriparatide 620 mcg/2.48mL* |
Procrit | Retacrit* |
Download and print a copy of the 2025 Formulary Changes (PDF).
If you determine that it is necessary for your patient to continue to receive the non-formulary drug in 2025, you will need to submit a Coverage Determination request on or after December 2, 2024.
Request forms are located on our website on the Coverage Determinations and Redeterminations for Drugs page www.wellcare.com/allwellWI or you can call to request authorization.If you have any questions, please contact Medicare Pharmacy Services at 1-800-867-6564.
2025 Alternative Drugs Covered
We strive to cover the most common drugs across all conditions. Please see the full list of common drugs not covered by the plan, along with alternative drugs that are covered. If your patient is currently on a drug that is not covered, please see if the formulary alternatives linked here that would work for your patient. You can also check our plan’s formulary (drug list) for a comprehensive listing of all drugs that are covered and any formulary restrictions that may apply.
Download and print a copy of the 2025 Alternative Drugs list (PDF).
Thank you for being a valued partner in caring for the health and well-being of our members. If you have any questions about the information above, please contact your Provider Relations representative or call the Provider Inquiry Line at 1-800-222-9831. If you are unsure who is your representative, please email us at WI_Provider_Relations@mhswi.com.