Summer 2019
Neighborhood Health Plan of Rhode Island (Neighborhood) is updating its provider-administered, injected or infused, medical benefit drug formulary. After a comprehensive review of pertinent clinical information, the following changes to the Neighborhood Medical Benefit Formulary were recently approved by the Pharmacy and Therapeutics (P&T) Committee. These changes will help keep health care costs as low as possible for everyone, while ensuring our members, your patients, have access to safe and effective prescription drugs.
Effective July 1, 2019, the following products will require step therapy before their use for the Medicaid (EFP, Subcare, CSN, RHP, RHE, RiteCare) and Exchange lines of business (SHOP and Individual):
| Therapy Class | Drugs with Step Therapy Requirements | Alternative Drugs withoutStep Therapy Requirements |
| Autoimmune Disorders | Remicade
Renflexis |
Inflectra |
| Retina Diseases | Lucentis
Eylea |
Avastin* |
| Long-acting Colony-Stimulating Factors | Fulphila | Neulasta*
Udenyca* |
| Short-acting Colony-Stimulating Factors | Neupogen
Nivestym Granix |
Zarxio* |
| Enzyme Replacement Therapy | Vpriv
Elelyso |
Cerezyme |
| Hyaluronic Acids | Synvisc-One, Durolane, Genvisc, Hyalgan, Supartz, Visco-3, Hymovis, OrthoVisc, Gel-One, Monovisc, Gelsyn-3, Trivisc | Euflexxa |
| Multiple Sclerosis | Lemtrada | Tysabri |
*These products are covered without a prior authorization on the medical benefit.
Step therapy requirements will apply to new starts ONLY, with the exception of products used for Autoimmune Disorders & Hyaluronic Acids. For medications in these two classes, once the current authorization has expired, the step therapy requirements will be applied during authorization renewal requests. The Clinical Medical Policies are posted on the Provider website at https://www.nhpri.org/Providers/ClinicalMedicalPolicies.aspx.
Please contact Neighborhood Health Plan of Rhode Island’s Pharmacy Department with any questions at 401-427-8200.