CommercialCoverageMedium impact
Formulary Policy Updates
MVP Health Care·Pharmacy·Pharmacy
We identified it
Jul 19, 2026
Summary
MVP Health Care has updated its Q2 2025 formulary, removing prior authorization requirements for Ojemda (tablet and suspension), excluding four new drugs (Duvyzat, Iqirvo, Myhibbin, Tyenne, Tofidence) from coverage, and adding two new generic medications (Octreotide IM injection and Hydrocortisone succinate PF) to the formulary. Changes take effect on each member's plan year start date.
Action Required
Before the member's Plan Year 2025 start date: (1) Billing team must remove prior authorization requirements from system for Ojemda tablet and Ojemda suspension on all Commercial, Marketplace, and Self-Funded plans. (2) Update billing software to flag and deny claims for Duvyzat, Iqirvo, Myhibbin, Tyenne, and Tofidence as non-covered drugs for these plan types. (3) Pharmacy staff must add Octreotide IM injection (generic for Sandostatin LAR Kit) and Hydrocortisone succinate PF (generic for Solu-Cortef) to the approved generic medication list in the formulary system. (4) Notify providers and front desk staff of these changes so they can counsel patients about coverage status. Failure to update systems may result in claim denials for excluded drugs or unnecessary prior auth submissions for Ojemda.