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The table lists each medication alongside the review date, clinical use category, current plan setup, and proposed EBD recommendations based on inputs from EBRx and Navitus. It also records impacted member counts, detailed cost figures (WAC, MAC, commissions), and Board of Finance approval recommendations for both ASE/PSE and overall review 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Avery","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-07","2026-10-02",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What information is provided for each drug in the EBD formulary recommendations?","Question",{"text":112,"@type":113},"Each entry includes the drug name, the date it was considered by EBD, therapeutic use, current setup, EBD recommendation details, impacted members, and cost information (e.g., WAC/MAC) plus approval recommendations for ASE/PSE and Board of Finance.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How are EBD recommendations determined for the formulary entries?",{"text":117,"@type":113},"The document states that EBD recommendations are based on input from EBRx and Navitus.",{"name":119,"@type":110,"acceptedAnswer":120},"Which time periods are covered by this exhibit?",{"text":121,"@type":113},"The exhibit covers formulary recommendation decisions for June 2025 and July 2025, with the title indicating the full scope includes August 2025 as well.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},496974,1791165908,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},1099523882367,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","EXHIBIT B1  \nEBD PHARMACY FORMULARY RECOMMENDATIONS (June, July, Aug 2025)  \n\n| June 2025 EBD Pharmacy Formulary Recommendations |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Drug Name | Date Drug Cosidered by EBD | Use | Current Setup | EBD Recommendation (based on Input from EBRx and Navitus) | Impacted Members | Cost Details | ASE / PSE\u003Cbr>Commissions | Board of Finance |\n| ALYFTREK TAB | 6/10/25 | Cystic Fibrosis | NC | Tier S, SP, PA, QL 10-50-125mg: 2 tabs/day\u003Cbr>4-20-50mg: 3 tabs/day | 0 | WAC: $350,585 annually | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| Brillinta | 6/10/25 | Antiplatelet | Tier 2 | NC | 77\u003Cbr>90 day grandfather-NVTwill send letters | WAC: $7.75 per tab\u003Cbr>$5,580 annually | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| ticagrelor | 6/10/25 | Antiplatelet | Tier 2 | Tier 2 | 2 | MAC: $7.18 per tab\u003Cbr>$5,169 annually | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| Jynarque | 6/10/25 | Autosomal Dominant Polycystic Kidney Disease | Tier S, PA, QL, LD | NC | 2\u003Cbr>90 day grandfather with lifetime approval for generic | WAC: $385 per tab\u003Cbr>$277,200 annually | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| tolvaptan | 6/10/25 | Autosomal Dominant Polycystic Kidney Disease | Tier 1, PA, QL, LD | NC | 0 | MAC: $200 per tab\u003Cbr>$144,000 annually | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| Promacta | 6/10/25 | Low Platelets | Tier S, SP, PA, QL | NC | 1\u003Cbr>90 day grandfather | WAC: $260- $708 per dose | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| eltrombopag | 6/10/25 | Low Platelets | Tier 1, SP, PA, QL | Tier 1, SP, PA, QL | 0 | WAC: $205- $558 per dose | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| CORLANOR TAB | 6/10/25 | Heart Failure | Tier 3, PA | NC | 3 | WAC: $10.43 per tab $7,509 annually | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| ivabradine hcl tab | 6/10/25 | Heart Failure | Tier 1, PA | Tier 1, PA | 14 | WAC: $2.25- $8.05 per tab,$5,796 annually | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| MIPLYFFA CAP | 6/10/25 | Niemann-Pick disease type C | New to Market | NC | 0 | WAC: $446.50- $1,1780 per cap, $1 .27M annually | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| AQNEURSA PACKET FOR SUSPENSION | 6/10/25 | Niemann-Pick disease type C | New to Market | NC | 1 | WAC: $480.36 per packet $518,788 annually | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| VALTOCO NASAL SPRAY | 6/10/25 | Seizures | Tier 3, QL=4 doses/fill | Tier 3, QL= 5 doses/fill | 9 | WAC: $365.94 per spray | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| PREVNAR 20 INJ | 6/10/25 | Vaccine | $0 VAC, covered for members 19 years and older | $0, VAC | 318 | WAC: ~$280 per inj | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| renaphro cap | 6/10/25 | Multivitamin | Tier 1 | NC | 1\u003Cbr>90 day grandfather | ~$5 . 00- $14.00 per script | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| dialyvite tab | 6/10/25 | Multivitamin | Tier 1 | NC | 3\u003Cbr>90 day grandfather |  | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| folbee tab | 6/10/25 | Multivitamin | Tier 1 | NC | 6\u003Cbr>90 day grandfather |  | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n\n\n| July 2025 EBD Pharmacy Formulary Recommendations |  |  |  |  |  |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Drug Name | Date Drug\u003Cbr>Cosidered by\u003Cbr>EBD | Use | Current Setup | EBD Recommendation (based on Input from EBRx and Navitus) | Impacted Members | Cost Details | ASE / PSE\u003Cbr>Commissions | Board of Finance |\n| TASIGNA CAP | 7/8/25 | Chronic Myeloid\u003Cbr>Leukemia | Tier S, SP, PA, SF | NC | 2 (lifetime\u003Cbr>grandfather) | WAC: $193.26 per capsule $141,079 .80 per year | Approve\u003Cbr>Recommendation | Approve\u003Cbr>Recommendation |\n| nilotinib cap | 7/8/25 | Chronic Myeloid\u003Cbr>Leukemia | NTM | Tier 1, SP, PA | 0 | WAC: $176.25 per capsule $128,662 .50 per","cbCaivkyS1fNTtJq","https://ap.wps.com/l/cbCaivkyS1fNTtJq","pdf",313349,"English","# Exhibit B1 - EBD Pharmacy Formulary Recommendations (June, July, Aug 2025)\n## June 2025\n## July 2025","[{\"question\":\"What information is provided for each drug in the EBD formulary recommendations?\",\"answer\":\"Each entry includes the drug name, the date it was considered by EBD, therapeutic use, current setup, EBD recommendation details, impacted members, and cost information (e.g., WAC/MAC) plus approval recommendations for ASE/PSE and Board of Finance.\"},{\"question\":\"How are EBD recommendations determined for the formulary entries?\",\"answer\":\"The document states that EBD recommendations are based on input from EBRx and Navitus.\"},{\"question\":\"Which time periods are covered by this exhibit?\",\"answer\":\"The exhibit covers formulary recommendation decisions for June 2025 and July 2025, with the title indicating the full scope includes August 2025 as well.\"}]","EXHIBIT B1 - EBD Pharmacy Formulary Recommendations - June, July, Aug 2025 | PDF",1790945194,15]