Change Sets / Atorvastatin — move to Tier 2 and add Prior Authorization

Atorvastatin — move to Tier 2 and add Prior Authorization

in_review 2027 MA-PD Parent Formulary

Request details

Target formulary
2027 MA-PD Parent Formulary
Requested by
J. Rivera (Clinical Pharmacy)
Business reason
2027 formulary strategy update
Created
2026-06-15 18:56 UTC

Proposed parent-baseline change as part of the 2027 formulary strategy review.

Member impact summary

2 potentially member-impacting changesThese changes make the formulary more restrictive (higher tier, PA/ST added, tighter QL, or coverage removed) and warrant careful review.

Structured diff (normalized business facts, not file cells)

DrugField changedOld valueNew valueMember impact
atorvastatin calcium 40 MG Oral Tablet
617311
Tier 1 2 Higher tier (1 → 2)
atorvastatin calcium 40 MG Oral Tablet
617311
Prior Authorization (PA) false true Prior Authorization added

Review actions

Approving records a reviewer decision. Merging applies the diff to the formulary’s items and marks the change set merged.

Approval history

ReviewerRoleDecisionCommentsWhen
No decisions recorded yet.