Formularies / 2027 Client A Enhanced Formulary
2027 Client A Enhanced Formulary
Derived approved Not independently submittable
This formulary is derived from a CMS-submitted parent formulary.
It is intentionally more generous to members and is not eligible for
independent HPMS submission. HPMS artifacts must be generated from the
parent baseline (2027 MA-PD Parent Formulary).
Details
HPMS submission status
Not eligible for independent submissionBlocked: This formulary is derived from a CMS-submitted parent formulary and is not eligible for independent HPMS submission.
Formulary items (8 drugs)
| Drug | RXCUI | Tier | PA | ST | QL | Covered | Effective |
|---|---|---|---|---|---|---|---|
| atorvastatin calcium 40 MG Oral Tablet | 617311 | 1 | — | — | — | Yes | 2027-01-01 |
| Eliquis 5 MG Oral Tablet | 1364447 | 2 | PA | — | — | Yes | 2027-01-01 |
| Entresto 49 MG / 51 MG Oral Tablet | 1656351 | 3 | PA | — | — | Yes | 2027-01-01 |
| Humira 40 MG in 0.8 ML Auto-Injector | 1655728 | 4 | PA | ST | 1 per 28 days | Yes | 2027-01-01 |
| Jardiance 10 MG Oral Tablet | 1545664 | 2 | — | ST | — | Yes | 2027-01-01 |
| metFORMIN HCl 500 MG Oral Tablet | 861007 | 1 | — | — | — | Yes | 2027-01-01 |
| OZEMPIC 4 MG in 3 ML Pen Injector | 2398842 | 3 | PA | — | 2 per 28 days | Yes | 2027-01-01 |
| TRELEGY ELLIPTA 100 MCG / 62.5 MCG / 25 MCG Dry Powder Inhaler, 30 Blisters | 1945048 | 3 | PA | — | — | Yes | 2027-01-01 |
Change history
| Change set | Requested by | Status | |
|---|---|---|---|
| No change sets. | |||
Submission artifacts
| Version | Generated | Hash | Status |
|---|---|---|---|
| No artifacts generated yet. | |||