Drug List Changes

  • Refer to your Premera member ID card or log in to find your pharmacy plan name.
  • Effective April 01, 2020

    Formulary Changes to the Preferred B2 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Restasis Multidose eye dropsNo longer coveredRestasis eye drops
    Sandostatin LAR Depot injectionNo longer coveredSomatuline Depot injection

    Formulary Changes to the Preferred B3 and B4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Bethkis inhalation solutionMoving to a higher leveltobramycin inhalation solution
    Extavia injectionMoving to a higher levelBetaseron injection
    Restasis Multidose eye dropsMoving to a higher levelRestasis eye drops
    Sandostatin LAR Depot injectionMoving to a higher levelSomatuline Depot injection
    Tobi inhalation solutionMoving to a higher leveltobramycin inhalation solution
    Tobi Podhaler inhalation powderMoving to a higher leveltobramycin inhalation solution

    Formulary Changes to the E1 and E4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Apriso extended-release capsuleMoving to a higher levelmesalamine extended-release capsule
    Bethkis inhalation solutionMoving to a higher leveltobramycin inhalation solution
    Extavia injectionMoving to a higher levelBetaseron injection
    Sandostatin LAR Depot injectionMoving to a higher levelSomatuline Depot injection

    Formulary Changes to the M1, M2 and M4 (2020) Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Apriso extended-release capsuleNo longer coveredmesalamine extended-release capsule
    Aubagio tabletNo longer coveredConsult doctor
    Bethkis inhalation solutionNo longer coveredtobramycin inhalation solution
    Ingrezza capsuleNo longer coveredAustedo tablet or tetrabenazine tablet
    Naftin 1% gelNo longer coverednaftifine 1% gel
    Restasis Multidose eye dropsNo longer coveredRestasis eye drops
    Sandostatin LAR Depot injectionNo longer coveredSomatuline Depot injection
    Signifor LAR injectionNo longer coveredSomatuline Depot injection
    Tobi Podhaler inhalation powderNo longer coveredtobramycin inhalation solution

    *These drugs have been selected by an independent group of experts made up of doctors and pharmacists. This group reviews drugs to see how well they work relative to their cost. They also compare their effectiveness to similar drugs used to treat the same condition. Please talk with your doctor to see if these new options are right for you.