Drug List Changes

  • Effective January 01, 2016

    Formulary Changes to the Preferred B2 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Femhrt tabletMoving to Non-Formularynorethindrone acetate/ethinyl estradiol tablet in Tier 1
    Halflytely/bisacodyl kitMoving to Non-Formularypolyethylene glycol 3350/bisacodyl kit in Tier 1
    Mestinon tabletMoving to Non-Formularypyridostigmine tablet in Tier 1
    Namenda tabletMoving to Non-Formularymemantine tablet in Tier 1

    Formulary Changes to the Preferred B3 & B4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Femhrt tabletMoving to Tier 3 from Tier 2norethindrone acetate/ethinyl estradiol tablet in Tier 1
    Halflytely/bisacodyl kitMoving to Tier 3 from Tier 2polyethylene glycol 3350/bisacodyl kit in Tier 1
    Mestinon tabletMoving to Tier 3 from Tier 2pyridostigmine tablet in Tier 1
    Namenda tabletMoving to Tier 3 from Tier 2memantine tablet in Tier 1

    Formulary Changes to the X1, X3 & X4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Aggrenox capsuleMoving to Non-Formularyaspirin/dipyridamole capsule in Tier 1
    Axert tabletMoving to Non-Formularyalmotriptan tablet in Tier 1
    Femhrt tabletMoving to Non-Formularynorethindrone acetate/ethinyl estradiol tablet in Tier 1
    Halflytely/bisacodyl kitMoving to Non-Formularypolyethylene glycol 3350/bisacodyl kit in Tier 1
    Mestinon tabletMoving to Non-Formularypyridostigmine tablet in Tier 1
    Namenda tabletMoving to Non-Formularymemantine tablet in Tier 1
    Olysio capsuleMoving to Specialty TierOlysio capsule in Specialty Tier
    Sovaldi tabletMoving to Specialty TierSovaldi tablet in Specialty Tier
    Zyvox tabletMoving to Non-Formularylinezolid tablet in Tier 1

    Formulary Changes to the Value-Based V1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Aggrenox capsuleMoving to Tier 4 from Tier 3aspirin/dipyridamole capsule in Tier 1
    Axert tabletMoving to Tier 4 from Tier 3almotriptan tablet in Tier 1
    Dipentum capsule Moving to Tier 4 from Tier 3sulfasalazine tablet in Tier 1; Asacol HD tablet in Tier 2; Pentasa capsule in Tier 2
    Femhrt tabletMoving to Tier 4 from Tier 2norethindrone acetate/ethinyl estradiol tablet in Tier 1
    Focalin XR capsuleMoving to Tier 4 from Tier 3dexmethylphenidate extended-release capsule in Tier 1
    Halflytely/bisacodyl kitMoving to Tier 4 from Tier 3polyethylene glycol 3350/bisacodyl kit in Tier 1
    Irenka capsuleMoving to Tier 4 from Tier 3duloxetine capsule in Tier 1
    Mestinon tabletMoving to Tier 4 from Tier 2pyridostigmine tablet in Tier 1
    Metozolv tabletMoving to Tier 4 from Tier 3metoclopramide orally disintegrating tablet in Tier 1
    Namenda tabletMoving to Tier 4 from Tier 2memantine tablet in Tier 1
    Naprelan tabletMoving to Tier 4 from Tier 3naproxen sodium extended-release tablet in Tier 1
    Targretin capsuleMoving to Tier 4 from Tier 3bexarotene capsule in Tier 1
    Zyvox tabletMoving to Tier 4 from Tier 3linezolid tablet in Tier 1

    *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.