Drug List Changes

  • Effective July 01, 2015

    Formulary Changes to the Preferred B2 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Cellcept suspensionMoving to Non-preferredmycophenolate mofetil suspension in Tier 1
    Exforge HCT tabletMoving to Non-preferredamlodipine/valsartan/hydrochlorothiazide tablet in Tier 1
    MetroGel 0.75% gelMoving to Non-preferredmetronidazole gel 0.75% in Tier 1
    Nexium capsuleMoving to Non-preferredesomeprazole capsule in Tier 1
    Stromectol tablet Moving to Non-preferredivermectin tablet in Tier 1
    Valcyte 450mg tabletMoving to Non-preferredvalganciclovir tablet in Tier 1
    Vivelle-Dot patchMoving to Non-preferredestradiol transdermal system in Tier 1

    Formulary Changes to the Preferred B3 & B4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Cellcept suspensionMoving to Tier 3 from Tier 2mycophenolate mofetil suspension in Tier 1
    Exforge HCT tabletMoving to Tier 3 from Tier 2amlodipine/valsartan/hydrochlorothiazide tablet in Tier 1
    MetroGel 0.75% gelMoving to Tier 3 from Tier 2metronidazole gel 0.75% in Tier 1
    Nexium capsuleMoving to Tier 3 from Tier 2esomeprazole capsule in Tier 1
    Stromectol tablet Moving to Tier 3 from Tier 2ivermectin tablet in Tier 1
    Valcyte 450mg tabletMoving to Tier 3 from Tier 2valganciclovir tablet in Tier 1
    Vivelle-Dot patchMoving to Tier 3 from Tier 2estradiol transdermal system in Tier 1

    Formulary Changes to the X1, X3 & X4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Celebrex capsuleMoving to Non-preferredcelecoxib capsule in Tier 1
    Cellcept suspensionMoving to Non-preferredmycophenolate mofetil suspension in Tier 1
    Duexis tabletMoving to Non-preferredibuprofen tablet in Tier 1 & famotidine tablet in Tier 1
    Edarbi tabletMoving to Non-preferredcandesartan cilexetil tablet in Tier 1, eprosartan tablet in Tier 1, irbesartan tablet in Tier 1, losartan tablet in Tier 1, telmisartan tablet in Tier 1, valsartan tablet in Tier 1
    Exforge HCT tabletMoving to Non-preferredamlodipine/valsartan/hydrochlorothiazide tablet in Tier 1
    Intuniv tabletMoving to Non-preferredguanfacine extended-release tablet in Tier 1
    MetroGel 0.75% gelMoving to Non-preferredmetronidazole gel 0.75% in Tier 1
    Nexium capsuleMoving to Non-preferredesomeprazole capsule in Tier 1
    Orapred ODT tabletMoving to Non-preferredprednisolone orally disintegrating tablet in Tier 1
    Stromectol tablet Moving to Non-preferredivermectin tablet in Tier 1
    Valcyte 450mg tabletMoving to Non-preferredvalganciclovir tablet in Tier 1
    Vivelle-Dot patchMoving to Non-preferredestradiol transdermal system in Tier 1

    Formulary Changes to the Value-Based V1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Bromfed-DM syrupMoving to Tier 4 from Tier 3brompheniramine/dextromethorphan/pseudoephedrine syrup in Tier 1
    Celebrex capsuleMoving to Tier 4 from Tier 3celecoxib capsule in Tier 1
    Clobex 0.05% sprayMoving to Tier 4 from Tier 3clobetasol 0.05% spray in Tier 1
    Exforge HCT tabletMoving to Tier 4 from Tier 2amlodipine/valsartan/hydrochlorothiazide tablet in Tier 1
    Focalin XR capsuleMoving to Tier 4 from Tier 3dexmethylphenidate extended-release capsule in Tier 1
    Intuniv tabletMoving to Tier 4 from Tier 3guanfacine extended-release tablet in Tier 1
    Lovaza capsuleMoving to Tier 4 from Tier 3omega-3 acid ethyl esters capsule in Tier 1
    MetroGel 0.75% gelMoving to Tier 4 from Tier 2metronidazole gel 0.75% in Tier 1
    Nexium capsuleMoving to Tier 4 from Tier 2esomeprazole capsule in Tier 1
    Orapred ODT tabletMoving to Tier 4 from Tier 3prednisolone orally disintegrating tablet in Tier 1
    Stromectol tabletMoving to Tier 4 from Tier 2ivermectin tablet in Tier 1
    Vivelle-Dot patchMoving to Tier 4 from Tier 2estradiol transdermal system in Tier 1

    Formulary Changes to the Select C4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Cellcept suspensionMoving to Tier 3 from Tier 2mycophenolate mofetil suspension 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.