Drug List Changes

  • Effective April 01, 2017

    Formulary Changes to the Preferred B2 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Emend capsuleNo longer coveredaprepitant capsule
    Kaletra solutionNo longer coveredlopinavir/ritonavir solution
    Seroquel XR tabletNo longer coveredquetiapine extended-release tablet
    Tamiflu capsuleNo longer coveredoseltamivir capsule
    Zetia tabletNo longer coveredezetimibe tablet

    Formulary Changes to the Preferred B3 and B4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Emend capsuleMoving to a higher levelaprepitant capsule
    Kaletra solutionMoving to a higher levellopinavir/ritonavir solution
    Seroquel XR tabletMoving to a higher levelquetiapine extended-release tablet
    Tamiflu capsuleMoving to a higher leveloseltamivir capsule
    Zetia tabletMoving to a higher levelezetimibe tablet

    Formulary Changes to the E1 and E4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Emend capsuleMoving to a higher levelaprepitant capsule
    Kaletra solutionMoving to a higher levellopinavir/ritonavir solution
    Seroquel XR tabletMoving to a higher levelquetiapine extended-release tablet
    Tamiflu capsuleMoving to a higher leveloseltamivir capsule
    Zetia tabletMoving to a higher levelezetimibe tablet

    Formulary Changes to the X1, X3 and X4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Analpram E 2.5% cream kitNo longer coveredhydrocortisone/pramoxine 2.5% cream kit
    Azilect tabletNo longer coveredrasagiline tablet
    Cafergot tabletNo longer coveredergotamine/caffeine tablet
    Carnitor solutionNo longer coveredlevocarnitine solution
    Cedax capsuleNo longer coveredceftibuten capsule
    Colyte with Flavor PacketsNo longer coveredpolyethylene glycol 3350 electrolyte solution
    Depo-Testosterone injectionNo longer coveredtestosterone cypionate injection
    Dibenzyline capsuleNo longer coveredphenoxybenzamine capsule
    Donnatal elixirNo longer coveredphenobarbital/hyoscyamine/atropine/scopolamine elixir
    Drysol 20% topical solutionNo longer coveredaluminum chloride 20% topical solution
    Emend capsuleNo longer coveredaprepitant capsule
    Epivir solutionNo longer coveredlamivudine solution
    Focalin XR capsuleNo longer covereddexmethylphenidate extended-release capsule
    Kaletra solutionNo longer coveredlopinavir/ritonavir solution
    Kayexalate powderNo longer coveredsodium polystyrene sulfonate powder
    Lithobid tabletNo longer coveredlithium carbonate extended-release tablet
    Naftin 1% creamNo longer coverednaftifine 1% cream
    Pulmicort Respules inhaled suspensionNo longer coveredbudesonide inhaled suspension
    Sarafem tabletNo longer coveredfluoxetine tablet
    Seroquel XR tabletNo longer coveredquetiapine extended-release tablet
    Tamiflu capsuleNo longer coveredoseltamivir capsule
    Zetia tabletNo longer coveredezetimibe tablet
    Zonalon 5% creamNo longer covereddoxepin 5% cream
    Zyban SR 150mg tabletNo longer coveredbupropion sustained-release 150mg tablet

    Formulary Changes to the M1, M2 and M4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Analpram E 2.5% cream kitNo longer coveredhydrocortisone/pramoxine 2.5% cream kit
    Azilect tabletNo longer coveredrasagiline tablet
    Cafergot tabletNo longer coveredergotamine/caffeine tablet
    Carnitor solutionNo longer coveredlevocarnitine solution
    Cedax capsuleNo longer coveredceftibuten capsule
    Colyte with Flavor PacketsNo longer coveredpolyethylene glycol 3350 electrolyte solution
    Depo-Testosterone injectionNo longer coveredtestosterone cypionate injection
    Dibenzyline capsuleNo longer coveredphenoxybenzamine capsule
    Donnatal elixirNo longer coveredphenobarbital/hyoscyamine/atropine/scopolamine elixir
    Drysol 20% topical solutionNo longer coveredaluminum chloride 20% topical solution
    Emend capsuleNo longer coveredaprepitant capsule
    Epivir solutionNo longer coveredlamivudine solution
    Focalin XR capsuleNo longer covereddexmethylphenidate extended-release capsule
    Kaletra solutionNo longer coveredlopinavir/ritonavir solution
    Kayexalate powderNo longer coveredsodium polystyrene sulfonate powder
    Lithobid tabletNo longer coveredlithium carbonate extended-release tablet
    Naftin 1% creamNo longer coverednaftifine 1% cream
    Pulmicort Respules inhaled suspensionNo longer coveredbudesonide inhaled suspension
    Sarafem tabletNo longer coveredfluoxetine tablet
    Seroquel XR tabletNo longer coveredquetiapine extended-release tablet
    Tamiflu capsuleNo longer coveredoseltamivir capsule
    Zetia tabletNo longer coveredezetimibe tablet
    Zonalon 5% creamNo longer covereddoxepin 5% cream
    Zyban SR 150mg tabletNo longer coveredbupropion sustained-release 150mg tablet

    Formulary Changes to the Value-Based V1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Azilect tabletMoving to a higher levelrasagiline tablet
    Emend capsuleMoving to a higher levelaprepitant capsule
    Focalin XR capsuleMoving to a higher leveldexmethylphenidate extended-release capsule
    Kaletra solutionMoving to a higher levellopinavir/ritonavir solution
    Naftin 1% creamMoving to a higher levelnaftifine 1% cream
    Seroquel XR tablet Moving to a higher levelquetiapine extended-release tablet
    Tamiflu capsuleMoving to a higher leveloseltamivir capsule

    Formulary Changes to the Select C4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Kaletra solutionMoving to a higher levellopinavir/ritonavir solution
    Seroquel XR tabletMoving to a higher levelquetiapine extended-release tablet
    Tamiflu capsuleMoving to a higher leveloseltamivir capsule

    *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.