Drug List Changes

  • Effective July 01, 2020

    Formulary Changes to the Preferred B2 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Carafate oral suspensionNo longer coveredsucralfate oral suspension
    Depen tabletNo longer coveredpenicillamine tablet
    NuvaRing contraceptiveNo longer coveredetonogestrel/ethinyl estradiol contraceptive

    Formulary Changes to the Preferred B3 and B4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Carafate oral suspensionMoving to a higher levelsucralfate oral suspension
    Depen tabletMoving to a higher levelpenicillamine tablet
    NuvaRing contraceptiveMoving to a higher leveletonogestrel/ethinyl estradiol contraceptive

    Formulary Changes to the E1 and E4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Depen tabletMoving to a higher levelpenicillamine tablet
    NuvaRing contraceptiveMoving to a higher leveletonogestrel/ethinyl estradiol contraceptive

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

    Drug Name Description of Change Cost-effective Alternatives*
    Carafate oral suspensionNo longer coveredsucralfate oral suspension
    Depen tabletNo longer coveredpenicillamine tablet
    Jadenu tabletNo longer covereddeferasirox tablet
    Moxeza eye dropsNo longer coveredmoxifloxacin eye drops
    NuvaRing contraceptiveNo longer coveredetonogestrel/ethinyl estradiol contraceptive
    Travatan Z eye dropsNo longer coveredtravoprost eye drops
    Zohydro extended-release capsuleNo longer coveredhydrocodone extended-release capsule

    Formulary Changes to the Select C4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    NuvaRing contraceptiveMoving to a higher leveletonogestrel/ethinyl estradiol contraceptive

    *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.