Drug List Changes

  • Effective January 01, 2020

    Formulary Changes to the Preferred B2 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Amicar solutionNo longer coveredaminocaproic acid solution
    Ery-Tab 500 mg delayed-release tabletNo longer coverederythromycin base 500 mg delayed-release tablet

    Formulary Changes to the Preferred B3 and B4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Amicar solutionMoving to a higher levelaminocaproic acid solution
    Ery-Tab 500 mg delayed-release tabletMoving to a higher levelerythromycin base 500 mg delayed-release tablet

    Formulary Changes to the E1 and E4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Abilify tabletNo longer coveredaripiprazole tablet
    Abilify Mycite tablet with sensorNo longer coveredConsult doctor
    Acanya gel with pump No longer coveredConsult doctor
    Aczone gel with pumpNo longer covereddapsone gel
    Adcirca tabletNo longer coveredtadalafil tablet
    Adderall tabletNo longer covereddextroamphetamine/amphetamine tablet
    Admelog Solostar insulin penNo longer coveredNovolog pen
    Akynzeo capsuleNo longer coveredConsult doctor
    Ala-Cort creamNo longer coveredhydrocortisone cream
    Alogliptin tabletNo longer coveredConsult doctor
    Ambien tabletNo longer coveredzolpidem tablet
    Ambien CR extended-release tabletNo longer coveredzolpidem extended-release tablet
    Ampyra extended-release tabletNo longer covereddalfampridine extended-release tablet
    Apadaz tabletNo longer coveredConsult doctor
    Apexicon E creamNo longer coveredtriamcinolone cream
    Aubagio tabletNo longer coveredConsult doctor
    Azelex creamNo longer coveredazelaic acid gel
    Baraclude solutionNo longer coveredConsult doctor
    Baraclude tabletNo longer coveredentecavir tablet
    Benzefoam foamNo longer coveredbenzoyl peroxide topical
    Benzefoam ultra foamNo longer coveredbenzoyl peroxide topical
    Benzhydrocodone-acetaminophen tabletNo longer coveredConsult doctor
    Bryhali lotionNo longer coveredhalobetasol propionate cream
    calcipotriene-betamethasone dipropionate ointmentNo longer coveredConsult doctor
    Capex shampooNo longer coveredclobetasol shampoo
    Cleansing wash cleanserNo longer coveredsulfacetamide sodium-sulfur topical
    clindamycin phosphate foamNo longer coveredclindamycin phosphate solution
    clindamycin phosphate-tretinoin gelNo longer coveredConsult doctor
    clindamycin-benzoyl peroxide gel with pumpNo longer coveredConsult doctor
    Clobex shampooNo longer coveredclobetasol shampoo
    Clobex sprayNo longer coveredclobetasol spray
    Clocortolone pivalate creamNo longer coveredtriamcinolone cream
    Cloderm creamNo longer coveredtriamcinolone cream
    Coremino extended-release tabletNo longer coveredminocycline capsule
    Cuprimine capsuleNo longer coveredpenicillamine capsule
    Cymbalta capsuleNo longer coveredduloxetine capsule
    Delstrigo tabletNo longer coveredConsult doctor
    Desonate gelNo longer covereddesonide ointment
    Diclosaicin solution and creamNo longer coveredConsult doctor
    diflorasone diacetate creamNo longer coveredtriamcinolone cream
    diflorasone diacetate ointmentNo longer coveredtriamcinolone ointment
    Ecoza foamNo longer coveredeconazole nitrate cream
    Effexor XR extended-release capsuleNo longer coveredvenlafaxine extended-release capsule
    Elidel creamNo longer coveredpimecrolimus cream
    Emend capsuleNo longer coveredaprepitant capsule
    Emend suspensionNo longer coveredConsult doctor
    esomeprazole magnesium capsuleNo longer coveredomeprazole capsule
    Evenity syringeNo longer coveredConsult doctor
    Evoclin foamNo longer coveredclindamycin phosphate foam
    Exelderm creamNo longer coveredketoconazole cream
    Exelderm solutionNo longer coveredketoconazole cream
    Exjade dispersible tabletNo longer covereddeferasirox dispersible tablet
    Extina foamNo longer coveredketoconazole cream
    Ezallor sprinkle capsuleNo longer coveredrosuvastatin tablet
    flunisolide spray aerosolNo longer coveredfluticasone spray aerosol
    flurandrenolide creamNo longer coveredtriamcinolone cream
    flurandrenolide lotionNo longer coveredtriamcinolone lotion
    flurandrenolide ointmentNo longer coveredtriamcinolone ointment
    Focalin tabletNo longer covereddexmethylphenidate tablet
    Focalin XR extended-release capsuleNo longer covereddexmethylphenidate extended-release capsule
    Ganirelix acetate syringe [brand]No longer coveredganirelix acetate syringe [generic]
    Gleevec tabletNo longer coveredimatinib tablet
    Glucotrol tabletNo longer coveredglipizide tablet
    Glucotrol XL extended-release tabletNo longer coveredglipizide extended-release tablet
    Ingrezza capsuleNo longer coveredConsult doctor
    Intuniv extended-release tabletNo longer coveredguanfacine extended-release tablet
    iodoquinol-hydrocortisone-aloe gelNo longer coveredConsult doctor
    Kapspargo sprinkle extended-release capsuleNo longer coveredmetoprolol succinate extended-release tablet
    Katerzia suspensionNo longer coveredConsult doctor
    Keppra solutionNo longer coveredlevetiracetam solution
    Keppra tabletNo longer coveredlevetiracetam tablet
    Keppra XR extended-release tabletNo longer coveredlevetiracetam extended-release tablet
    ketoconazole foamNo longer coveredketoconazole cream
    Lamictal tabletNo longer coveredlamotrigine tablet
    Lamictal chewable tabletNo longer coveredlamotrigine chewable tablet
    Lamictal disintegrating tabletNo longer coveredlamotrigine disintegrating tablet
    Lamictal XR extended-release tabletNo longer coveredlamotrigine extended-release tablet
    Lidocaine-tetracaine creamNo longer coveredlidocaine-prilocaine cream
    Locoid lipocream creamNo longer coveredhydrocortisone butyrate cream
    Loprox shampooNo longer coveredciclopirox shampoo
    Lucemyra tabletNo longer coveredConsult doctor
    Luliconazole creamNo longer coveredketoconazole cream
    Lunesta tabletNo longer coveredeszopiclone tablet
    Luxiq foamNo longer coveredbetamethasone valerate foam
    Luzu creamNo longer coveredketoconazole cream
    Lyrica capsuleNo longer coveredpregabalin capsule
    Lyrica solutionNo longer coveredpregabalin solution
    Lyrica CR extended-release tabletNo longer coveredpregabalin capsule
    metoprolol succinate-hctz extended-release tabletNo longer coveredConsult doctor
    Metrogel gel with pumpNo longer coveredmetronidazole gel
    metronidazole gel with pumpNo longer coveredmetronidazole gel
    Miconazole-zinc oxide ointmentNo longer coveredketoconazole cream
    Mondoxyne NL capsuleNo longer covereddoxycycline capsule
    Mulpleta tabletNo longer coveredConsult doctor
    Naftin gelNo longer coverednaftifine cream
    Nalfon tabletNo longer coveredfenoprofen tablet
    Neurontin capsuleNo longer coveredgabapentin capsule
    Neurontin solutionNo longer coveredgabapentin solution
    Neurontin tabletNo longer coveredgabapentin tablet
    Okebo capsuleNo longer covereddoxycycline capsule
    Olux foamNo longer coveredclobetasol propionate foam
    Olux-E foamNo longer coveredclobetasol propionate foam
    oxiconazole nitrate creamNo longer coveredketoconazole cream
    Oxistat lotionNo longer coveredketoconazole cream
    Pataday dropsNo longer coveredolopatadine drops
    Pifeltro tabletNo longer coveredConsult doctor
    Pravachol tabletNo longer coveredpravastatin tablet
    Pristiq extended-release tabletNo longer covereddesvenlafaxine extended-release tablet
    Prizotral creamNo longer coveredlidocaine-prilocaine cream
    Provigil tabletNo longer coveredmodafinil tablet
    rabeprazole capsuleNo longer coveredomeprazole capsule
    Rhofade creamNo longer coveredConsult doctor
    Sandostatin LAR depot vialNo longer coveredConsult doctor
    Scalacort lotionNo longer coveredtriamcinolone lotion
    Sernivo aerosol sprayNo longer coveredclobetasol spray
    Seroquel tabletNo longer coveredquetiapine tablet
    Seroquel XR extended-release tabletNo longer coveredquetiapine extended-release tablet
    Signifor LAR vialNo longer coveredConsult doctor
    Siklos tabletNo longer coveredhydroxyurea capsule
    Soloxide tabletNo longer coveredConsult doctor
    Strattera capsuleNo longer coveredatomoxetine capsule
    Striverdi Respimat inhalerNo longer coveredConsult doctor
    Synera adhesive patchNo longer coveredlidocaine-prilocaine cream
    Tikosyn capsuleNo longer covereddofetilide capsule
    Topamax capsuleNo longer coveredtopiramate capsule
    Topamax tabletNo longer coveredtopiramate tablet
    tretinoin microsphere gel with pumpNo longer coveredtretinoin gel
    triamcinolone acetonide aerosolNo longer coveredtriamcinolone cream
    Triderm creamNo longer coveredtriamcinolone cream
    Trileptal suspensionNo longer coveredoxcarbazepine suspension
    Trileptal tabletNo longer coveredoxcarbazepine tablet
    Valium tabletNo longer covereddiazepam tablet
    Victoza pen injectorNo longer coveredConsult doctor
    Vivlodex capsuleNo longer coveredmeloxicam tablet
    Vizimpro tabletNo longer coveredConsult doctor
    Vusion ointmentNo longer coveredketoconazole cream
    Wellbutrin SR sustained-release tabletNo longer coveredbupropion sustained-release tablet
    Xanax tabletNo longer coveredalprazolam tablet
    Xanax XR extended-release tabletNo longer coveredalprazolam extended-release tablet
    Xatmep solutionNo longer coveredConsult doctor
    Xelpros eye dropsNo longer coveredlatanoprost eye drops
    Zavesca capsuleNo longer coveredmiglustat capsule
    Zilacaine patchNo longer coveredlidocaine patch
    Zithranol shampooNo longer coveredConsult doctor
    Zithranol rapid-release creamNo longer coveredConsult doctor
    Zorvolex capsuleNo longer covereddiclofenac tablet
    Zytiga tabletNo longer coveredabiraterone acetate tablet

    Formulary Changes to the E4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Firazyr syringeMoving to a higher levelicatibant syringe

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

    Drug Name Description of Change Cost-effective Alternatives*
    Amicar solutionNo longer coveredaminocaproic acid solution
    Diastat kitNo longer covereddiazepam kit
    Dyrenium capsuleNo longer coveredtriamterene capsule
    Ery-Tab 500 mg delayed-release tabletNo longer coverederythromycin base 500 mg delayed-release tablet
    Firazyr syringeNo longer coveredicatibant syringe
    Lyrica capsuleNo longer coveredpregabalin capsule
    Lyrica solutionNo longer coveredpregabalin solution
    Noxafil delayed-release tabletNo longer coveredposaconazole delayed-release tablet
    Orfadin 2 mg, 5 mg, 10 mg capsulesNo longer coverednitisinone 2 mg, 5 mg, 10 mg capsules
    Rozerem tabletNo longer coveredramelteon tablet

    Formulary Changes to the Select C4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Amicar solutionMoving to a higher levelaminocaproic acid 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.