Drug List Changes

  • Effective April 01, 2016

    Formulary Changes to the Preferred B2 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Androgel topical gelMoving to Non-Formularytestosterone topical gel in Tier 1
    Exelon patchMoving to Non-Formularyrivastigmine patch in Tier 1
    Namenda solutionMoving to Non-Formularymemantine solution in Tier 1
    Neoral capsuleMoving to Non-Formularycyclosporine modified capsule in Tier 1
    Neoral solutionMoving to Non-Formularycyclosporine modified solution in Tier 1
    Ortho Tri-Cyclen Lo tabletMoving to Non-Formularynorgestimate/ethinyl estradiol tablet in Tier 1
    Patanol eye dropsMoving to Non-Formularyolopatadine eye drops in Tier 1
    Sandimmune capsuleMoving to Non-Formularycyclosporine capsule in Tier 1
    Xenazine tabletMoving to Non-Formularytetrabenazine tablet in Tier 1

    Formulary Changes to the Preferred B3 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Androgel topical gelMoving to Tier 3 from Tier 2testosterone topical gel in Tier 1
    Exelon patchMoving to Tier 3 from Tier 2rivastigmine patch in Tier 1
    Namenda solutionMoving to Tier 3 from Tier 2memantine solution in Tier 1
    Neoral capsuleMoving to Tier 3 from Tier 2cyclosporine modified capsule in Tier 1
    Neoral solutionMoving to Tier 3 from Tier 2cyclosporine modified solution in Tier 1
    Ortho Tri-Cyclen Lo tabletMoving to Tier 3 from Tier 2norgestimate/ethinyl estradiol tablet in Tier 1
    Patanol eye dropsMoving to Tier 3 from Tier 2olopatadine eye drops in Tier 1
    Sandimmune capsuleMoving to Tier 3 from Tier 2cyclosporine capsule in Tier 1
    Xenazine tabletMoving to Tier 3 from Tier 2tetrabenazine tablet in Tier 1

    Formulary Changes to the Preferred B4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Androgel topical gelMoving to Tier 3 from Tier 2testosterone topical gel in Tier 1
    Exelon patchMoving to Tier 3 from Tier 2rivastigmine patch in Tier 1
    Namenda solutionMoving to Tier 3 from Tier 2memantine solution in Tier 1
    Neoral capsuleMoving to Tier 3 from Tier 2cyclosporine modified capsule in Tier 1
    Neoral solutionMoving to Tier 3 from Tier 2cyclosporine modified solution in Tier 1
    Ortho Tri-Cyclen Lo tabletMoving to Tier 3 from Tier 2norgestimate/ethinyl estradiol tablet in Tier 1
    Patanol eye dropsMoving to Tier 3 from Tier 2olopatadine eye drops in Tier 1
    Sandimmune capsuleMoving to Tier 3 from Tier 2cyclosporine capsule in Tier 1

    Formulary Changes to the X1, X3 & X4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Abilify Discmelt tabletMoving to Non-Formularyaripiprazole orally disintegrating tablet in Tier 1
    Androgel topical gelMoving to Non-Formularytestosterone topical gel in Tier 1
    Avodart capsuleMoving to Non-Formularydutasteride capsule in Tier 1
    Invega tabletMoving to Non-Formularypaliperidone tablet in Tier1
    Jalyn capsuleMoving to Non-Formularydutasteride/tamsulosin capsule in Tier 1
    Namenda solutionMoving to Non-Formularymemantine solution in Tier 1
    Orap tabletMoving to Non-Formularypimozide tablet in Tier 1
    Ortho Tri-Cyclen Lo tabletMoving to Non-Formularynorgestimate/ethinyl estradiol tablet in Tier 0
    Xenazine tabletMoving to Non-Formularytetrabenazine tablet in Specialty Tier
    Zyvox suspensionMoving to Non-Formularylinezolid suspension in Tier 1

    Formulary Changes to the Value-Based V1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Androgel topical gelMoving to Tier 4 from Tier 2testosterone topical gel in Tier 1
    Atralin gelMoving to Tier 4 from Tier 3tretinoin gel in Tier 1
    Avodart capsuleMoving to Tier 4 from Tier 3dutasteride capsule in Tier 1
    Cutivate lotionMoving to Tier 4 from Tier 3fluticasone lotion in Tier 1
    Exelon patchMoving to Tier 4 from Tier 2rivastigmine patch in Tier 1
    Jalyn capsuleMoving to Tier 4 from Tier 3dutasteride/tamsulosin capsule in Tier 1
    Namenda solutionMoving to Tier 4 from Tier 2memantine solution in Tier 1
    Naprelan extended-release tabletMoving to Tier 4 from Tier 3naproxen extended-release tablet in Tier 1
    Neoral capsuleMoving to Tier 4 from Tier 2cyclosporine modified capsule in Tier 1
    Neoral solutionMoving to Tier 4 from Tier 2cyclosporine modified solution in Tier 1
    Orap tabletMoving to Tier 4 from Tier 3pimozide tablet in Tier 1
    Ortho Tri-Cyclen Lo tabletMoving to Tier 4 from Tier 3norgestimate/ethinyl estradiol tablet in Tier 1
    Patanol eye dropsMoving to Tier 4 from Tier 2olopatadine eye drops in Tier 1
    Prandimet tabletMoving to Tier 4 from Tier 3repaglinide/metformin tablet in Tier 1
    Sandimmune capsuleMoving to Tier 4 from Tier 2cyclosporine capsule in Tier 1
    Zyvox suspensionMoving to Tier 4 from Tier 3linezolid 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.