Drug List Changes

  • Effective January 01, 2021

    Formulary Changes to the Preferred B3 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Ciloxan ointmentMoving to a higher levelciprofloxacin eye drops
    Cosentyx syringeMoving to a higher levelTaltz syringe
    Demser capsuleMoving to a higher levelmetyrosine capsule
    Emtriva capsuleMoving to a higher levelemtricitabine capsule
    Pazeo eye dropsMoving to a higher levelolopatadine eye drops
    Praluent syringeMoving to a higher levelRepatha syringe
    Proair Respiclick inhalerMoving to a higher levelalbuterol HFA inhaler
    Proctofoam-HC foamMoving to a higher levelhydrocortisone/pramoxine cream
    Procysbi delayed-release capsuleMoving to a higher levelCystagon capsule
    Sulconazole creamMoving to a higher levelketoconazole cream
    Sulconazole solutionMoving to a higher levelketoconazole cream
    Ventolin HFA inhalerMoving to a higher levelalbuterol HFA inhaler

    Formulary Changes to the Preferred B4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Ciloxan ointmentMoving to a higher levelciprofloxacin eye drops
    Demser capsuleMoving to a higher levelmetyrosine capsule
    Emtriva capsuleMoving to a higher levelemtricitabine capsule
    Pazeo eye dropsMoving to a higher levelolopatadine eye drops
    Praluent syringeMoving to a higher levelRepatha syringe
    Proair Respiclick inhalerMoving to a higher levelalbuterol HFA inhaler
    Proctofoam-HC foamMoving to a higher levelhydrocortisone/pramoxine cream
    Sulconazole creamMoving to a higher levelketoconazole cream
    Sulconazole solutionMoving to a higher levelketoconazole cream
    Ventolin HFA inhalerMoving to a higher levelalbuterol HFA inhaler

    Formulary Changes to the E1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Aggrenox capsuleNo longer coveredaspirin/dipyridamole capsule
    Airduo Respiclick inhalerNo longer coveredWixela Inhub inhaler, fluticasone/salmeterol inhaler (generic)
    Airduo Digihaler inhalerNo longer coveredWixela Inhub inhaler, fluticasone/salmeterol inhaler (generic)
    Apriso extended-release capsuleNo longer coveredmesalamine extended-release capsule
    Aptiom tabletNo longer coveredConsult doctor
    Atralin gelNo longer coveredtretinoin gel
    Bunavail filmNo longer coveredbuprenorphine/naloxone sublingual tablet
    Ciloxan ointmentNo longer coveredciprofloxacin eye drops
    Concerta extended-release tabletNo longer coveredmethylphenidate extended-release tablet
    Cosentyx syringeNo longer coveredTaltz syringe
    Doral tabletNo longer coveredestazolam tablet
    Duragesic patchNo longer coveredfentanyl patch
    Elestrin gelNo longer coveredDivigel gel
    Estrace creamNo longer coveredestradiol cream
    Firazyr syringeNo longer coveredicatibant syringe
    Firvanq solutionNo longer coveredvancomycin solution
    Fluticasone/salmeterol (brand)No longer coveredWixela Inhub inhaler, fluticasone/salmeterol inhaler (generic)
    Inderal XL extended-release capsuleNo longer coveredpropranolol extended-release capsule
    Lastacaft eye dropsNo longer coveredepinastine eye drops
    Letairis tabletNo longer coveredambrisentan tablet
    Lialda delayed-release tabletNo longer coveredmesalamine delayed-release tablet
    Locoid topicalNo longer coveredhydrocortisone butyrate topical
    Mestinoin tabletNo longer coveredpyridostigmine tablet
    Mestinoin syrupNo longer coveredpyridostigmine syrup
    Minivelle patchNo longer coveredestradiol patch
    Morphabond extended-release tabletNo longer coveredmorphine extended-release capsule
    Mytesi delayed-release tabletNo longer coveredloperamide capsule, diphenoxylate/atropine tablet
    Natroba topical suspensionNo longer coveredspinosad topical suspension
    Neulasta syringeNo longer coveredUdenyca syringe or Ziextenzo syringe
    Neulasta OnPro kitNo longer coveredUdenyca syringe or Ziextenzo syringe
    Noxafil delayed-release tabletNo longer coveredposaconazole delayed-release tablet
    Nucynta tabletNo longer coveredConsult doctor
    Nucynta extended-release tabletNo longer coveredmorphine extended-release capsule
    Otrexup auto-injectorNo longer coveredRasuvo auto-injector
    Pazeo eye dropsNo longer coveredolopatadine eye drops
    Praluent syringeNo longer coveredRepatha syringe
    Proair Digihaler inhalerNo longer coveredalbuterol HFA inhaler
    Proair Respiclick inhalerNo longer coveredalbuterol HFA inhaler
    Proctofoam-HC foamNo longer coveredhydrocortisone/pramoxine cream
    Procysbi delayed-release capsuleNo longer coveredCystagon capsule
    Procysbi delayed-release granulesNo longer coveredCystagon capsule
    Qbrexza clothNo longer coveredDrysol solution
    Quazepam tabletNo longer coveredestazolam tablet
    Ranexa extended-release tabletNo longer coveredranolazine extended-release tablet
    Rozerem tabletNo longer coveredramelteon tablet
    Sulconazole creamNo longer coveredketoconazole cream
    Sulconazole solutionNo longer coveredketoconazole cream
    Targretin capsuleNo longer coveredbexarotene capsule
    Tavalisse tabletNo longer coveredPromacta tablet or Doptelet tablet
    Travatan Z eye dropsNo longer coveredtravoprost eye drops
    Uloric tabletNo longer coveredfebuxostat tablet
    Vanos creamNo longer coveredfluocinonide cream
    Xtampza extended-release capsuleNo longer coveredmorphine extended-release capsule
    Zelapar orally disintegrating tabletNo longer coveredrasagiline tablet
    Zohydro extended-release capsuleNo longer coveredhydrocodone extended-release capsule
    Zovirax ointmentNo longer coveredacyclovir ointment

    Formulary Changes to the E4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Aggrenox capsuleNo longer coveredaspirin/dipyridamole capsule
    Airduo Respiclick inhalerNo longer coveredWixela Inhub inhaler, fluticasone/salmeterol inhaler (generic)
    Airduo Digihaler inhalerNo longer coveredWixela Inhub inhaler, fluticasone/salmeterol inhaler (generic)
    Apriso extended-release capsuleNo longer coveredmesalamine extended-release capsule
    Aptiom tabletNo longer coveredConsult doctor
    Atralin gelNo longer coveredtretinoin gel
    Bunavail filmNo longer coveredbuprenorphine/naloxone sublingual tablet
    Ciloxan ointmentNo longer coveredciprofloxacin eye drops
    Concerta extended-release tabletNo longer coveredmethylphenidate extended-release tablet
    Cosentyx syringeNo longer coveredTaltz syringe
    Demser capsuleMoving to a higher levelmetyrosine capsule
    Doral tabletNo longer coveredestazolam tablet
    Duragesic patchNo longer coveredfentanyl patch
    Elestrin gelNo longer coveredDivigel gel
    Emtriva capsuleMoving to a higher levelemtricitabine capsule
    Estrace creamNo longer coveredestradiol cream
    Estrostep FE-28 tabletMoving to a higher levelnorethindrone/ethinyl estradiol tablet
    Firazyr syringeNo longer coveredicatibant syringe
    Firvanq solutionNo longer coveredvancomycin solution
    Fluticasone/salmeterol (brand)No longer coveredWixela Inhub inhaler, fluticasone/salmeterol inhaler (generic)
    Inderal XL extended-release capsuleNo longer coveredpropranolol extended-release capsule
    Lastacaft eye dropsNo longer coveredepinastine eye drops
    Letairis tabletNo longer coveredambrisentan tablet
    Lialda delayed-release tabletNo longer coveredmesalamine delayed-release tablet
    Locoid topicalNo longer coveredhydrocortisone butyrate topical
    Mestinoin tabletNo longer coveredpyridostigmine tablet
    Mestinoin syrupNo longer coveredpyridostigmine syrup
    Minivelle patchNo longer coveredestradiol patch
    Morphabond extended-release tabletNo longer coveredmorphine extended-release capsule
    Mytesi delayed-release tabletNo longer coveredloperamide capsule, diphenoxylate/atropine tablet
    Natroba topical suspensionNo longer coveredspinosad topical suspension
    Neulasta syringeNo longer coveredUdenyca syringe or Ziextenzo syringe
    Neulasta OnPro kitNo longer coveredUdenyca syringe or Ziextenzo syringe
    Noxafil delayed-release tabletNo longer coveredposaconazole delayed-release tablet
    Nucynta tabletNo longer coveredConsult doctor
    Nucynta extended-release tabletNo longer coveredmorphine extended-release capsule
    Otrexup auto-injectorNo longer coveredRasuvo auto-injector
    Pazeo eye dropsNo longer coveredolopatadine eye drops
    Praluent syringeNo longer coveredRepatha syringe
    Proair Digihaler inhalerNo longer coveredalbuterol HFA inhaler
    Proair Respiclick inhalerNo longer coveredalbuterol HFA inhaler
    Proctofoam-HC foamNo longer coveredhydrocortisone/pramoxine cream
    Procysbi delayed-release capsuleNo longer coveredCystagon capsule
    Procysbi delayed-release granulesNo longer coveredCystagon capsule
    Qbrexza clothNo longer coveredDrysol solution
    Quazepam tabletNo longer coveredestazolam tablet
    Ranexa extended-release tabletNo longer coveredranolazine extended-release tablet
    Rozerem tabletNo longer coveredramelteon tablet
    Sulconazole creamNo longer coveredketoconazole cream
    Sulconazole solutionNo longer coveredketoconazole cream
    Targretin capsuleNo longer coveredbexarotene capsule
    Tavalisse tabletNo longer coveredPromacta tablet or Doptelet tablet
    Toprol XL extended-release tabletMoving to a higher levelmetoprolol extended-release tablet
    Transderm Scop patchMoving to a higher levelscopolamine patch
    Travatan Z eye dropsNo longer coveredtravoprost eye drops
    Uloric tabletNo longer coveredfebuxostat tablet
    Vanos creamNo longer coveredfluocinonide cream
    Ventolin HFA inhalerMoving to a higher levelalbuterol HFA inhaler
    Xtampza extended-release capsuleNo longer coveredmorphine extended-release capsule
    Zelapar orally disintegrating tabletNo longer coveredrasagiline tablet
    Zohydro extended-release capsuleNo longer coveredhydrocodone extended-release capsule
    Zovirax ointmentNo longer coveredacyclovir ointment

    Formulary Changes to the M1, M2 and M4 (2021) Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Aczone 7.5% gelNo longer coveredtretinoin gel
    Apidra vialNo longer coveredNovolog vial
    Apidra Solostar penNo longer coveredNovolog pen
    Atripla tabletNo longer coveredConsult doctor
    Benzoyl peroxide washNo longer coveredbenzepro topical towelette
    Ciprodex ear dropsNo longer coveredciprofloxacin/dexamethasone ear drops
    Colcrys tabletNo longer coveredcolchicine tablet
    Delstrigo tabletNo longer coveredConsult doctor
    Demser capsuleNo longer coveredmetyrosine capsule
    Emtriva capsuleNo longer coveredemtricitabine capsule
    Finacea 15% foamNo longer coveredazelaic acid 15% gel
    Firdapse tabletNo longer coveredRuzurgi tablet
    Jadenu Sprinkle oral granulesNo longer covereddeferasirox oral granules
    Moviprep oral solutionNo longer coveredpolyethylene glycol oral solution
    Mycophenolate suspensionNo longer coveredmycophenolate capsule or mycophenolate tablet
    Neulasta syringeNo longer coveredUdenyca syringe or Ziextenzo syringe
    Nucynta tabletNo longer coveredConsult doctor
    Praluent syringeNo longer coveredRepatha syringe
    Pentasa capsuleNo longer coveredmesalamine extended-release capsule
    Proair Respiclick inhalerNo longer coveredalbuterol HFA inhaler
    Proctofoam-HC foamNo longer coveredhydrocortisone/pramoxine cream
    Procysbi delayed-release capsuleNo longer coveredCystagon capsule
    Procysbi delayed-release granulesNo longer coveredCystagon capsule
    Qbrexza clothNo longer coveredDrysol solution
    Sulconazole creamNo longer coveredketoconazole cream
    Sulconazole solutionNo longer coveredketoconazole cream
    Sulfacetamide/sulfur topicalNo longer coveredmetronidazole gel and azelaic acid gel
    Tavalisse tabletNo longer coveredPromacta tablet or Doptelet tablet
    Transderm Scop patchNo longer coveredscopolamine patch
    Ventolin HFA inhalerNo longer coveredalbuterol HFA inhaler
    Zelapar orally disintegrating tabletNo longer coveredrasagiline tablet

    *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.