Drug List Changes

Effective April 01, 2018

Formulary Changes to the Preferred B2 Drug List

Drug Name	Description of Change	Cost-effective Alternatives*
Coreg CR capsule	No longer covered	carvedilol controlled-release capsule
Emend capsule	No longer covered	aprepitant capsule
Estrace 0.01% cream	No longer covered	estradiol 0.01% cream
Lexiva tablet	No longer covered	fosamprenavir tablet
Reyataz capsule	No longer covered	atazanavir capsule
Sustiva capsule	No longer covered	efavirenz capsule
Viread tablet	No longer covered	tenofovir disoproxil tablet
Ziagen solution	No longer covered	abacavir solution

Formulary Changes to the Preferred B3 and B4 Drug Lists

Drug Name	Description of Change	Cost-effective Alternatives*
Coreg CR capsule	Moving to a higher level	carvedilol controlled-release capsule
Emend capsule	Moving to a higher level	aprepitant capsule
Estrace 0.01% cream	Moving to a higher level	estradiol 0.01% cream
Lexiva tablet	Moving to a higher level	fosamprenavir tablet
Reyataz capsule	Moving to a higher level	atazanavir capsule
Sustiva capsule	Moving to a higher level	efavirenz capsule
Viread tablet	Moving to a higher level	tenofovir disoproxil tablet
Ziagen solution	Moving to a higher level	abacavir solution

Formulary Changes to the E1 and E4 Drug Lists

Drug Name	Description of Change	Cost-effective Alternatives*
Emend capsule	Moving to a higher level	aprepitant capsule
Estrace 0.01% cream	Moving to a higher level	estradiol 0.01% cream
Lexiva tablet	Moving to a higher level	fosamprenavir tablet
Reyataz capsule	Moving to a higher level	atazanavir capsule
Sustiva capsule	Moving to a higher level	efavirenz capsule
Viread tablet	Moving to a higher level	tenofovir disoproxil tablet
Ziagen solution	Moving to a higher level	abacavir solution

Formulary Changes to the M1, M2 and M4 Drug Lists

Drug Name	Description of Change	Cost-effective Alternatives*
Aczone 5% topical gel	No longer covered	dapsone 5% topical gel
Buphenyl tablet	No longer covered	sodium phenylbutyrate tablet
Coreg CR capsule	No longer covered	carvedilol controlled-release capsule
Emend capsule	No longer covered	aprepitant capsule
Estrace 0.01% cream	No longer covered	estradiol 0.01% cream
Lexiva tablet	No longer covered	fosamprenavir tablet
Reyataz capsule	No longer covered	atazanavir capsule
Sabril tablet	No longer covered	vigabatrin tablet
Sustiva capsule	No longer covered	efavirenz capsule
Testim 1% gel	No longer covered	testosterone 1% gel
Viread tablet	No longer covered	tenofovir disoproxil tablet
Vogelxo 1% gel	No longer covered	testosterone 1% gel

Formulary Changes to the Select C4 Drug List

Drug Name	Description of Change	Cost-effective Alternatives*
Estrace 0.01% cream	Moving to a higher level	estradiol 0.01% cream
Lexiva tablet	Moving to a higher level	fosamprenavir tablet
Reyataz capsule	Moving to a higher level	atazanavir capsule
Sustiva capsule	Moving to a higher level	efavirenz capsule
Viread tablet	Moving to a higher level	tenofovir disoproxil tablet
Ziagen solution	Moving to a higher level	abacavir solution

Formulary Changes to the Value-Based V1 Drug List

Drug Name	Description of Change	Cost-effective Alternatives*
Aczone 5% topical gel	Moving to a higher level	dapsone 5% topical gel
Buphenyl tablet	Moving to a higher level	sodium phenylbutyrate tablet
CellCept tablet	Moving to a higher level	mycophenolate mofetil tablet
Coreg CR capsule	Moving to a higher level	carvedilol controlled-release capsule
Donnatal elixir	Moving to a higher level	phenobarbital/hyoscyamine/atropine/scopolamine elixir
Emend capsule	Moving to a higher level	aprepitant capsule
Estrace 0.01% cream	Moving to a higher level	estradiol 0.01% cream
Istalol eye drops	Moving to a higher level	timolol eye drops
Lexiva tablet	Moving to a higher level	fosamprenavir tablet
Retin-A Micro 0.04% gel	Moving to a higher level	tretinoin 0.04% gel
Reyataz capsule	Moving to a higher level	atazanavir capsule
Sustiva capsule	Moving to a higher level	efavirenz capsule
Testim 1% gel	Moving to a higher level	testosterone 1% gel
Viread tablet	Moving to a higher level	tenofovir disoproxil tablet
Vogelxo 1% gel	Moving to a higher level	testosterone 1% gel
Ziagen solution	Moving to a higher level	abacavir 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.