Aggrenox capsule | No longer covered | aspirin/dipyridamole capsule |
Airduo Respiclick inhaler | No longer covered | Wixela Inhub inhaler, fluticasone/salmeterol inhaler (generic) |
Airduo Digihaler inhaler | No longer covered | Wixela Inhub inhaler, fluticasone/salmeterol inhaler (generic) |
Apriso extended-release capsule | No longer covered | mesalamine extended-release capsule |
Aptiom tablet | No longer covered | Consult doctor |
Atralin gel | No longer covered | tretinoin gel |
Bunavail film | No longer covered | buprenorphine/naloxone sublingual tablet |
Ciloxan ointment | No longer covered | ciprofloxacin eye drops |
Concerta extended-release tablet | No longer covered | methylphenidate extended-release tablet |
Cosentyx syringe | No longer covered | Taltz syringe |
Demser capsule | Moving to a higher level | metyrosine capsule |
Doral tablet | No longer covered | estazolam tablet |
Duragesic patch | No longer covered | fentanyl patch |
Elestrin gel | No longer covered | Divigel gel |
Emtriva capsule | Moving to a higher level | emtricitabine capsule |
Estrace cream | No longer covered | estradiol cream |
Estrostep FE-28 tablet | Moving to a higher level | norethindrone/ethinyl estradiol tablet |
Firazyr syringe | No longer covered | icatibant syringe |
Firvanq solution | No longer covered | vancomycin solution |
Fluticasone/salmeterol (brand) | No longer covered | Wixela Inhub inhaler, fluticasone/salmeterol inhaler (generic) |
Inderal XL extended-release capsule | No longer covered | propranolol extended-release capsule |
Lastacaft eye drops | No longer covered | epinastine eye drops |
Letairis tablet | No longer covered | ambrisentan tablet |
Lialda delayed-release tablet | No longer covered | mesalamine delayed-release tablet |
Locoid topical | No longer covered | hydrocortisone butyrate topical |
Mestinoin tablet | No longer covered | pyridostigmine tablet |
Mestinoin syrup | No longer covered | pyridostigmine syrup |
Minivelle patch | No longer covered | estradiol patch |
Morphabond extended-release tablet | No longer covered | morphine extended-release capsule |
Mytesi delayed-release tablet | No longer covered | loperamide capsule, diphenoxylate/atropine tablet |
Natroba topical suspension | No longer covered | spinosad topical suspension |
Neulasta syringe | No longer covered | Udenyca syringe or Ziextenzo syringe |
Neulasta OnPro kit | No longer covered | Udenyca syringe or Ziextenzo syringe |
Noxafil delayed-release tablet | No longer covered | posaconazole delayed-release tablet |
Nucynta tablet | No longer covered | Consult doctor |
Nucynta extended-release tablet | No longer covered | morphine extended-release capsule |
Otrexup auto-injector | No longer covered | Rasuvo auto-injector |
Pazeo eye drops | No longer covered | olopatadine eye drops |
Praluent syringe | No longer covered | Repatha syringe |
Proair Digihaler inhaler | No longer covered | albuterol HFA inhaler |
Proair Respiclick inhaler | No longer covered | albuterol HFA inhaler |
Proctofoam-HC foam | No longer covered | hydrocortisone/pramoxine cream |
Procysbi delayed-release capsule | No longer covered | Cystagon capsule |
Procysbi delayed-release granules | No longer covered | Cystagon capsule |
Qbrexza cloth | No longer covered | Drysol solution |
Quazepam tablet | No longer covered | estazolam tablet |
Ranexa extended-release tablet | No longer covered | ranolazine extended-release tablet |
Rozerem tablet | No longer covered | ramelteon tablet |
Sulconazole cream | No longer covered | ketoconazole cream |
Sulconazole solution | No longer covered | ketoconazole cream |
Targretin capsule | No longer covered | bexarotene capsule |
Tavalisse tablet | No longer covered | Promacta tablet or Doptelet tablet |
Toprol XL extended-release tablet | Moving to a higher level | metoprolol extended-release tablet |
Transderm Scop patch | Moving to a higher level | scopolamine patch |
Travatan Z eye drops | No longer covered | travoprost eye drops |
Uloric tablet | No longer covered | febuxostat tablet |
Vanos cream | No longer covered | fluocinonide cream |
Ventolin HFA inhaler | Moving to a higher level | albuterol HFA inhaler |
Xtampza extended-release capsule | No longer covered | morphine extended-release capsule |
Zelapar orally disintegrating tablet | No longer covered | rasagiline tablet |
Zohydro extended-release capsule | No longer covered | hydrocodone extended-release capsule |
Zovirax ointment | No longer covered | acyclovir ointment |