Drug List Changes

  • Effective October 01, 2017

    Formulary Changes to the Preferred B2 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Alkeran tabletNo longer coveredmelphalan tablet
    Imuran tabletNo longer coveredazathioprine tablet
    Lialda delayed release tabletNo longer coveredmesalamine delayed release tablet
    Loprox 0.77% creamNo longer coveredciclopirox 0.77% cream
    Loprox 0.77% suspensionNo longer coveredciclopirox 0.77% suspension
    Metrogel 1% gelNo longer coveredmetronidazole 1% gel
    Pataday 0.2% eye dropsNo longer coveredolopatadine 0.2% eye drops
    Protopic ointmentNo longer coveredtacrolimus ointment
    Renvela tabletNo longer coveredsevelamer tablet
    Strattera capsuleNo longer coveredatomoxetine capsule
    Vytorin tabletNo longer coveredezetimibe/simvastatin tablet

    Formulary Changes to the Preferred B3 and B4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Alkeran tabletMoving to a higher levelmelphalan tablet
    Imuran tabletMoving to a higher levelazathioprine tablet
    Lialda delayed release tabletMoving to a higher levelmesalamine delayed release tablet
    Loprox 0.77% creamMoving to a higher levelciclopirox 0.77% cream
    Loprox 0.77% suspensionMoving to a higher levelciclopirox 0.77% suspension
    Metrogel 1% gelMoving to a higher levelmetronidazole 1% gel
    Pataday 0.2% eye dropsMoving to a higher levelolopatadine 0.2% eye drops
    Protopic ointmentMoving to a higher leveltacrolimus ointment
    Renvela tabletMoving to a higher levelsevelamer tablet
    Strattera capsuleMoving to a higher levelatomoxetine capsule
    Vytorin tabletMoving to a higher levelezetimibe/simvastatin tablet

    Formulary Changes to the E1 and E4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Alkeran tabletMoving to a higher levelmelphalan tablet
    Ancobon capsuleMoving to a higher levelflucytosine capsule
    Atacand tabletMoving to a higher levelcandesartan tablet
    Combivir tabletMoving to a higher levellamivudine/zidovudine tablet
    Epivir HBV tabletMoving to a higher levellamivudine tablet
    Lialda delayed release tabletMoving to a higher levelmesalamine delayed release tablet
    Myambutol tabletMoving to a higher levelethambutol tablet
    Nulytely with Flavor Packs solutionMoving to a higher levelPEG-3350 electrolyte with flavor packs solution

    Formulary Changes to the X1, X3 and X4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Alkeran tabletNo longer coveredmelphalan tablet
    Axiron 2% topical solutionNo longer coveredtestosterone 2% topical solution
    Cordran 0.05% ointmentNo longer coveredflurandrenolide 0.05% ointment
    Lialda delayed release tabletNo longer coveredmesalamine delayed release tablet
    Pataday 0.2% eye dropsNo longer coveredolopatadine 0.2% eye drops
    Renvela powder packetNo longer coveredsevelamer powder packet
    Renvela tabletNo longer coveredsevelamer tablet
    Strattera capsuleNo longer coveredatomoxetine capsule
    Vigamox eye dropsNo longer coveredmoxifloxacin eye drops
    Vytorin tabletNo longer coveredezetimibe/simvastatin tablet

    Formulary Changes to the M1, M2 and M4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Alkeran tabletNo longer coveredmelphalan tablet
    Axiron 2% topical solutionNo longer coveredtestosterone 2% topical solution
    Cordran 0.05% ointmentNo longer coveredflurandrenolide 0.05% ointment
    Lialda delayed release tabletNo longer coveredmesalamine delayed release tablet
    Pataday 0.2% eye dropsNo longer coveredolopatadine 0.2% eye drops
    Renvela powder packetNo longer coveredsevelamer powder packet
    Renvela tabletNo longer coveredsevelamer tablet
    Strattera capsuleNo longer coveredatomoxetine capsule
    Vigamox eye dropsNo longer coveredmoxifloxacin eye drops
    Vytorin tabletNo longer coveredezetimibe/simvastatin tablet

    Formulary Changes to the Select C4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Alkeran tabletMoving to a higher levelmelphalan tablet
    Epivir 10mg/ml solutionMoving to a higher levellamivudine 10mg/ml solution
    Imuran tabletMoving to a higher levelazathioprine tablet

    Formulary Changes to the Value-Based V1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Acticlate tabletMoving to a higher leveldoxycycline tablet
    Adderall tabletMoving to a higher leveldextroamphetamine/amphetamine tablet
    Analpram HC creamMoving to a higher levelhydrocortisone/pramoxine cream
    Ancobon capsuleMoving to a higher levelflucytosine capsule
    Bleph-10 eye dropsMoving to a higher levelsulfacetamide eye drops
    Cordran 0.05% ointmentMoving to a higher levelflurandrenolide 0.05% ointment
    Derma Smoothe FS 0.01% body oilMoving to a higher levelfluocinolone 0.01% body oil
    Dibenzyline capsuleMoving to a higher levelphenoxybenzamine capsule
    Efudex 5% creamMoving to a higher levelfluorouracil 5% cream
    Epivir 10mg/ml solutionMoving to a higher levellamivudine 10mg/ml solution
    Epivir HBV tabletMoving to a higher levellamivudine tablet
    Exforge tabletMoving to a higher levelamlodipine/valsartan tablet
    Exforge HCT tabletMoving to a higher levelamlodipine/valsartan/hydrochlorothiazide tablet
    Gastrocrom solutionMoving to a higher levelcromolyn solution
    Hepsera tabletMoving to a higher leveladefovir tablet
    Imuran tabletMoving to a higher levelazathioprine tablet
    Klaron 10% lotionMoving to a higher levelsodium sulfacetamide 10% lotion
    Lialda delayed release tabletMoving to a higher levelmesalamine delayed release tablet
    Pataday 0.2% eye dropsMoving to a higher levelolopatadine 0.2% eye drops
    Phenytek capsuleMoving to a higher levelphenytoin extended release capsule
    Protopic ointmentMoving to a higher leveltacrolimus ointment
    Razadyne ER capsuleMoving to a higher levelgalantamine extended release capsule
    Renvela powder packetMoving to a higher levelsevelamer powder packet
    Sandostatin injectable solutionMoving to a higher leveloctreotide injectable solution
    Soriatane capsuleMoving to a higher levelacitretin capsule
    Strattera capsuleMoving to a higher levelatomoxetine capsule
    Tobi 300mg/5ml solutionMoving to a higher leveltobramycin 300mg/5ml solution
    Trizivir tabletMoving to a higher levelabacavir/lamivudine/zidovudine tablet
    Vigamox eye dropsMoving to a higher levelmoxifloxacin eye drops
    Zomig tabletMoving to a higher levelzolmitriptan tablet
    Zomig ZMT tabletMoving to a higher levelzolmitriptan orally disintegrating 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.