• Formulary Changes Effective July 01, 2014

    Formulary Changes to the Preferred B2 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Avelox tabletMoving to Non-preferredmoxifloxacin tablet in Tier 1
    Evista tabletMoving to Non-preferredraloxifene tablet in Tier 1
    Incivek tabletMoving to Non-preferredOlysio capsule in Tier 2; Sovaldi tablet in Tier 2
    Mepron suspensionMoving to Non-preferredatovaquone suspension in Tier 1
    Micardis HCT tablet Moving to Non-preferredtelmisartan/hydrochlorothiazide tablet in Tier 1
    Myfortic tabletMoving to Non-preferredmycophenolate tablet in Tier 1
    Neulasta injectionMoving to Non-preferredGranix injection in Tier 2
    Neupogen injectionMoving to Non-preferredGranix injection in tier 2
    Twynsta tabletMoving to Non-preferredtelmisartan/amlodipine tablet in Tier 1
    Victrelis capsuleMoving to Non-preferredOlysio capsule in Tier 2; Sovaldi tablet in Tier 2
    Xeloda tabletMoving to Non-preferredcapecitabine tablet in Tier 1

    Formulary Changes to the Preferred B3 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Avelox tabletMoving to Tier 3 from Tier 2moxifloxacin tablet in Tier 1
    Evista tabletMoving to Tier 3 from Tier 2raloxifene tablet in Tier 1
    Incivek tabletMoving to Tier 3 from Tier 2Olysio capsule in Tier 2; Sovaldi tablet in Tier 2
    Mepron suspensionMoving to Tier 3 from Tier 2atovaquone suspension in Tier 1
    Micardis HCT tablet Moving to Tier 3 from Tier 2telmisartan/hydrochlorothiazide tablet in Tier 1
    Myfortic tabletMoving to Tier 3 from Tier 2mycophenolate tablet in Tier 1
    Neulasta injectionMoving to Tier 3 from Tier 2Granix injection in Tier 2
    Neupogen injectionMoving to Tier 3 from Tier 2Granix injection in tier 2
    Twynsta tabletMoving to Tier 3 from Tier 2telmisartan/amlodipine tablet in Tier 1
    Victrelis capsuleMoving to Tier 3 from Tier 2Olysio capsule in Tier 2; Sovaldi tablet in Tier 2
    Xeloda tabletMoving to Tier 3 from Tier 2capecitabine tablet in Tier 1

    Formulary Changes to the Preferred B4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Avelox tabletMoving to Tier 3 from Tier 2moxifloxacin tablet in Tier 1
    Evista tabletMoving to Tier 3 from Tier 2raloxifene tablet in Tier 1
    Mepron suspensionMoving to Tier 3 from Tier 2atovaquone suspension in Tier 1
    Micardis HCT tablet Moving to Tier 3 from Tier 2telmisartan/hydrochlorothiazide tablet in Tier 1
    Myfortic tabletMoving to Tier 3 from Tier 2mycophenolate tablet in Tier 1
    Twynsta tabletMoving to Tier 3 from Tier 2telmisartan/amlodipine tablet in Tier 1

    Formulary Changes to the X3 and X4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Avelox tabletMoving to Non-preferredmoxifloxacin tablet in Tier 1
    Cloderm creamMoving to Non-preferredclocortolone cream in Tier 1
    Evista tabletMoving to Non-preferredraloxifene tablet in Tier 1
    Hectoral capsuleMoving to Non-preferreddoxercalciferol capsule in Tier 1
    Incivek tabletMoving to Non-preferredOlysio capsule in Specialty Tier ; Sovaldi tablet in Specialty Tier
    Mepron suspensionMoving to Non-preferredatovaquone suspension in Tier 1
    Neulasta injectionMoving to Non-preferredGranix injection in Specialty Tier
    Neupogen injectionMoving to Non-preferredGranix injection in Specialty Tier
    Rapamune 0.5mg tabletMoving to Non-preferredsirolimus 0.5mg tablet in Tier 1
    Trilipix capsuleMoving to Non-preferredfenofibric acid capsule in Tier 1
    Victrelis capsuleMoving to Non-preferredOlysio capsule in Specialty Tier; Sovaldi tablet in Specialty Tier
    Xeloda tabletMoving to Non-preferredcapecitabine tablet in Tier 1

    Formulary Changes to the Value-Based V1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Avelox tabletMoving to Tier 4 from Tier 2 moxifloxacin tablet in Tier 1
    Avinza capsuleMoving to Tier 4 from Tier 3morphine sulfate extended-release capsule in Tier 1
    Cloderm creamMoving to Tier 4 from Tier 3clocortolone cream in Tier 3
    Detrol LA capsuleMoving to Tier 4 from Tier 2tolterodine extended-release capsule in Tier 1
    Evista tabletMoving to Tier 4 from Tier 2raloxifene tablet in Tier 1
    Hectorol capsuleMoving to Tier 4 from Tier 3doxercalciferol capsule in Tier 1
    Lodosyn tabletMoving to Tier 4 from Tier 3carbidopa tablet in Tier 1
    Mepron suspensionMoving to Tier 4 from Tier 2atovaquone suspension in Tier 1
    Myfortic tabletMoving to Tier 4 from Tier 3mycophenolate tablet in Tier 1
    pioglitazone tabletMoving to Tier 2 from Tier 1metformin tablet in Tier 1
    Rapamune 0.5 mg tabletMoving to Tier 4 from Tier 3sirolimus tablet in Tier 1
    Twynsta tabletMoving to Tier 4 from Tier 2telmisartan/amlodipine tablet in Tier 1
    Urocit-K tabletMoving to Tier 4 from Tier 3potassium citrate tablet in Tier 1
    Vanos creamMoving to Tier 4 from Tier 3fluocinonide cream in Tier 1
    Zutripro solutionMoving to Tier 4 from Tier 3chlorpheniramine/hydrocodone/pseudoephedrine solution in Tier 1

    Formulary Changes to the Select C4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Avelox tabletMoving to Tier 3 from Tier 2moxifloxacin tablet in Tier 1
    Incivek tabletMoving to Tier 3 from Tier 2Olysio capsule in Tier 2; Sovaldi tablet in Tier 2
    Neulasta injectionMoving to Tier 3 from Tier 2Granix injection in Tier 2
    Neupogen injectionMoving to Tier 3 from Tier 2Granix injection in Tier 2
    Victrelis capsuleMoving to Tier 3 from Tier 2Olysio capsule in Tier 2; Sovaldi tablet in Tier 2
    Xeloda tabletMoving to Tier 3 from Tier 2capecitabine tablet 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.