Drug List Changes

  • Effective July 01, 2017

    Formulary Changes to the Preferred B2 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Adderall tabletNo longer coveredamphetamine/dextroamphetamine tablet
    Bupap tabletNo longer coveredbutalbital/acetaminophen tablet
    Copaxone 20 mg/ml syringeNo longer coveredGlatopa 20mg/ml syringe
    Millipred solutionNo longer coveredprednisolone sodium phosphate solution
    Tazorac 0.1% creamNo longer coveredtazarotene 0.1% cream

    Formulary Changes to the Preferred B3 and B4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Adderall tabletMoving to a higher levelamphetamine/dextroamphetamine tablet
    Bupap tabletMoving to a higher levelbutalbital/acetaminophen tablet
    Copaxone 20 mg/ml syringeMoving to a higher levelGlatopa 20mg/ml syringe
    Millipred solutionMoving to a higher levelprednisolone sodium phosphate solution
    Tazorac 0.1% creamMoving to a higher leveltazarotene 0.1% cream

    Formulary Changes to the E1 and E4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Millipred solutionMoving to a higher levelprednisolone sodium phosphate solution
    Minastrin 24 FE tabletMoving to a higher levelnorethindrone/ethinyl estradiol tablet

    Formulary Changes to the X1, X3 and X4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Copaxone 20 mg/ml syringeNo longer coveredGlatopa 20mg/ml syringe
    Millipred solutionNo longer coveredprednisolone sodium phosphate solution
    Minastrin 24 FE tabletNo longer coverednorethindrone/ethinyl estradiol tablet
    Pristiq tabletNo longer covereddesvenlafaxine tablet
    Ritalin LA capsuleNo longer coveredmethylphenidate extended-release capsule
    Tazorac 0.1% creamNo longer coveredtazarotene 0.1% cream
    Zyflo CR tablet No longer coveredzileuton extended-release tablet

    Formulary Changes to the M1, M2 and M4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Copaxone 20 mg/ml syringeNo longer coveredGlatopa 20mg/ml syringe
    Millipred solutionNo longer coveredprednisolone sodium phosphate solution
    Minastrin 24 FE tabletNo longer coverednorethindrone/ethinyl estradiol tablet
    Pristiq tabletNo longer covereddesvenlafaxine tablet
    Ritalin LA capsuleNo longer coveredmethylphenidate extended-release capsule
    Tazorac 0.1% creamNo longer coveredtazarotene 0.1% cream
    Zyflo CR tablet No longer coveredzileuton extended-release tablet

    Formulary Changes to the Value-Based V1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Millipred solutionMoving to a higher levelprednisolone sodium phosphate solution
    Minastrin 24 FE tabletMoving to a higher levelnorethindrone/ethinyl estradiol tablet
    Pristiq tabletMoving to a higher leveldesvenlafaxine tablet
    Ritalin LA capsuleMoving to a higher levelmethylphenidate extended-release capsule
    Tazorac 0.1% creamMoving to a higher leveltazarotene 0.1% cream
    Zyflo CR tablet Moving to a higher levelzileuton extended-release 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.