Drug List Changes

  • Effective July 01, 2018

    Formulary Changes to the Preferred B2 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Accu-Chek Test StripsNo longer coveredOneTouch Ultra or OneTouch Verio Test Strips
    Aloxi injectionNo longer coveredpalonosetron injection
    Breeze 2 Test StripsNo longer coveredOneTouch Ultra or OneTouch Verio Test Strips
    Contour & Contour Next Test StripsNo longer coveredOneTouch Ultra or OneTouch Verio Test Strips
    FreeStyle & FreeStyle Lite Test StripsNo longer coveredOneTouch Ultra or OneTouch Verio Test Strips
    Norvir tabletNo longer coveredritonavir tablet
    Prodigy Test StripsNo longer coveredOneTouch Ultra or OneTouch Verio Test Strips
    Sustiva tabletNo longer coveredefavirenz tablet
    TRUE Metrix Test StripsNo longer coveredOneTouch Ultra or OneTouch Verio Test Strips
    TRUEtrack Test StripsNo longer coveredOneTouch Ultra or OneTouch Verio Test Strips
    WaveSense Test StripsNo longer coveredOneTouch Ultra or OneTouch Verio Test Strips

    Formulary Changes to the Preferred B3 and B4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Accu-Chek Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    Aloxi injectionMoving to a higher levelpalonosetron injection
    Breeze 2 Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    Contour & Contour Next Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    FreeStyle & FreeStyle Lite Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    Norvir tabletMoving to a higher levelritonavir tablet
    Prodigy Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    Sustiva tabletMoving to a higher levelefavirenz tablet
    TRUE Metrix Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    TRUEtrack Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    WaveSense Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips

    Formulary Changes to the E1 and E4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Aubagio tabletMoving to a higher levelGilenya capsule or Tecfidera capsule
    Norvir tabletMoving to a higher levelritonavir tablet
    Sustiva tabletMoving to a higher levelefavirenz tablet

    Formulary Changes to the M1, M2 and M4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Gabitril tabletNo longer coveredtiagabine tablet
    Namenda XR capsuleNo longer coveredmemantine extended-release capsule
    Norvir tabletNo longer coveredritonavir tablet
    Prevacid SoluTab tabletNo longer coveredlansoprazole orally disintegrating tablet
    Ritalin LA capsuleNo longer coveredmethylphenidate extended-release capsule
    Solodyn tabletNo longer coveredminocycline extended-release tablet
    Sustiva tabletNo longer coveredefavirenz tablet
    Syprine capsuleNo longer coveredtrientine capsule
    Treximet tabletNo longer coveredsumatriptan/naproxen sodium tablet

    Formulary Changes to the Select C4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Accu-Chek Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    Breeze 2 Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    Contour & Contour Next Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    FreeStyle & FreeStyle Lite Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    Prodigy Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    Sustiva tabletMoving to a higher levelefavirenz tablet
    TRUE Metrix Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    TRUEtrack Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    WaveSense Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips

    Formulary Changes to the Value-Based V1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Accu-Chek Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    Aloxi injectionMoving to a higher levelpalonosetron injection
    Breeze 2 Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    CellCept tabletMoving to a higher levelmycophenolate mofetil tablet
    Contour & Contour Next Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    FreeStyle & FreeStyle Lite Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    Namenda XR capsuleMoving to a higher levelmemantine extended-release capsule
    Norvir tabletMoving to a higher levelritonavir tablet
    Prodigy Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    Ritalin LA capsuleMoving to a higher levelmethylphenidate extended-release capsule
    Sulfamylon packetMoving to a higher levelmafenide packet
    Sustiva tabletMoving to a higher levelefavirenz tablet
    Syprine capsuleMoving to a higher leveltrientine capsule
    Treximet tabletMoving to a higher levelsumatriptan/naproxen sodium tablet
    TRUE Metrix Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    TRUEtrack Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips
    WaveSense Test StripsMoving to a higher levelOneTouch Ultra or OneTouch Verio Test Strips

    *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.