Drug List Changes

  • Effective August 01, 2020

    Formulary Changes to the Open A1 and Preferred A2 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Alvesco inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex HFA inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex Twisthaler inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Basaglar injectablePrior authorizationLantus, Levemir, Toujeo, or Tresiba
    Invokamet tabletPrior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokamet XR extended-release tabletPrior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokana tabletPrior authorizationFarxiga or Jardiance
    Kombiglyze XR extended-release tabletPrior authorizationJanumet, Janumet XR, Jentadueto, Jentadueto XR
    Onglyza tabletPrior authorizationJanuvia or Tradjenta
    Pulmicort Flexhaler inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Pulmicort Respules inhalation suspensionPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Segluromet tabletPrior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Steglatro tabletPrior authorizationFarxiga or Jardiance

    Formulary Changes to the Preferred B2 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Asmanex HFA inhalerNo longer coveredArnuity Ellipta, Flovent, or Qvar
    Asmanex Twisthaler inhalerNo longer coveredArnuity Ellipta, Flovent, or Qvar
    Basaglar injectableNo longer coveredLantus, Levemir, Toujeo, or Tresiba
    Carafate oral suspension [Change Effective July 1, 2020]No longer coveredsucralfate oral suspension
    Depen tablet [Change Effective July 1, 2020]No longer coveredpenicillamine tablet
    Invokamet tabletNo longer coveredSynjardy, Synjardy XR, or Xigduo XR
    Invokamet XR extended-release tabletNo longer coveredSynjardy, Synjardy XR, or Xigduo XR
    Invokana tabletNo longer coveredFarxiga or Jardiance
    Kombiglyze XR extended-release tabletNo longer coveredJanumet, Janumet XR, Jentadueto, Jentadueto XR
    NuvaRing contraceptive [Change Effective July 1, 2020]No longer coveredetonogestrel/ethinyl estradiol contraceptive
    Onglyza tabletNo longer coveredJanuvia or Tradjenta
    Pulmicort Flexhaler inhalerNo longer coveredArnuity Ellipta, Flovent, or Qvar
    Steglatro tabletNo longer coveredFarxiga or Jardiance

    Formulary Changes to the Preferred B3 and B4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Alvesco inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex HFA inhalerMoving to a higher level; Prior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex Twisthaler inhalerMoving to a higher level; Prior authorizationArnuity Ellipta, Flovent, or Qvar
    Basaglar injectableMoving to a higher level; Prior authorizationLantus, Levemir, Toujeo, or Tresiba
    Carafate oral suspension [Change Effective July 1, 2020]Moving to a higher levelsucralfate oral suspension
    Depen tablet [Change Effective July 1, 2020]Moving to a higher levelpenicillamine tablet
    Invokamet tabletMoving to a higher level; Prior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokamet XR extended-release tabletMoving to a higher level; Prior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokana tabletMoving to a higher level; Prior authorizationFarxiga or Jardiance
    Kombiglyze XR extended-release tabletMoving to a higher level; Prior authorizationJanumet, Janumet XR, Jentadueto, Jentadueto XR
    NuvaRing contraceptive [Change Effective July 1, 2020]Moving to a higher leveletonogestrel/ethinyl estradiol contraceptive
    Onglyza tabletMoving to a higher level; Prior authorizationJanuvia or Tradjenta
    Pulmicort Flexhaler inhalerMoving to a higher level; Prior authorizationArnuity Ellipta, Flovent, or Qvar
    Pulmicort Respules inhalation suspensionPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Segluromet tabletPrior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Steglatro tabletMoving to a higher level; Prior authorizationFarxiga or Jardiance

    Formulary Changes to the E1 and E4 Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Alvesco inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex HFA inhalerMoving to a higher level; Prior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex Twisthaler inhalerMoving to a higher level; Prior authorizationArnuity Ellipta, Flovent, or Qvar
    Basaglar injectableMoving to a higher level; Prior authorizationLantus, Levemir, Toujeo, or Tresiba
    Depen tablet [Change Effective July 1, 2020]Moving to a higher levelpenicillamine tablet
    Invokamet tabletMoving to a higher level; Prior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokamet XR extended-release tabletMoving to a higher level; Prior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokana tabletMoving to a higher level; Prior authorizationFarxiga or Jardiance
    Kombiglyze XR extended-release tabletMoving to a higher level; Prior authorizationJanumet, Janumet XR, Jentadueto, Jentadueto XR
    NuvaRing contraceptive [Change Effective July 1, 2020]Moving to a higher leveletonogestrel/ethinyl estradiol contraceptive
    Onglyza tabletMoving to a higher level; Prior authorizationJanuvia or Tradjenta
    Pulmicort Flexhaler inhalerMoving to a higher level; Prior authorizationArnuity Ellipta, Flovent, or Qvar
    Segluromet tabletPrior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Steglatro tabletMoving to a higher level; Prior authorizationFarxiga or Jardiance

    Formulary Changes to the M1, M2 and M4 (2020) Drug Lists

    Drug Name Description of Change Cost-effective Alternatives*
    Alvesco inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex HFA inhalerNo longer coveredArnuity Ellipta, Flovent, or Qvar
    Asmanex Twisthaler inhalerNo longer coveredArnuity Ellipta, Flovent, or Qvar
    Basaglar injectableNo longer coveredLantus, Levemir, Toujeo, or Tresiba
    Carafate oral suspension [Change Effective July 1, 2020]No longer coveredsucralfate oral suspension
    Depen tablet [Change Effective July 1, 2020]No longer coveredpenicillamine tablet
    Invokamet tabletNo longer coveredSynjardy, Synjardy XR, or Xigduo XR
    Invokamet XR extended-release tabletNo longer coveredSynjardy, Synjardy XR, or Xigduo XR
    Invokana tabletNo longer coveredFarxiga or Jardiance
    Jadenu tablet [Change Effective July 1, 2020]No longer covereddeferasirox tablet
    Kombiglyze XR extended-release tabletNo longer coveredJanumet, Janumet XR, Jentadueto, Jentadueto XR
    Moxeza eye drops [Change Effective July 1, 2020]No longer coveredmoxifloxacin eye drops
    NuvaRing contraceptive [Change Effective July 1, 2020]No longer coveredetonogestrel/ethinyl estradiol contraceptive
    Onglyza tabletNo longer coveredJanuvia or Tradjenta
    Pulmicort Flexhaler inhalerNo longer coveredArnuity Ellipta, Flovent, or Qvar
    Steglatro tabletNo longer coveredFarxiga or Jardiance
    Travatan Z eye drops [Change Effective July 1, 2020]No longer coveredtravoprost eye drops
    Zohydro extended-release capsule [Change Effective July 1, 2020]No longer coveredhydrocodone extended-release capsule

    Formulary Changes to the Select C4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Alvesco inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex HFA inhalerMoving to a higher level; Prior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex Twisthaler inhalerMoving to a higher level; Prior authorizationArnuity Ellipta, Flovent, or Qvar
    Basaglar injectablePrior authorizationLantus, Levemir, Toujeo, or Tresiba
    Invokamet tabletMoving to a higher level; Prior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokamet XR extended-release tabletMoving to a higher level; Prior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokana tabletMoving to a higher level; Prior authorizationFarxiga or Jardiance
    Kombiglyze XR extended-release tabletMoving to a higher level; Prior authorizationJanumet, Janumet XR, Jentadueto, Jentadueto XR
    NuvaRing contraceptive [Change Effective July 1, 2020]Moving to a higher leveletonogestrel/ethinyl estradiol contraceptive
    Onglyza tabletMoving to a higher level; Prior authorizationJanuvia or Tradjenta
    Pulmicort Flexhaler inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Pulmicort Respules inhalation suspensionPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Segluromet tabletPrior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Steglatro tabletPrior authorizationFarxiga or Jardiance

    *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.