| Aggrenox capsule | No longer covered | aspirin/dipyridamole capsule |
| Airduo Respiclick inhaler | No longer covered | Wixela Inhub inhaler, fluticasone/salmeterol inhaler (generic) |
| Airduo Digihaler inhaler | No longer covered | Wixela Inhub inhaler, fluticasone/salmeterol inhaler (generic) |
| Apriso extended-release capsule | No longer covered | mesalamine extended-release capsule |
| Aptiom tablet | No longer covered | Consult doctor |
| Atralin gel | No longer covered | tretinoin gel |
| Bunavail film | No longer covered | buprenorphine/naloxone sublingual tablet |
| Ciloxan ointment | No longer covered | ciprofloxacin eye drops |
| Concerta extended-release tablet | No longer covered | methylphenidate extended-release tablet |
| Cosentyx syringe | No longer covered | Taltz syringe |
| Demser capsule | Moving to a higher level | metyrosine capsule |
| Doral tablet | No longer covered | estazolam tablet |
| Duragesic patch | No longer covered | fentanyl patch |
| Elestrin gel | No longer covered | Divigel gel |
| Emtriva capsule | Moving to a higher level | emtricitabine capsule |
| Estrace cream | No longer covered | estradiol cream |
| Estrostep FE-28 tablet | Moving to a higher level | norethindrone/ethinyl estradiol tablet |
| Firazyr syringe | No longer covered | icatibant syringe |
| Firvanq solution | No longer covered | vancomycin solution |
| Fluticasone/salmeterol (brand) | No longer covered | Wixela Inhub inhaler, fluticasone/salmeterol inhaler (generic) |
| Inderal XL extended-release capsule | No longer covered | propranolol extended-release capsule |
| Lastacaft eye drops | No longer covered | epinastine eye drops |
| Letairis tablet | No longer covered | ambrisentan tablet |
| Lialda delayed-release tablet | No longer covered | mesalamine delayed-release tablet |
| Locoid topical | No longer covered | hydrocortisone butyrate topical |
| Mestinoin tablet | No longer covered | pyridostigmine tablet |
| Mestinoin syrup | No longer covered | pyridostigmine syrup |
| Minivelle patch | No longer covered | estradiol patch |
| Morphabond extended-release tablet | No longer covered | morphine extended-release capsule |
| Mytesi delayed-release tablet | No longer covered | loperamide capsule, diphenoxylate/atropine tablet |
| Natroba topical suspension | No longer covered | spinosad topical suspension |
| Neulasta syringe | No longer covered | Udenyca syringe or Ziextenzo syringe |
| Neulasta OnPro kit | No longer covered | Udenyca syringe or Ziextenzo syringe |
| Noxafil delayed-release tablet | No longer covered | posaconazole delayed-release tablet |
| Nucynta tablet | No longer covered | Consult doctor |
| Nucynta extended-release tablet | No longer covered | morphine extended-release capsule |
| Otrexup auto-injector | No longer covered | Rasuvo auto-injector |
| Pazeo eye drops | No longer covered | olopatadine eye drops |
| Praluent syringe | No longer covered | Repatha syringe |
| Proair Digihaler inhaler | No longer covered | albuterol HFA inhaler |
| Proair Respiclick inhaler | No longer covered | albuterol HFA inhaler |
| Proctofoam-HC foam | No longer covered | hydrocortisone/pramoxine cream |
| Procysbi delayed-release capsule | No longer covered | Cystagon capsule |
| Procysbi delayed-release granules | No longer covered | Cystagon capsule |
| Qbrexza cloth | No longer covered | Drysol solution |
| Quazepam tablet | No longer covered | estazolam tablet |
| Ranexa extended-release tablet | No longer covered | ranolazine extended-release tablet |
| Rozerem tablet | No longer covered | ramelteon tablet |
| Sulconazole cream | No longer covered | ketoconazole cream |
| Sulconazole solution | No longer covered | ketoconazole cream |
| Targretin capsule | No longer covered | bexarotene capsule |
| Tavalisse tablet | No longer covered | Promacta tablet or Doptelet tablet |
| Toprol XL extended-release tablet | Moving to a higher level | metoprolol extended-release tablet |
| Transderm Scop patch | Moving to a higher level | scopolamine patch |
| Travatan Z eye drops | No longer covered | travoprost eye drops |
| Uloric tablet | No longer covered | febuxostat tablet |
| Vanos cream | No longer covered | fluocinonide cream |
| Ventolin HFA inhaler | Moving to a higher level | albuterol HFA inhaler |
| Xtampza extended-release capsule | No longer covered | morphine extended-release capsule |
| Zelapar orally disintegrating tablet | No longer covered | rasagiline tablet |
| Zohydro extended-release capsule | No longer covered | hydrocodone extended-release capsule |
| Zovirax ointment | No longer covered | acyclovir ointment |