Drug List Changes

Effective November 01, 2016

Formulary Changes to the Preferred B2 Drug List

Drug Name	Description of Change	Cost-effective Alternatives*
Apidra vial	Taken off the drug list	Novolog vial in Tier 2
Apidra Solostar	Taken off the drug list	Novolog Flexpen in Tier 2
Humalog vial	Taken off the drug list	Novolog vial in Tier 2
Humalog Mix 50/50 vial and Humalog Mix 75/25 vial	Taken off the drug list	Novolog Mix 70/30 vial in Tier 2
Humulin 70/30 vial and Humulin 70/30 Kwikpen	Taken off the drug list	Novolin 70/30 vial in Tier 2
Humulin N vial and Humulin N Kwikpen	Taken off the drug list	Novolin N vial in Tier 2
Humulin R vial	Taken off the drug list	Novolin R vial in Tier 2

Formulary Changes to the Preferred B3 Drug List

Drug Name	Description of Change	Cost-effective Alternatives*
Apidra vial	Moving to level 3 from level 2	Novolog vial in Tier 2
Apidra Solostar	Moving to level 3 from level 2	Novolog Flexpen in Tier 2
Humalog vial	Moving to level 3 from level 2	Novolog vial in Tier 2
Humalog Mix 50/50 vial and Humalog Mix 75/25 vial	Moving to level 3 from level 2	Novolog Mix 70/30 vial in Tier 2
Humulin 70/30 vial and Humulin 70/30 Kwikpen	Moving to level 3 from level 2	Novolin 70/30 vial in Tier 2
Humulin N vial and Humulin N Kwikpen	Moving to level 3 from level 2	Novolin N vial in Tier 2
Humulin R vial	Moving to level 3 from level 2	Novolin R vial in Tier 2

Formulary Changes to the Preferred B4 Drug List

Drug Name	Description of Change	Cost-effective Alternatives*
Apidra vial	Moving to level 3 from level 2	Novolog vial in Tier 2
Apidra Solostar	Moving to level 3 from level 2	Novolog Flexpen in Tier 2
Humalog vial	Moving to level 3 from level 2	Novolog vial in Tier 2
Humalog Mix 50/50 vial and Humalog Mix 75/25 vial	Moving to level 3 from level 2	Novolog Mix 70/30 vial in Tier 2
Humulin 70/30 vial and Humulin 70/30 Kwikpen	Moving to level 3 from level 2	Novolin 70/30 vial in Tier 2
Humulin N vial and Humulin N Kwikpen	Moving to level 3 from level 2	Novolin N vial in Tier 2
Humulin R vial	Moving to level 3 from level 2	Novolin R vial in Tier 2

Formulary Changes to the Value-Based V1 Drug List

Drug Name	Description of Change	Cost-effective Alternatives*
Alogliptin tablet	Moving to level 4 from level 3	Januvia tablet or Onglyza tablet in Tier 3
Alogliptin/metformin tablet	Moving to level 4 from level 3	Janumet tablet, Janumet XR tablet or Kombiglyze XR tablet in Tier 3
Alogliptin/pioglitazone tablet	Moving to level 4 from level 3	Januvia tablet, Janumet tablet, Janumet XR tablet, Kombiglyze tablet or Onglyza tablet in Tier 3
Apidra vial	Moving to level 3 from level 2	Novolog vial in Tier 2
Apidra Solostar	Moving to level 3 from level 2	Novolog Flexpen in Tier 2
Glyxambi tablet	Moving to level 4 from level 3	Januvia tablet, Janumet tablet, Janumet XR tablet, Kombiglyze tablet or Onglyza tablet in Tier 3
Humalog vial	Moving to level 3 from level 2	Novolog vial in Tier 2
Humalog Mix 50/50 vial and Humalog Mix 75/25 vial	Moving to level 3 from level 2	Novolog Mix 70/30 vial in Tier 2
Humulin 70/30 vial and Humulin 70/30 Kwikpen	Moving to level 3 from level 2	Novolin 70/30 vial in Tier 2
Humulin N vial and Humulin N Kwikpen	Moving to level 3 from level 2	Novolin N vial in Tier 2
Humulin R vial	Moving to level 3 from level 2	Novolin R vial in Tier 2
Jentadueto tablet	Moving to level 4 from level 3	Janumet tablet, Janumet XR tablet or Kombiglyze tablet in Tier 3
Kazano tablet	Moving to level 4 from level 3	Janumet tablet, Janumet XR tablet or Kombiglyze tablet in Tier 3
Oseni tablet	Moving to level 4 from level 3	Januvia tablet, Janumet tablet, Janumet XR tablet, Kombiglyze tablet or Onglyza tablet in Tier 3
Tradjenta tablet	Moving to level 4 from level 3	Januvia tablet, Janumet tablet, Janumet XR tablet, Kombiglyze tablet or Onglyza tablet in Tier 3

Formulary Changes to the Select C4 Drug List

Drug Name	Description of Change	Cost-effective Alternatives*
Apidra vial	Moving to level 3 from level 2	Novolog vial in Tier 2
Apidra Solostar	Moving to level 3 from level 2	Novolog Flexpen in Tier 2
Humalog vial	Moving to level 3 from level 2	Novolog vial in Tier 2
Humalog Mix 50/50 vial and Humalog Mix 75/25 vial	Moving to level 3 from level 2	Novolog Mix 70/30 vial in Tier 2
Humulin 70/30 vial and Humulin 70/30 Kwikpen	Moving to level 3 from level 2	Novolin 70/30 vial in Tier 2
Humulin N vial and Humulin N Kwikpen	Moving to level 3 from level 2	Novolin N vial in Tier 2
Humulin R vial	Moving to level 3 from level 2	Novolin R vial in Tier 2

*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.