Drug List Changes

  • Effective July 01, 2016

    Formulary Changes to the Preferred B2 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Gleevec tabletMoving to Non-Formularyimatinib tablet in Tier 1
    Intermezzo dissolvable tabletMoving to Non-Formularyzolpidem dissolvable tablet in Tier 1

    Formulary Changes to the Preferred B3 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Gleevec tabletMoving to Tier 3 from Tier 2imatinib tablet in Tier 1
    Intermezzo dissolvable tabletMoving to Tier 3 from Tier 2zolpidem dissolvable tablet in Tier 1

    Formulary Changes to the Preferred B4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Intermezzo dissolvable tabletMoving to Tier 3 from Tier 2zolpidem dissolvable tablet in Tier 1

    Formulary Changes to the X1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Enablex extended-release tabletMoving to Non-Formularydarifenacin extended-release tablet in Tier 1
    Frova tabletMoving to Non-Formularyfrovatriptan tablet in Tier 1
    Gleevec tabletMoving to Non-Formularyimatinib tablet in Tier 1
    Intermezzo dissolvable tabletMoving to Non-Formularyzolpidem dissolvable tablet in Tier 1
    Naftin 2% topical creamMoving to Non-Formularynaftifine 2% topical cream in Tier 1
    Nasonex nasal sprayMoving to Non-Formularymometasone nasal spray in Tier 1
    Oxistat 1% topical creamMoving to Non-Formularyoxiconazole topical cream in Tier 1
    Synalar 0.01% topical solutionMoving to Non-Formularyfluocinolone 0.01% topical solution in Tier 1
    Voltaren 1% topical gelMoving to Non-Formularydiclofenac 1% topical gel in Tier 1

    Formulary Changes to the X3 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Enablex extended-release tabletMoving to Non-Formularydarifenacin extended-release tablet in Tier 1
    Frova tabletMoving to Non-Formularyfrovatriptan tablet in Tier 1
    Gleevec tabletMoving to Non-Formularyimatinib tablet in Tier 3
    Intermezzo dissolvable tabletMoving to Non-Formularyzolpidem dissolvable tablet in Tier 1
    Naftin 2% topical creamMoving to Non-Formularynaftifine 2% topical cream in Tier 1
    Nasonex nasal sprayMoving to Non-Formularymometasone nasal spray in Tier 1
    Oxistat 1% topical creamMoving to Non-Formularyoxiconazole topical cream in Tier 1
    Synalar 0.01% topical solutionMoving to Non-Formularyfluocinolone 0.01% topical solution in Tier 1
    Voltaren 1% topical gelMoving to Non-Formularydiclofenac 1% topical gel in Tier 1

    Formulary Changes to the X4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Enablex extended-release tabletMoving to Non-Formularydarifenacin extended-release tablet in Tier 1
    Frova tabletMoving to Non-Formularyfrovatriptan tablet in Tier 1
    Gleevec tabletMoving to Non-Formularyimatinib tablet in Tier 4
    Intermezzo dissolvable tabletMoving to Non-Formularyzolpidem dissolvable tablet in Tier 1
    Naftin 2% topical creamMoving to Non-Formularynaftifine 2% topical cream in Tier 1
    Nasonex nasal sprayMoving to Non-Formularymometasone nasal spray in Tier 1
    Oxistat 1% topical creamMoving to Non-Formularyoxiconazole topical cream in Tier 1
    Synalar 0.01% topical solutionMoving to Non-Formularyfluocinolone 0.01% topical solution in Tier 1
    Voltaren 1% topical gelMoving to Non-Formularydiclofenac 1% topical gel in Tier 1

    Formulary Changes to the Value-Based V1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Enablex extended-release tabletMoving to Tier 4 from Tier 3darifenacin extended-release tablet in Tier 1
    Frova tabletMoving to Tier 4 from Tier 3frovatriptan tablet in Tier 1
    Gleevec tabletMoving to Tier 4 from Tier 1imatinib tablet in Tier 1
    Intermezzo dissolvable tabletMoving to Tier 4 from Tier 3zolpidem dissolvable tablet in Tier 1
    Naftin 2% topical creamMoving to Tier 4 from Tier 3naftifine 2% topical cream in Tier 1
    Nasonex nasal sprayMoving to Tier 4 from Tier 3mometasone nasal spray in Tier 1
    Oxistat 1% topical creamMoving to Tier 4 from Tier 3oxiconazole topical cream in Tier 1

    Formulary Changes to the Select C4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Nasonex nasal sprayMoving to Tier 3 from Tier 2mometasone nasal spray in Tier 1

    *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.