Drug List Changes

  • Effective October 01, 2015

    Formulary Changes to the Preferred B2 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Abilify tabletMoving to Non-Formularyaripiprazole tablet in Tier 1
    Generess FE chewable tabletMoving to Non-Formularynorethindrone/ethinyl estradiol chewable tablet in Tier 1
    Kenalog topical sprayMoving to Non-Formularytriamcinolone topical spray in Tier 1
    Methylin chewable tabletMoving to Non-Formularymethylphenidate chewable tablet in Tier 1
    Suprax suspensionMoving to Non-Formularycefixime suspension in Tier 1

    Formulary Changes to the Preferred B3 & B4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Abilify tabletMoving to Tier 3 from Tier 2aripiprazole tablet in Tier 1
    Generess FE chewable tabletMoving to Tier 3 from Tier 2norethindrone/ethinyl estradiol chewable tablet in Tier 1
    Kenalog topical sprayMoving to Tier 3 from Tier 2triamcinolone topical spray in Tier 1
    Methylin chewable tabletMoving to Tier 3 from Tier 2methylphenidate chewable tablet in Tier 1
    Suprax suspensionMoving to Tier 3 from Tier 2cefixime suspension in Tier 1

    Formulary Changes to the X1, X3 & X4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Abilify tabletMoving to Non-Formularyaripiprazole tablet in Tier 1
    Actonel tabletMoving to Non-Formularyrisedronate tablet in Tier 1
    DermOtic ear dropsMoving to Non-Formularyfluocinolone acetonide ear drops in Tier 1
    Diastat Acudial kitMoving to Non-Formularydiazepam kit in Tier 1
    Diovan HCT tabletMoving to Non-Formularyvalsartan/hydrochlorothiazide tablet in Tier 1
    Exforge tabletMoving to Non-Formularyamlodipine/valsartan tablet in Tier 1
    Generess FE chewable tabletMoving to Non-Formularynorethindrone/ethinyl estradiol chewable tablet in Tier 1
    GoLytely solutionMoving to Non-Formularypolyethylene glycol/electrolytes in Tier 1
    Imuran tabletMoving to Non-Formularyazathioprine tablet in Tier 1
    Lotronex tabletMoving to Non-Formularyalosetron tablet in Tier 1
    Mepron suspensionMoving to Non-Formularyatovaquone suspension in Tier 1
    Micardis HCT tabletMoving to Non-Formularytelmisartan/hydrochlorothiazide tablet in Tier 1
    Micardis tabletMoving to Non-Formularytelmisartan tablet in Tier 1
    Migranal nasal sprayMoving to Non-Formularydihydroergotamine nasal spray in Tier 1
    Nephrocaps capsuleMoving to Non-FormularyB complex/vitamin C/folic acid capsule in Tier 1
    NuLytely solutionMoving to Non-Formularypolyethylene glycol/electrolytes in Tier 1
    Pred Forte eye dropsMoving to Non-Formularyprednisolone acetate eye drops in Tier 1
    Prometrium capsuleMoving to Non-Formularyprogesterone micronized capsule in Tier 1
    Roxicodone tabletMoving to Non-Formularyoxycodone tablet in Tier 1
    Sandostatin injectionMoving to Non-Formularyoctreotide acetate injection in Tier 1
    Sfrowasa suspensionMoving to Non-Formularymesalamine suspension in Tier 1
    Solaraze topical gelMoving to Non-Formularydiclofenac sodium topical gel in Tier 1
    Soriatane capsuleMoving to Non-Formularyacitretin capsule in Tier 1
    Suprax suspensionMoving to Non-Formularycefixime suspension in Tier 1
    Tasmar tabletMoving to Non-Formularytolcapone tablet in Tier 1
    Tricor tabletMoving to Non-Formularyfenofibrate nanocrystallized tablet in Tier 1
    Zomig tabletMoving to Non-Formularyzolmitriptan tablet in Tier 1
    Zomig ZMT tabletMoving to Non-Formularyzolmitriptan orally-disintegrating tablet in Tier 1

    Formulary Changes to the Value-Based V1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Abilify tabletMoving to Tier 4 from Tier 3aripiprazole tablet in Tier 1
    Generess FE chewable tabletMoving to Tier 4 from Tier 3norethindrone/ethinyl estradiol chewable tablet in Tier 1
    Lotronex tabletMoving to Tier 4 from Tier 3alosetron tablet in Tier 1
    Tasmar tabletMoving to Tier 4 from Tier 3tolcapone tablet in Tier 1
    Zonatuss capsuleMoving to Tier 4 from Tier 3benzonatate capsule 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.