Drug List Changes

  • Effective October 01, 2016

    Formulary Changes to the Preferred B2 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Android capsuleTaken off the drug listmethyltestosterone capsule in level 1
    Benzaclin topical gelTaken off the drug listclindamycin/benzoyl peroxide topical gel in level 1
    Crestor tabletTaken off the drug listrosuvastatin tablet in level 1
    Testred capsuleTaken off the drug listmethyltestosterone capsule in level 1

    Formulary Changes to the Preferred B3 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Android capsuleMoving to level 3 from level 2methyltestosterone capsule in level 1
    Benzaclin topical gelMoving to level 3 from level 2clindamycin/benzoyl peroxide topical gel in level 1
    Crestor tabletMoving to level 3 from level 2rosuvastatin tablet in level 1
    Testred capsuleMoving to level 3 from level 2methyltestosterone capsule in level 1

    Formulary Changes to the Preferred B4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Android capsuleMoving to level 3 from level 2methyltestosterone capsule in level 1
    Benzaclin topical gelMoving to level 3 from level 2clindamycin/benzoyl peroxide topical gel in level 1
    Crestor tabletMoving to level 3 from level 2rosuvastatin tablet in level 1
    Testred capsuleMoving to level 3 from level 2methyltestosterone capsule in level 1

    Formulary Changes to the X1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Cordran topical creamTaken off the drug listflurandrenolide topical cream in level 1
    Crestor tabletTaken off the drug listrosuvastatin tablet in level 1
    Doryx tabletTaken off the drug listdoxycycline hyclate tablet in level 1
    Edecrin tabletTaken off the drug listethacrynic tablet in level 1
    Glyset tabletTaken off the drug listmiglitol tablet in level 1
    Nuvigil tabletTaken off the drug listarmodafinil tablet in level 1
    Tikosyn capsuleTaken off the drug listdofetilide capsule in level 1
    Voltaren topical gelTaken off the drug listdiclofenac sodium topical gel in level 1
    Ziana topical gelTaken off the drug listclindamycin/tretinoin topical gel in level 1

    Formulary Changes to the X3 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Cordran topical creamTaken off the drug listflurandrenolide topical cream in level 1
    Crestor tabletTaken off the drug listrosuvastatin tablet in level 1
    Doryx tabletTaken off the drug listdoxycycline hyclate tablet in level 1
    Edecrin tabletTaken off the drug listethacrynic tablet in level 1
    Glyset tabletTaken off the drug listmiglitol tablet in level 1
    Nuvigil tabletTaken off the drug listarmodafinil tablet in level 1
    Tikosyn capsuleTaken off the drug listdofetilide capsule in level 1
    Voltaren topical gelTaken off the drug listdiclofenac sodium topical gel in level 1
    Ziana topical gelTaken off the drug listclindamycin/tretinoin topical gel in level 1

    Formulary Changes to the X4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Cordran topical creamTaken off the drug listflurandrenolide topical cream in level 1
    Crestor tabletTaken off the drug listrosuvastatin tablet in level 1
    Doryx tabletTaken off the drug listdoxycycline hyclate tablet in level 1
    Edecrin tabletTaken off the drug listethacrynic tablet in level 1
    Glyset tabletTaken off the drug listmiglitol tablet in level 1
    Nuvigil tabletTaken off the drug listarmodafinil tablet in level 1
    Tikosyn capsuleTaken off the drug listdofetilide capsule in level 1
    Voltaren topical gelTaken off the drug listdiclofenac sodium topical gel in level 1
    Ziana topical gelTaken off the drug listclindamycin/tretinoin topical gel in level 1

    Formulary Changes to the Value-Based V1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Android capsuleMoving to level 4 from level 2methyltestosterone capsule in level 1
    Benzaclin topical gelMoving to level 4 from level 2clindamycin/benzoyl peroxide topical gel in level 1
    Cordran topical creamMoving to level 4 from level 3flurandrenolide topical cream in level 1
    Crestor tabletMoving to level 4 from level 3rosuvastatin tablet in level 1
    Edecrin tabletMoving to level 4 from Tier 3ethacrynic tablet in level 1
    Glyset tablet Moving to level 4 from Tier 3miglitol tablet in level 1
    Nuvigil tabletMoving to level 4 from Tier 3armodafinil tablet in level 1
    Testred capsuleMoving to level 4 from level 2methyltestosterone capsule in level 1
    Tikosyn capsuleMoving to level 4 from level 3dofetilide capsule in level 1
    Voltaren topical gelMoving to level 4 from level 3diclofenac sodium topical gel in level 1
    Ziana topical gelMoving to level 4 from level 3clindamycin/tretinoin topical gel in level 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.