Drug Changes

Here you will find a listing of the drugs that have been changed on our drug list (formulary) for the plan year you select.



Astagraf XL CAPSULE EXTENDED RELEASE 24 HOUR 0.5 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Drug removed
Reason Changed:
Removed, alternative available provider and member notified

Astagraf XL CAPSULE EXTENDED RELEASE 24 HOUR 1 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Drug removed
Reason Changed:
Removed, alternative available provider and member notified

Astagraf XL CAPSULE EXTENDED RELEASE 24 HOUR 5 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Drug removed
Reason Changed:
Removed, alternative available provider and member notified

Eliquis TABLET 2.5 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Cyclobenzaprine HCl TABLET 7.5 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Drug removed
Reason Changed:
Removed, alternative available provider and member notified

Diazepam 10 MG


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Diazepam 2.5 MG


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Diazepam 20 MG


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Paromomycin Sulfate CAPSULE 250 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

EpiPen Jr 2-Pak 0.15 MG/0.3ML INJECTION


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Drug removed
Reason Changed:
Removed, alternative available provider and member notified

Carisoprodol TABLET 350 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Drug removed
Reason Changed:
Removed, alternative available provider and member notified

Carisoprodol-Aspirin TABLET 200-325 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Drug removed
Reason Changed:
Removed, alternative available provider and member notified

Carisoprodol-Aspirin-Codeine TABLET 200-325-16 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Drug removed
Reason Changed:
Removed, alternative available provider and member notified

Doxazosin Mesylate TABLET 1 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Doxazosin Mesylate TABLET 2 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Doxazosin Mesylate TABLET 4 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Doxazosin Mesylate TABLET 8 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Prevacid 24HR CAPSULE DELAYED RELEASE 15 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Drug removed
Reason Changed:
Removed, alternative available provider and member notified

Prevacid CAPSULE DELAYED RELEASE 15 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Drug removed
Reason Changed:
Removed, alternative available provider and member notified

Relenza Diskhaler AEROSOL POWDER, BREATH ACTIVATED 5 MG/BLISTER INHALATION


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Sivextro SOLUTION RECONSTITUTED 200 MG INTRAVENOUS


Post Date:
4/12/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Tamiflu CAPSULE 30 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Tamiflu CAPSULE 45 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Tamiflu CAPSULE 75 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Tamiflu SUSPENSION RECONSTITUTED 6 MG/ML ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Tretinoin CAPSULE 10 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Tyzeka TABLET 600 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Drug removed
Reason Changed:
Removed, alternative available provider and member notified

ValGANciclovir HCl TABLET 450 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Xarelto TABLET 10 MG ORAL


Post Date:
4/15/2016
Effective Date:
4/15/2016
Type of Change:
Utilization management added
Reason Changed:
Update quantity limit, provider and member notified

Crestor TABLET 10 MG ORAL


Post Date:
6/15/2016
Effective Date:
6/15/2016
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Crestor TABLET 20 MG ORAL


Post Date:
6/15/2016
Effective Date:
6/15/2016
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Crestor TABLET 40 MG ORAL


Post Date:
6/15/2016
Effective Date:
6/15/2016
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Crestor TABLET 5 MG ORAL


Post Date:
6/15/2016
Effective Date:
6/15/2016
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available


There are currently no changes for 2019