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Drug Changes

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


EPINEPHrine Solution Auto-Injector 0.15 MG/0.15ML Injection


Post Date:
3/11/2022
Effective Date:
3/15/2022
Type of Change:
Utilization management added
Reason Changed:
Quantity limit updated

EPINEPHrine Solution Auto-Injector 0.3 MG/0.3ML Injection


Post Date:
3/11/2022
Effective Date:
3/15/2022
Type of Change:
Utilization management added
Reason Changed:
Quantity limit updated

Upneeq Solution 0.1 % Ophthalmic


Post Date:
10/15/2022
Effective Date:
10/15/2022
Type of Change:
Drug removed
Reason Changed:
Medication is used to treat conditions not covered by plan

Nuedexta CAPSULE 20-10 MG ORAL


Post Date:
10/15/2022
Effective Date:
10/15/2022
Type of Change:
Drug removed
Reason Changed:
Medication is used to treat conditions not covered by plan

Pyrimethamine Tablet 25 MG Oral


Post Date:
10/15/2022
Effective Date:
10/15/2022
Type of Change:
Utilization management added
Reason Changed:
Prior authorization is required

Ruzurgi Tablet 10 MG Oral


Post Date:
10/15/2022
Effective Date:
10/15/2022
Type of Change:
Drug removed
Reason Changed:
Drug discontinued from marketplace


There are currently no changes for 2023