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.



Lyrica CAPSULE 225 MG Oral


Post Date:
8/15/2019
Effective Date:
8/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Pregabalin Capsule 225 MG Oral Tier 1 PA, QL Anticonvulsants - Misc.
* Please reference your Evidence of Coverage for applicable cost-sharing.

Lyrica Capsule 25 MG Oral


Post Date:
8/15/2019
Effective Date:
8/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Pregabalin Capsule 25 MG Oral Tier 1 PA, QL Anticonvulsants - Misc.
* Please reference your Evidence of Coverage for applicable cost-sharing.

Lyrica Capsule 300 MG Oral


Post Date:
8/15/2019
Effective Date:
8/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Pregabalin Capsule 300 MG Oral Tier 1 PA, QL Anticonvulsants - Misc.
* Please reference your Evidence of Coverage for applicable cost-sharing.

Lyrica Capsule 50 MG Oral


Post Date:
8/15/2019
Effective Date:
8/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Pregabalin Capsule 50 MG Oral Tier 1 PA, QL Anticonvulsants - Misc.
* Please reference your Evidence of Coverage for applicable cost-sharing.

Lyrica Capsule 75 MG Oral


Post Date:
8/15/2019
Effective Date:
8/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Pregabalin Capsule 75 MG Oral Tier 1 PA, QL Anticonvulsants - Misc.
* Please reference your Evidence of Coverage for applicable cost-sharing.

Lyrica Capsule 100 MG Oral


Post Date:
8/15/2019
Effective Date:
8/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Pregabalin Capsule 100 MG Oral Tier 1 PA, QL Anticonvulsants - Misc.
* Please reference your Evidence of Coverage for applicable cost-sharing.

Lyrica Capsule 150 MG Oral


Post Date:
8/15/2019
Effective Date:
8/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Pregabalin Capsule 150 MG Oral Tier 1 PA, QL Anticonvulsants - Misc.
* Please reference your Evidence of Coverage for applicable cost-sharing.

Lyrica Capsule 200 MG Oral


Post Date:
8/15/2019
Effective Date:
8/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Pregabalin Capsule 200 MG Oral Tier 1 PA, QL Anticonvulsants - Misc.
* Please reference your Evidence of Coverage for applicable cost-sharing.

Tracleer Tablet 125 MG Oral


Post Date:
9/15/2019
Effective Date:
9/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Bosentan Tablet 125 MG Oral Tier 3 PA Pulmonary Hypertension - Endothelin Receptor Antagonists
* Please reference your Evidence of Coverage for applicable cost-sharing.

Tracleer Tablet 62.5 MG Oral


Post Date:
9/15/2019
Effective Date:
9/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Bosentan Tablet 62.5 MG Oral Tier 3 PA Pulmonary Hypertension - Endothelin Receptor Antagonists
* Please reference your Evidence of Coverage for applicable cost-sharing.

Tarceva Tablet 100 MG Oral


Post Date:
9/15/2019
Effective Date:
9/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Erlotinib HCl Tablet 100 MG Oral Tier 3 PA, QL Antineoplastic - Tyrosine Kinase Inhibitors
* Please reference your Evidence of Coverage for applicable cost-sharing.

Tarceva Tablet 150 MG Oral


Post Date:
9/15/2019
Effective Date:
9/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Erlotinib HCl Tablet 150 MG Oral Tier 3 PA, QL Antineoplastic - Tyrosine Kinase Inhibitors
* Please reference your Evidence of Coverage for applicable cost-sharing.

Tarceva Tablet 25 MG Oral


Post Date:
9/15/2019
Effective Date:
9/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Erlotinib HCl Tablet 25 MG Oral Tier 3 PA, QL Antineoplastic - Tyrosine Kinase Inhibitors
* Please reference your Evidence of Coverage for applicable cost-sharing.

Diclegis Tablet Delayed Release 10-10 MG Oral


Post Date:
9/15/2019
Effective Date:
9/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Doxylamine-Pyridoxine Tablet Delayed Release 10-10 MG Oral Tier 1 PA Antiemetic Combinations
* Please reference your Evidence of Coverage for applicable cost-sharing.

Uloric Tablet 40 MG Oral


Post Date:
10/15/2019
Effective Date:
10/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Febuxostat Tablet 40 MG Oral Tier 1 ST Gout Agents
* Please reference your Evidence of Coverage for applicable cost-sharing.

Uloric Tablet 80 MG Oral


Post Date:
10/15/2019
Effective Date:
10/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Febuxostat Tablet 80 MG Oral Tier 1 ST Gout Agents
* Please reference your Evidence of Coverage for applicable cost-sharing.

Firazyr Solution 30 MG/3ML Subcutaneous


Post Date:
10/15/2019
Effective Date:
10/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Icatibant Acetate Solution 30 MG/3ML Subcutaneous Tier 3 PA Bradykinin B2 Receptor Antagonists
* Please reference your Evidence of Coverage for applicable cost-sharing.

Suprax Capsule 400 MG Oral


Post Date:
10/15/2019
Effective Date:
10/15/2019
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Cefixime Capsule 400 MG Oral Tier 1 Cephalosporins - 3rd Generation
* Please reference your Evidence of Coverage for applicable cost-sharing.


There are currently no changes for 2020