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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.

Amicar Tablet 1000 MG Oral


Post Date:
2/15/2021
Effective Date:
2/15/2021
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Aminocaproic Acid Tablet 1000 MG Oral Tier 1 Hemostatics - Systemic
* Please reference your Evidence of Coverage for applicable cost-sharing.

Amicar Tablet 500 MG Oral


Post Date:
2/15/2021
Effective Date:
2/15/2021
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Apriso Capsule Extended Release 24 Hour 0.375 GM Oral


Post Date:
2/15/2021
Effective Date:
2/15/2021
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Atripla Tablet 600-200-300 MG Oral


Post Date:
2/15/2021
Effective Date:
2/15/2021
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Carafate Suspension 1 GM/10ML Oral


Post Date:
2/15/2021
Effective Date:
2/15/2021
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Ciprodex Suspension 0.3-0.1 % Otic


Post Date:
2/15/2021
Effective Date:
2/15/2021
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Samsca Tablet 15 MG Oral


Post Date:
2/15/2021
Effective Date:
2/15/2021
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Samsca Tablet 30 MG Oral


Post Date:
2/15/2021
Effective Date:
2/15/2021
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Emtriva Capsule 200 MG Oral


Post Date:
2/15/2021
Effective Date:
2/15/2021
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Symfi Lo Tablet 400-300-300 MG Oral


Post Date:
2/15/2021
Effective Date:
2/15/2021
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Symfi Tablet 600-300-300 MG Oral


Post Date:
2/15/2021
Effective Date:
2/15/2021
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Truvada Tablet 200-300 MG Oral


Post Date:
2/15/2021
Effective Date:
2/15/2021
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Kuvan Packet 100 MG Oral


Post Date:
2/15/2021
Effective Date:
2/15/2021
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Kuvan Packet 500 MG Oral


Post Date:
2/15/2021
Effective Date:
2/15/2021
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available

Kuvan Tablet Soluble 100 MG Oral


Post Date:
2/15/2021
Effective Date:
2/15/2021
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available