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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 plan year you select.
To request Medicare Part D prescription drug coverage determinations (including tiering or formulary exception requests) please use the following form:
Denavir Cream 1 % External
Post Date:
2/1/2023
Effective Date:
2/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Penciclovir Cream 1 % External | Tier 2 | ST | Topical Anti-infectives |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Tazorac Gel 0.05 % External
Post Date:
2/1/2023
Effective Date:
2/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Tazarotene Gel 0.05 % External | Tier 4 | Acne and Rosacea Agents | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Tazorac Gel 0.1 % External
Post Date:
2/1/2023
Effective Date:
2/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Tazarotene Gel 0.1 % External | Tier 4 | Acne and Rosacea Agents | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Esbriet Capsule 267 MG Oral
Post Date:
3/27/2023
Effective Date:
4/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Pirfenidone Capsule 267 MG Oral | Tier 5 | PA, QL | Pulmonary Fibrosis Agents |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Hetlioz Capsule 20 MG Oral
Post Date:
4/25/2023
Effective Date:
5/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Tasimelteon Capsule 20 MG Oral | Tier 5 | PA, QL | Sleep Promoting Agents |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Latuda Tablet 120 MG Oral
Post Date:
4/25/2023
Effective Date:
5/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Lurasidone HCl Tablet 120 MG Oral | Tier 5 | 2nd Generation/Atypical | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Latuda Tablet 20 MG Oral
Post Date:
4/25/2023
Effective Date:
5/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Lurasidone HCl Tablet 20 MG Oral | Tier 5 | QL | 2nd Generation/Atypical |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Latuda Tablet 40 MG Oral
Post Date:
4/25/2023
Effective Date:
5/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Lurasidone HCl Tablet 40 MG Oral | Tier 5 | QL | 2nd Generation/Atypical |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Latuda Tablet 60 MG Oral
Post Date:
4/25/2023
Effective Date:
5/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Lurasidone HCl Tablet 60 MG Oral | Tier 5 | QL | 2nd Generation/Atypical |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Latuda Tablet 80 MG Oral
Post Date:
4/25/2023
Effective Date:
5/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Lurasidone HCl Tablet 80 MG Oral | Tier 5 | 2nd Generation/Atypical | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Cardizem LA Tablet Extended Release 24 Hour 120 MG Oral
Post Date:
5/18/2023
Effective Date:
6/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| dilTIAZem HCl ER Tablet Extended Release 24 Hour 120 MG Oral | Tier 2 | Calcium Channel Blocking Agents, Nondihydropyridines | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Kyzatrex Capsule 100 MG Oral
Post Date:
5/18/2023
Effective Date:
6/1/2023
Type of Change:
Drug removed - Discontinued from marketplace
Reason Changed:
Drug discontinued from marketplace
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Testosterone Cypionate Solution 100 MG/ML Intramuscular | Tier 2 | Androgens | |
| Testosterone Cypionate Solution 200 MG/ML Intramuscular | Tier 2 | Androgens | |
| Testosterone Enanthate Solution 200 MG/ML Intramuscular | Tier 2 | Androgens | |
| Testosterone Gel 10 MG/ACT (2%) Transdermal | Tier 2 | QL | Androgens |
| Testosterone Gel 12.5 MG/ACT (1%) Transdermal | Tier 2 | QL | Androgens |
| Testosterone Gel 25 MG/2.5GM (1%) Transdermal | Tier 2 | QL | Androgens |
| Testosterone Gel 50 MG/5GM (1%) Transdermal | Tier 2 | QL | Androgens |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Kyzatrex Capsule 150 MG Oral
Post Date:
5/18/2023
Effective Date:
6/1/2023
Type of Change:
Drug removed - Discontinued from marketplace
Reason Changed:
Drug discontinued from marketplace
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Testosterone Cypionate Solution 100 MG/ML Intramuscular | Tier 2 | Androgens | |
| Testosterone Cypionate Solution 200 MG/ML Intramuscular | Tier 2 | Androgens | |
| Testosterone Enanthate Solution 200 MG/ML Intramuscular | Tier 2 | Androgens | |
| Testosterone Gel 10 MG/ACT (2%) Transdermal | Tier 2 | QL | Androgens |
| Testosterone Gel 12.5 MG/ACT (1%) Transdermal | Tier 2 | QL | Androgens |
| Testosterone Gel 25 MG/2.5GM (1%) Transdermal | Tier 2 | QL | Androgens |
| Testosterone Gel 50 MG/5GM (1%) Transdermal | Tier 2 | QL | Androgens |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Kyzatrex Capsule 200 MG Oral
Post Date:
5/18/2023
Effective Date:
6/1/2023
Type of Change:
Drug removed - Discontinued from marketplace
Reason Changed:
Drug discontinued from marketplace
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Testosterone Gel 12.5 MG/ACT (1%) Transdermal | Tier 2 | QL | Androgens |
| Testosterone Gel 25 MG/2.5GM (1%) Transdermal | Tier 2 | QL | Androgens |
| Testosterone Gel 50 MG/5GM (1%) Transdermal | Tier 2 | QL | Androgens |
| Testosterone Cypionate Solution 100 MG/ML Intramuscular | Tier 2 | Androgens | |
| Testosterone Cypionate Solution 200 MG/ML Intramuscular | Tier 2 | Androgens | |
| Testosterone Enanthate Solution 200 MG/ML Intramuscular | Tier 2 | Androgens | |
| Testosterone Gel 10 MG/ACT (2%) Transdermal | Tier 2 | QL | Androgens |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Matzim LA Tablet Extended Release 24 Hour 180 MG Oral
Post Date:
5/18/2023
Effective Date:
6/1/2023
Type of Change:
Drug removed - Discontinued from marketplace
Reason Changed:
Drug discontinued from marketplace
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Matzim LA Tablet Extended Release 24 Hour 180 MG Oral | Tier 2 | Calcium Channel Blocking Agents, Nondihydropyridines | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Matzim LA Tablet Extended Release 24 Hour 240 MG Oral
Post Date:
5/18/2023
Effective Date:
6/1/2023
Type of Change:
Drug removed - Discontinued from marketplace
Reason Changed:
Drug discontinued from marketplace
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Matzim LA Tablet Extended Release 24 Hour 240 MG Oral | Tier 2 | Calcium Channel Blocking Agents, Nondihydropyridines | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Matzim LA Tablet Extended Release 24 Hour 300 MG Oral
Post Date:
5/18/2023
Effective Date:
6/1/2023
Type of Change:
Drug removed - Discontinued from marketplace
Reason Changed:
Drug discontinued from marketplace
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Matzim LA Tablet Extended Release 24 Hour 300 MG Oral | Tier 2 | Calcium Channel Blocking Agents, Nondihydropyridines | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Matzim LA Tablet Extended Release 24 Hour 360 MG Oral
Post Date:
5/18/2023
Effective Date:
6/1/2023
Type of Change:
Drug removed - Discontinued from marketplace
Reason Changed:
Drug discontinued from marketplace
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Matzim LA Tablet Extended Release 24 Hour 360 MG Oral | Tier 2 | Calcium Channel Blocking Agents, Nondihydropyridines | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Matzim LA Tablet Extended Release 24 Hour 420 MG Oral
Post Date:
5/18/2023
Effective Date:
6/1/2023
Type of Change:
Drug removed - Discontinued from marketplace
Reason Changed:
Drug discontinued from marketplace
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Matzim LA Tablet Extended Release 24 Hour 420 MG Oral | Tier 2 | Calcium Channel Blocking Agents, Nondihydropyridines | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Naftin Gel 2 % External
Post Date:
6/20/2023
Effective Date:
7/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Naftifine HCl Gel 2 % External | Tier 4 | Antifungals | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Noxafil Suspension 40 MG/ML Oral
Post Date:
6/20/2023
Effective Date:
7/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Posaconazole Suspension 40 MG/ML Oral | Tier 5 | PA | Antifungals |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Celontin Capsule 300 MG Oral
Post Date:
7/26/2023
Effective Date:
8/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Methsuximide Capsule 300 MG Oral | Tier 4 | Calcium Channel Modifying Agents | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Iressa Tablet 250 MG Oral
Post Date:
7/26/2023
Effective Date:
8/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Gefitinib Tablet 250 MG Oral | Tier 5 | PA, QL | Molecular Target Inhibitors |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Orfadin Capsule 20 MG Oral
Post Date:
7/26/2023
Effective Date:
8/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Nitisinone Capsule 20 MG Oral | Tier 5 | PA | Genetic or Enzyme or Protein Disorder: Replacement, Modifiers, Treatment |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Prezista Tablet 600 MG Oral
Post Date:
8/25/2023
Effective Date:
9/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Darunavir Tablet 600 MG Oral | Tier 5 | Anti-HIV Agents, Protease Inhibitors (PI) | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Prezista Tablet 800 MG Oral
Post Date:
8/25/2023
Effective Date:
9/1/2023
Type of Change:
Drug removed
Reason Changed:
Generic therapeutically equivalent product available
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Darunavir Tablet 800 MG Oral | Tier 5 | Anti-HIV Agents, Protease Inhibitors (PI) | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||