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:
- Request for Medicare Prescription Drug Coverage Determination Form, updated 10/1/2023
Votrient Tablet 200 MG Oral
Post Date:
1/29/2024
Effective Date:
2/1/2024
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 |
|---|---|---|---|
| PAZOPanib HCl Tablet 200 MG Oral | Tier 5 | PA, QL | Molecular Target Inhibitors |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Vyvanse Capsule 10 MG Oral
Post Date:
1/29/2024
Effective Date:
2/1/2024
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 |
|---|---|---|---|
| Lisdexamfetamine Dimesylate Capsule 10 MG Oral | Tier 2 | QL | Attention Deficit Hyperactivity Disorder Agents, Amphetamines |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Vyvanse Capsule 20 MG Oral
Post Date:
1/29/2024
Effective Date:
2/1/2024
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 |
|---|---|---|---|
| Lisdexamfetamine Dimesylate Capsule 20 MG Oral | Tier 2 | QL | Attention Deficit Hyperactivity Disorder Agents, Amphetamines |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Vyvanse Capsule 30 MG Oral
Post Date:
1/29/2024
Effective Date:
2/1/2024
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 |
|---|---|---|---|
| Lisdexamfetamine Dimesylate Capsule 30 MG Oral | Tier 2 | QL | Attention Deficit Hyperactivity Disorder Agents, Amphetamines |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Vyvanse Capsule 40 MG Oral
Post Date:
1/29/2024
Effective Date:
2/1/2024
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 |
|---|---|---|---|
| Lisdexamfetamine Dimesylate Capsule 40 MG Oral | Tier 2 | QL | Attention Deficit Hyperactivity Disorder Agents, Amphetamines |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Vyvanse Capsule 50 MG Oral
Post Date:
1/29/2024
Effective Date:
2/1/2024
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 |
|---|---|---|---|
| Lisdexamfetamine Dimesylate Capsule 50 MG Oral | Tier 2 | QL | Attention Deficit Hyperactivity Disorder Agents, Amphetamines |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Vyvanse Capsule 60 MG Oral
Post Date:
1/29/2024
Effective Date:
2/1/2024
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 |
|---|---|---|---|
| Lisdexamfetamine Dimesylate Capsule 60 MG Oral | Tier 2 | QL | Attention Deficit Hyperactivity Disorder Agents, Amphetamines |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Vyvanse Capsule 70 MG Oral
Post Date:
1/29/2024
Effective Date:
2/1/2024
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 |
|---|---|---|---|
| Lisdexamfetamine Dimesylate Capsule 70 MG Oral | Tier 2 | QL | Attention Deficit Hyperactivity Disorder Agents, Amphetamines |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Zulresso Solution 100 MG/20ML Intravenous
Post Date:
1/29/2024
Effective Date:
2/1/2024
Type of Change:
Drug removed
Reason Changed:
Not a self-administered drug
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Citalopram Hydrobromide Tablet 10 MG Oral | Tier 1 | SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors) | |
| Citalopram Hydrobromide Tablet 20 MG Oral | Tier 1 | SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors) | |
| Citalopram Hydrobromide Tablet 40 MG Oral | Tier 1 | SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors) | |
| FLUoxetine HCl Capsule 10 MG Oral | Tier 1 | SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors) | |
| FLUoxetine HCl Capsule 20 MG Oral | Tier 1 | SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors) | |
| FLUoxetine HCl Capsule 40 MG Oral | Tier 1 | SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors) | |
| Sertraline HCl Tablet 100 MG Oral | Tier 1 | SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors) | |
| Sertraline HCl Tablet 25 MG Oral | Tier 1 | SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors) | |
| Sertraline HCl Tablet 50 MG Oral | Tier 1 | SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors) | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Alphagan P Solution 0.1 % Ophthalmic
Post Date:
2/22/2024
Effective Date:
3/1/2024
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 |
|---|---|---|---|
| Brimonidine Tartrate Solution 0.1 % Ophthalmic | Tier 2 | Ophthalmic Intraocular Pressure Lowering Agents, Other | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Ciprodex Suspension 0.3-0.1 % Otic
Post Date:
2/22/2024
Effective Date:
3/1/2024
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 |
|---|---|---|---|
| Ciprofloxacin-Dexamethasone Suspension 0.3-0.1 % Otic | Tier 2 | Otic Agents | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Condylox Gel 0.5 % External
Post Date:
2/22/2024
Effective Date:
3/1/2024
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 |
|---|---|---|---|
| Podofilox Gel 0.5 % External | Tier 4 | Dermatological Agents, Other | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Livalo Tablet 1 MG Oral
Post Date:
2/22/2024
Effective Date:
3/1/2024
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 |
|---|---|---|---|
| Pitavastatin Calcium Tablet 1 MG Oral | Tier 2 | QL | Dyslipidemics, HMG CoA Reductase Inhibitors |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Livalo Tablet 2 MG Oral
Post Date:
2/22/2024
Effective Date:
3/1/2024
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 |
|---|---|---|---|
| Pitavastatin Calcium Tablet 2 MG Oral | Tier 2 | QL | Dyslipidemics, HMG CoA Reductase Inhibitors |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Livalo Tablet 4 MG Oral
Post Date:
2/22/2024
Effective Date:
3/1/2024
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 |
|---|---|---|---|
| Pitavastatin Calcium Tablet 4 MG Oral | Tier 2 | QL | Dyslipidemics, HMG CoA Reductase Inhibitors |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Korlym Tablet 300 MG Oral
Post Date:
4/24/2024
Effective Date:
5/1/2024
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 |
|---|---|---|---|
| miFEPRIStone Tablet 300 MG Oral | Tier 5 | PA | Glycemic Agents |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Rectiv Ointment 0.4 % Rectal
Post Date:
5/28/2024
Effective Date:
6/1/2024
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 |
|---|---|---|---|
| Nitroglycerin Ointment 0.4 % Rectal | Tier 4 | Vasodilators, Direct-acting Arterial/ Venous | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Relyvrio Packet 3-1 GM Oral
Post Date:
5/28/2024
Effective Date:
6/1/2024
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 |
|---|---|---|---|
| Riluzole Tablet 50 MG Oral | Tier 2 | Central Nervous System, Other | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Sorine Tablet 80 MG Oral
Post Date:
5/28/2024
Effective Date:
6/1/2024
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 |
|---|---|---|---|
| Sotalol HCl (AF) Tablet 80 MG Oral | Tier 2 | Antiarrhythmics | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Exkivity Capsule 40 MG Oral
Post Date:
7/29/2024
Effective Date:
8/1/2024
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 |
|---|---|---|---|
| Tagrisso Tablet 40 MG Oral | Tier 5 | LA, PA, QL | Molecular Target Inhibitors |
| Tagrisso Tablet 80 MG Oral | Tier 5 | LA, PA, QL | Molecular Target Inhibitors |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Zejula Capsule 100 MG Oral
Post Date:
8/29/2024
Effective Date:
9/1/2024
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 |
|---|---|---|---|
| Zejula Tablet 100 MG Oral | Tier 5 | PA, QL | Molecular Target Inhibitors |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Amcinonide Cream 0.1 % External
Post Date:
8/29/2024
Effective Date:
9/1/2024
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 |
|---|---|---|---|
| Amcinonide Ointment 0.1 % External | Tier 4 | Dermatitis and Pruitus Agents | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Endari Packet 5 GM Oral
Post Date:
9/26/2024
Effective Date:
10/1/2024
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 |
|---|---|---|---|
| L-Glutamine Packet 5 GM Oral | Tier 5 | QL, ST | Genetic or Enzyme or Protein Disorder: Replacement, Modifiers, Treatment |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Isturisa Tablet 10 MG Oral
Post Date:
9/26/2024
Effective Date:
10/1/2024
Type of Change:
Drug removed
Reason Changed:
Drug discontinued from marketplace and Part D No
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Isturisa Tablet 1 MG Oral | Tier 5 | PA, QL | Hormonal Agents, Stimulant/ Replacement/ Modifying (Adrenal) |
| Isturisa Tablet 5 MG Oral | Tier 5 | PA, QL | Hormonal Agents, Stimulant/ Replacement/ Modifying (Adrenal) |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Lexiva Suspension 50 MG/ML Oral
Post Date:
9/26/2024
Effective Date:
10/1/2024
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 |
|---|---|---|---|
| Fosamprenavir Calcium Tablet 700 MG Oral | Tier 5 | Anti-HIV Agents, Protease Inhibitors (PI) | |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||
Zorbtive Solution Reconstituted 8.8 MG Subcutaneous
Post Date:
9/26/2024
Effective Date:
10/1/2024
Type of Change:
Drug removed
Reason Changed:
Drug discontinued from marketplace and Part D No
Applies To:
All Rx Plans
Alternative Drugs
| Drug | Tier* | Drug Restrictions | Therapy Class |
|---|---|---|---|
| Gattex KIT 5 MG Subcutaneous | Tier 5 | LA, PA | Gastrointestinal Agents, Other |
| * Please reference your Evidence of Coverage for applicable cost-sharing. | |||