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:


Brisdelle CAPSULE 7.5 MG Oral


Post Date:
3/3/2018
Effective Date:
5/1/2018
Type of Change:
Drug removed
Reason Changed:
This brand named drug will be removed and replaced with the generic equivalent.
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
PARoxetine Mesylate CAPSULE 7.5 MG Oral Tier 2 SSRIs/ SNRIs
* Please reference your Evidence of Coverage for applicable cost-sharing.

Budesonide SUSPENSION 32 MCG/ACT Nasal


Post Date:
3/3/2018
Effective Date:
3/3/2018
Type of Change:
Drug removed - Manufacturer not contracted
Reason Changed:
This drug is not a covered benefit under Medicare part D regulations.
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Flunisolide SOLUTION 25 MCG/ACT (0.025%) Nasal Tier 2 QL, ST Anti-inflammatories, Inhaled Corticosteroids
Fluticasone Propionate SUSPENSION 50 MCG/ACT Nasal Tier 1 QL, ST Anti-inflammatories, Inhaled Corticosteroids
* Please reference your Evidence of Coverage for applicable cost-sharing.

Aczone GEL 5 % External


Post Date:
3/3/2018
Effective Date:
5/1/2018
Type of Change:
Drug removed - Deemed unsafe by FDA
Reason Changed:
This brand named drug will be removed and replaced with the generic equivalent.
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Dapsone GEL 5 % External Tier 4 Dermatological Agents
* Please reference your Evidence of Coverage for applicable cost-sharing.

Sustiva CAPSULE 50 MG Oral


Post Date:
3/3/2018
Effective Date:
5/1/2018
Type of Change:
Drug removed
Reason Changed:
This brand named drug will be removed and replaced with the generic equivalent.
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Efavirenz CAPSULE 50 MG Oral Tier 3 Anti-HIV Agents, Non-nucleoside Reverse Transcriptase Inhibitors (NNRTI)
* Please reference your Evidence of Coverage for applicable cost-sharing.

Cosmegen SOLUTION RECONSTITUTED 0.5 MG Intravenous


Post Date:
3/3/2018
Effective Date:
5/1/2018
Type of Change:
Drug removed
Reason Changed:
This brand named drug will be removed and replaced with the generic equivalent.
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
DACTINomycin SOLUTION RECONSTITUTED 0.5 MG Intravenous Tier 5 PA Antineoplastics
* Please reference your Evidence of Coverage for applicable cost-sharing.

Lexiva TABLET 700 MG Oral


Post Date:
3/3/2018
Effective Date:
5/1/2018
Type of Change:
Drug removed
Reason Changed:
This brand named drug will be removed and replaced with the generic equivalent.
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
* Please reference your Evidence of Coverage for applicable cost-sharing.

Estrace CREAM 0.1 MG/GM Vaginal


Post Date:
4/1/2018
Effective Date:
6/1/2018
Type of Change:
Drug removed
Reason Changed:
Brand drug removed from formulary and has been replaced with the generic equivalent.
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Estradiol CREAM 0.1 MG/GM Vaginal Tier 2 Estrogens
* Please reference your Evidence of Coverage for applicable cost-sharing.

Reyataz CAPSULE 150 MG Oral


Post Date:
4/1/2018
Effective Date:
6/1/2018
Type of Change:
Drug removed
Reason Changed:
Brand drug removed from formulary and has been replaced with the generic equivalent.
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Atazanavir Sulfate CAPSULE 150 MG Oral Tier 5 Anti-HIV Agents, Protease Inhibitors
* Please reference your Evidence of Coverage for applicable cost-sharing.

Reyataz CAPSULE 200 MG Oral


Post Date:
4/1/2018
Effective Date:
6/1/2018
Type of Change:
Drug removed
Reason Changed:
Brand drug removed from formulary and has been replaced with the generic equivalent.
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Atazanavir Sulfate CAPSULE 200 MG Oral Tier 5 Anti-HIV Agents, Protease Inhibitors
* Please reference your Evidence of Coverage for applicable cost-sharing.

Reyataz CAPSULE 300 MG Oral


Post Date:
4/1/2018
Effective Date:
6/1/2018
Type of Change:
Drug removed
Reason Changed:
Brand drug removed from formulary and has been replaced with the generic equivalent.
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Atazanavir Sulfate CAPSULE 300 MG Oral Tier 5 Anti-HIV Agents, Protease Inhibitors
* Please reference your Evidence of Coverage for applicable cost-sharing.

Viread TABLET 300 MG Oral


Post Date:
4/1/2018
Effective Date:
6/1/2018
Type of Change:
Drug removed
Reason Changed:
Brand drug removed from formulary and has been replaced with the generic equivalent.
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Tenofovir Disoproxil Fumarate TABLET 300 MG Oral Tier 5 Anti-hepatitis B (HBV) Agents
* Please reference your Evidence of Coverage for applicable cost-sharing.

Estrace CREAM 0.1 MG/GM Vaginal


Post Date:
5/2/2018
Effective Date:
6/1/2018
Type of Change:
Drug removed
Reason Changed:
Brand drug removed from formulary and has been replaced with the generic equivalent
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Estradiol CREAM 0.1 MG/GM Vaginal Tier 2 Estrogens
* Please reference your Evidence of Coverage for applicable cost-sharing.

Reyataz CAPSULE 150 MG Oral


Post Date:
5/2/2018
Effective Date:
6/1/2018
Type of Change:
Drug removed
Reason Changed:
Brand drug removed from formulary and has been replaced with the generic equivalent
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Atazanavir Sulfate CAPSULE 150 MG Oral Tier 5 Anti-HIV Agents, Protease Inhibitors
* Please reference your Evidence of Coverage for applicable cost-sharing.

Reyataz CAPSULE 200 MG Oral


Post Date:
5/2/2018
Effective Date:
6/1/2018
Type of Change:
Drug removed
Reason Changed:
Brand drug removed from formulary and has been replaced with the generic equivalent
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Atazanavir Sulfate CAPSULE 200 MG Oral Tier 5 Anti-HIV Agents, Protease Inhibitors
* Please reference your Evidence of Coverage for applicable cost-sharing.

Reyataz CAPSULE 300 MG Oral


Post Date:
5/2/2018
Effective Date:
6/1/2018
Type of Change:
Drug removed
Reason Changed:
Brand drug removed from formulary and has been replaced with the generic equivalent
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Atazanavir Sulfate CAPSULE 300 MG Oral Tier 5 Anti-HIV Agents, Protease Inhibitors
* Please reference your Evidence of Coverage for applicable cost-sharing.

Viread TABLET 300 MG Oral


Post Date:
5/2/2018
Effective Date:
6/1/2018
Type of Change:
Drug removed
Reason Changed:
Brand drug removed from formulary and has been replaced with the generic equivalent
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Tenofovir Disoproxil Fumarate Tablet 300 MG Oral Tier 5 Anti-hepatitis B (HBV) Agents
* Please reference your Evidence of Coverage for applicable cost-sharing.

Namenda XR CAPSULE EXTENDED RELEASE 24 HOUR 7 MG Oral


Post Date:
5/4/2018
Effective Date:
7/1/2018
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
Memantine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 7 MG Oral Tier 4 ST N-methyl-D-aspartate (NMDA) Receptor Antagonist
* Please reference your Evidence of Coverage for applicable cost-sharing.

Namenda XR CAPSULE EXTENDED RELEASE 24 HOUR 14 MG Oral


Post Date:
5/4/2018
Effective Date:
7/1/2018
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
Memantine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 14 MG Oral Tier 4 ST N-methyl-D-aspartate (NMDA) Receptor Antagonist
* Please reference your Evidence of Coverage for applicable cost-sharing.

Namenda XR CAPSULE EXTENDED RELEASE 24 HOUR 21 MG Oral


Post Date:
5/4/2018
Effective Date:
7/1/2018
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
Memantine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 21 MG Oral Tier 4 ST N-methyl-D-aspartate (NMDA) Receptor Antagonist
* Please reference your Evidence of Coverage for applicable cost-sharing.

Namenda XR CAPSULE EXTENDED RELEASE 24 HOUR 28 MG Oral


Post Date:
5/4/2018
Effective Date:
7/1/2018
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
Memantine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 28 MG Oral Tier 4 ST N-methyl-D-aspartate (NMDA) Receptor Antagonist
* Please reference your Evidence of Coverage for applicable cost-sharing.

Syprine CAPSULE 250 MG Oral


Post Date:
5/4/2018
Effective Date:
7/1/2018
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
Trientine HCl CAPSULE 250 MG Oral Tier 5 Electrolyte/Mineral/Metal Modifiers
* Please reference your Evidence of Coverage for applicable cost-sharing.

Ziagen SOLUTION 20 MG/ML Oral


Post Date:
5/4/2018
Effective Date:
7/1/2018
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
Abacavir Sulfate SOLUTION 20 MG/ML Oral Tier 4 Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)
* Please reference your Evidence of Coverage for applicable cost-sharing.

Gabitril Tablet 12 MG Oral


Post Date:
6/1/2018
Effective Date:
8/1/2018
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
TiaGABine HCl Tablet 12 MG Oral Tier 4 Gamma-aminobutyric Acid (GABA) Augmenting Agents
* Please reference your Evidence of Coverage for applicable cost-sharing.

Gabitril Tablet 16 MG Oral


Post Date:
6/1/2018
Effective Date:
8/1/2018
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
TiaGABine HCl Tablet 16 MG Oral Tier 4 Gamma-aminobutyric Acid (GABA) Augmenting Agents
* Please reference your Evidence of Coverage for applicable cost-sharing.

Norvir CAPSULE 100 MG ORAL


Post Date:
6/1/2018
Effective Date:
8/1/2018
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
Ritonavir Tablet 100 MG Oral Tier 2 Anti-HIV Agents, Protease Inhibitors
* Please reference your Evidence of Coverage for applicable cost-sharing.