Questions about getting a COVID-19 vaccine? See the latest on our blog

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:


Atripla Tablet 600-200-300 MG Oral


Post Date:
2/1/2021
Effective Date:
2/1/2021
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
Efavirenz-Emtricitab-Tenofovir Tablet 600-200-300 MG Oral Tier 5 QL Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)
* Please reference your Evidence of Coverage for applicable cost-sharing.

Demser Capsule 250 MG Oral


Post Date:
2/1/2021
Effective Date:
2/1/2021
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
metyroSINE Capsule 250 MG Oral Tier 5 PA Cardiovascular Agents, Other
* Please reference your Evidence of Coverage for applicable cost-sharing.

Emtriva Capsule 200 MG Oral


Post Date:
2/1/2021
Effective Date:
2/1/2021
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
Emtricitabine Capsule 200 MG Oral Tier 2 QL Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)
* Please reference your Evidence of Coverage for applicable cost-sharing.

Ferriprox Tablet 500 MG Oral


Post Date:
2/1/2021
Effective Date:
2/1/2021
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
Deferiprone Tablet 500 MG Oral Tier 5 PA Electrolyte/Mineral/Metal Modifiers
* Please reference your Evidence of Coverage for applicable cost-sharing.

Kuvan Packet 100 MG Oral


Post Date:
2/1/2021
Effective Date:
2/1/2021
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
Sapropterin Dihydrochloride Packet 100 MG Oral Tier 5 PA Genetic or Enzyme or Protein Disorder: Replacement, Modifiers, Treatment
* Please reference your Evidence of Coverage for applicable cost-sharing.

Kuvan Packet 500 MG Oral


Post Date:
2/1/2021
Effective Date:
2/1/2021
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
Sapropterin Dihydrochloride Packet 500 MG Oral Tier 5 PA Genetic or Enzyme or Protein Disorder: Replacement, Modifiers, Treatment
* Please reference your Evidence of Coverage for applicable cost-sharing.

Kuvan Tablet Soluble 100 MG Oral


Post Date:
2/1/2021
Effective Date:
2/1/2021
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
Sapropterin Dihydrochloride Tablet Soluble 100 MG Oral Tier 5 PA Genetic or Enzyme or Protein Disorder: Replacement, Modifiers, Treatment
* Please reference your Evidence of Coverage for applicable cost-sharing.

MoviPrep Solution Reconstituted 100 GM Oral


Post Date:
2/1/2021
Effective Date:
2/1/2021
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
PEG-KCl-NaCl-NaSulf-Na Asc-C Solution Reconstituted 100 GM Oral Tier 2 Anti-Constipation Agents
* Please reference your Evidence of Coverage for applicable cost-sharing.

Symfi Lo Tablet 400-300-300 MG Oral


Post Date:
2/1/2021
Effective Date:
2/1/2021
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
Efavirenz-lamiVUDine-Tenofovir Tablet 400-300-300 MG Oral Tier 2 Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)
* Please reference your Evidence of Coverage for applicable cost-sharing.

Symfi Tablet 600-300-300 MG Oral


Post Date:
2/1/2021
Effective Date:
2/1/2021
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
Efavirenz-lamiVUDine-Tenofovir Tablet 600-300-300 MG Oral Tier 2 Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)
* Please reference your Evidence of Coverage for applicable cost-sharing.

Truvada Tablet 200-300 MG Oral


Post Date:
2/1/2021
Effective Date:
2/1/2021
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
Emtricitabine-Tenofovir DF Tablet 200-300 MG Oral Tier 5 QL Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)
* Please reference your Evidence of Coverage for applicable cost-sharing.

Tykerb Tablet 250 MG Oral


Post Date:
2/1/2021
Effective Date:
2/1/2021
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
Lapatinib Ditosylate Tablet 250 MG Oral Tier 5 PA Molecular Target Inhibitors
* Please reference your Evidence of Coverage for applicable cost-sharing.

Banzel Suspension 40 MG/ML Oral


Post Date:
3/1/2021
Effective Date:
3/1/2021
Type of Change:
Drug removed
Reason Changed:
Generic available
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Rufinamide Suspension 40 MG/ML Oral Tier 5 PA Sodium Channel Agents
* Please reference your Evidence of Coverage for applicable cost-sharing.

Saphris Tablet Sublingual 10 MG Sublingual


Post Date:
3/1/2021
Effective Date:
3/1/2021
Type of Change:
Drug removed
Reason Changed:
Generic available
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Asenapine Maleate Tablet Sublingual 10 MG Sublingual Tier 4 QL 2nd Generation/Atypical
* Please reference your Evidence of Coverage for applicable cost-sharing.

Saphris Tablet Sublingual 2.5 MG Sublingual


Post Date:
3/1/2021
Effective Date:
3/1/2021
Type of Change:
Drug removed
Reason Changed:
Generic available
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Asenapine Maleate Tablet Sublingual 2.5 MG Sublingual Tier 4 QL 2nd Generation/Atypical
* Please reference your Evidence of Coverage for applicable cost-sharing.

Saphris Tablet Sublingual 5 MG Sublingual


Post Date:
3/1/2021
Effective Date:
3/1/2021
Type of Change:
Drug removed
Reason Changed:
Generic available
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Asenapine Maleate Tablet Sublingual 5 MG Sublingual Tier 4 QL 2nd Generation/Atypical
* Please reference your Evidence of Coverage for applicable cost-sharing.

Alinia Tablet 500 MG Oral


Post Date:
4/1/2021
Effective Date:
4/1/2021
Type of Change:
Drug removed
Reason Changed:
Generic available
Applies To:
All Rx Plans

Alternative Drugs


Drug Tier* Drug Restrictions Therapy Class
Nitazoxanide Tablet 500 MG Oral Tier 4 QL Antiprotozoals
* Please reference your Evidence of Coverage for applicable cost-sharing.

Truvada Tablet 100-150 MG Oral


Post Date:
5/1/2021
Effective Date:
5/1/2021
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
Emtricitabine-Tenofovir DF Tablet 100-150 MG Oral Tier 5 Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)
* Please reference your Evidence of Coverage for applicable cost-sharing.

Truvada Tablet 133-200 MG Oral


Post Date:
5/1/2021
Effective Date:
5/1/2021
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
Emtricitabine-Tenofovir DF Tablet 133-200 MG Oral Tier 5 Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)
* Please reference your Evidence of Coverage for applicable cost-sharing.

Truvada Tablet 167-250 MG Oral


Post Date:
5/1/2021
Effective Date:
5/1/2021
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
Emtricitabine-Tenofovir DF Tablet 167-250 MG Oral Tier 5 Anti-HIV Agents, Nucleoside and Nucleotide Reverse Transcriptase Inhibitors (NRTI)
* Please reference your Evidence of Coverage for applicable cost-sharing.

Northera Capsule 100 MG Oral


Post Date:
6/2/2021
Effective Date:
6/2/2021
Type of Change:
Invalid Negative Change
Reason Changed:
Invalid Negative Change
Applies To:
All Rx Plans

Northera Capsule 200 MG Oral


Post Date:
6/3/2021
Effective Date:
6/3/2021
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
Droxidopa Capsule 200 MG Oral Tier 5 PA Alpha-adrenergic Agonists
* Please reference your Evidence of Coverage for applicable cost-sharing.

Northera Capsule 300 MG Oral


Post Date:
6/3/2021
Effective Date:
6/3/2021
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
Droxidopa Capsule 300 MG Oral Tier 5 PA Alpha-adrenergic Agonists
* Please reference your Evidence of Coverage for applicable cost-sharing.

Azopt Suspension 1 % Ophthalmic


Post Date:
7/1/2021
Effective Date:
7/1/2021
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
Brinzolamide Suspension 1 % Ophthalmic Tier 2 Ophthalmic Intraocular Pressure Lowering Agents, Other
* Please reference your Evidence of Coverage for applicable cost-sharing.

Lyrica CR Tablet Extended Release 24 Hour 165 MG Oral


Post Date:
7/1/2021
Effective Date:
7/1/2021
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
Pregabalin ER Tablet Extended Release 24 Hour 165 MG Oral Tier 2 QL Calcium Channel Modifying Agents
* Please reference your Evidence of Coverage for applicable cost-sharing.

Lyrica CR Tablet Extended Release 24 Hour 330 MG Oral


Post Date:
7/1/2021
Effective Date:
7/1/2021
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
Pregabalin ER Tablet Extended Release 24 Hour 330 MG Oral Tier 2 QL Calcium Channel Modifying Agents
* Please reference your Evidence of Coverage for applicable cost-sharing.

Lyrica CR Tablet Extended Release 24 Hour 82.5 MG Oral


Post Date:
7/1/2021
Effective Date:
7/1/2021
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
Pregabalin ER Tablet Extended Release 24 Hour 82.5 MG Oral Tier 2 QL Calcium Channel Modifying Agents
* Please reference your Evidence of Coverage for applicable cost-sharing.