Drug List Changes

Effective July 01, 2019

Formulary Changes to the Preferred B2 Drug List

Drug Name	Description of Change	Cost-effective Alternatives*
Advair Diskus inhaler	No longer covered	fluticasone-salmeterol inhaler
Emend capsule	No longer covered	aprepitant capsule
Fareston tablet	No longer covered	toremifene tablet
Mestinon syrup	No longer covered	pyridostigmine syrup
Renagel tablet	No longer covered	sevelamer hydrochloride tablet
Sensipar tablet	No longer covered	cinacalcet tablet
Suboxone film	No longer covered	buprenorphine/naloxone film
Zovirax 5% cream	No longer covered	acyclovir 5% cream

Formulary Changes to the Preferred B3 and B4 Drug Lists

Drug Name	Description of Change	Cost-effective Alternatives*
Advair Diskus inhaler	Moving to a higher level	fluticasone-salmeterol inhaler
Emend capsule	Moving to a higher level	aprepitant capsule
Fareston tablet	Moving to a higher level	toremifene tablet
Mestinon syrup	Moving to a higher level	pyridostigmine syrup
Renagel tablet	Moving to a higher level	sevelamer hydrochloride tablet
Sensipar tablet	Moving to a higher level	cinacalcet tablet
Suboxone film	Moving to a higher level	buprenorphine/naloxone film
Zovirax 5% cream	Moving to a higher level	acyclovir 5% cream

Formulary Changes to the E4 Drug List

Drug Name	Description of Change	Cost-effective Alternatives*
Advair Diskus inhaler	Moving to a higher level	fluticasone-salmeterol inhaler
Emend capsule	Moving to a higher level	aprepitant capsule
Fareston tablet	Moving to a higher level	toremifene tablet
Mestinon syrup	Moving to a higher level	pyridostigmine syrup
Suboxone film	Moving to a higher level	buprenorphine/naloxone film

Formulary Changes to the M1, M2 and M4 (2019) Drug Lists

Drug Name	Description of Change	Cost-effective Alternatives*
Advair Diskus inhaler	No longer covered	fluticasone-salmeterol inhaler
Emend capsule	No longer covered	aprepitant capsule
Fareston tablet	No longer covered	toremifene tablet
Mestinon syrup	No longer covered	pyridostigmine syrup
Ranexa extended-release tablet	No longer covered	ranolazine extended-release tablet
Rapamune solution	No longer covered	sirolimus solution
Remodulin vial	No longer covered	treprostinil vial
Renagel tablet	No longer covered	sevelamer hydrochloride tablet
Sabril tablet	No longer covered	vigabatrin tablet
Sensipar tablet	No longer covered	cinacalcet tablet
Suboxone film	No longer covered	buprenorphine/naloxone film
Tekturna tablet	No longer covered	aliskiren tablet

Formulary Changes to the M1, M2 and M4 (2018) Drug Lists

Drug Name	Description of Change	Cost-effective Alternatives*
Advair Diskus inhaler	No longer covered	fluticasone-salmeterol inhaler
Emend capsule	No longer covered	aprepitant capsule
Fareston tablet	No longer covered	toremifene tablet
Mestinon syrup	No longer covered	pyridostigmine syrup
Ranexa extended-release tablet	No longer covered	ranolazine extended-release tablet
Rapamune solution	No longer covered	sirolimus solution
Remodulin vial	No longer covered	treprostinil vial
Renagel tablet	No longer covered	sevelamer hydrochloride tablet
Sabril tablet	No longer covered	vigabatrin tablet
Sensipar tablet	No longer covered	cinacalcet tablet
Solodyn extended-release tablet	No longer covered	minocycline extended-release tablet
Suboxone film	No longer covered	buprenorphine/naloxone film
Tekturna tablet	No longer covered	aliskiren tablet
Zovirax 5% cream	No longer covered	acyclovir 5% cream

Formulary Changes to the Select C4 Drug List

Drug Name	Description of Change	Cost-effective Alternatives*
Advair Diskus inhaler	Moving to a higher level	fluticasone-salmeterol inhaler
Fareston tablet	Moving to a higher level	toremifene tablet

*These drugs have been selected by an independent group of experts made up of doctors and pharmacists. This group reviews drugs to see how well they work relative to their cost. They also compare their effectiveness to similar drugs used to treat the same condition. Please talk with your doctor to see if these new options are right for you.