Drug List Changes

  • Effective August 01, 2020

    Formulary Changes to the Open A1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Alvesco inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex HFA inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex Twisthaler inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Basaglar injectablePrior authorizationLantus, Levemir, Toujeo, or Tresiba
    Invokamet tabletPrior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokamet XR extended-release tabletPrior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokana tabletPrior authorizationFarxiga or Jardiance
    Kombiglyze XR extended-release tabletPrior authorizationJanumet, Janumet XR, Jentadueto, Jentadueto XR
    Onglyza tabletPrior authorizationJanuvia or Tradjenta
    Pulmicort Flexhaler inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Pulmicort Respules inhalation suspensionPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Segluromet tabletPrior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Steglatro tabletPrior authorizationFarxiga or Jardiance

    Formulary Changes to the Preferred B4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Alvesco inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex HFA inhalerMoving to a higher level; Prior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex Twisthaler inhalerMoving to a higher level; Prior authorizationArnuity Ellipta, Flovent, or Qvar
    Basaglar injectableMoving to a higher level; Prior authorizationLantus, Levemir, Toujeo, or Tresiba
    Carafate oral suspension [Change Effective July 1, 2020]Moving to a higher levelsucralfate oral suspension
    Depen tablet [Change Effective July 1, 2020]Moving to a higher levelpenicillamine tablet
    Invokamet tabletMoving to a higher level; Prior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokamet XR extended-release tabletMoving to a higher level; Prior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokana tabletMoving to a higher level; Prior authorizationFarxiga or Jardiance
    Kombiglyze XR extended-release tabletMoving to a higher level; Prior authorizationJanumet, Janumet XR, Jentadueto, Jentadueto XR
    NuvaRing contraceptive [Change Effective July 1, 2020]Moving to a higher leveletonogestrel/ethinyl estradiol contraceptive
    Onglyza tabletMoving to a higher level; Prior authorizationJanuvia or Tradjenta
    Pulmicort Flexhaler inhalerMoving to a higher level; Prior authorizationArnuity Ellipta, Flovent, or Qvar
    Pulmicort Respules inhalation suspensionPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Segluromet tabletPrior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Steglatro tabletMoving to a higher level; Prior authorizationFarxiga or Jardiance

    Formulary Changes to the E1 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Alvesco inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex HFA inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex Twisthaler inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Basaglar injectablePrior authorizationLantus, Levemir, Toujeo, or Tresiba
    Invokamet tabletPrior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokamet XR extended-release tabletPrior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokana tabletPrior authorizationFarxiga or Jardiance
    Kombiglyze XR extended-release tabletPrior authorizationJanumet, Janumet XR, Jentadueto, Jentadueto XR
    Onglyza tabletPrior authorizationJanuvia or Tradjenta
    Pulmicort Flexhaler inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Segluromet tabletPrior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Steglatro tabletPrior authorizationFarxiga or Jardiance

    Formulary Changes to the E4 Drug List

    Drug Name Description of Change Cost-effective Alternatives*
    Alvesco inhalerPrior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex HFA inhalerMoving to a higher level; Prior authorizationArnuity Ellipta, Flovent, or Qvar
    Asmanex Twisthaler inhalerMoving to a higher level; Prior authorizationArnuity Ellipta, Flovent, or Qvar
    Basaglar injectableMoving to a higher level; Prior authorizationLantus, Levemir, Toujeo, or Tresiba
    Depen tablet [Change Effective July 1, 2020]Moving to a higher levelpenicillamine tablet
    Invokamet tabletMoving to a higher level; Prior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokamet XR extended-release tabletMoving to a higher level; Prior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Invokana tabletMoving to a higher level; Prior authorizationFarxiga or Jardiance
    Kombiglyze XR extended-release tabletMoving to a higher level; Prior authorizationJanumet, Janumet XR, Jentadueto, Jentadueto XR
    NuvaRing contraceptive [Change Effective July 1, 2020]Moving to a higher leveletonogestrel/ethinyl estradiol contraceptive
    Onglyza tabletMoving to a higher level; Prior authorizationJanuvia or Tradjenta
    Pulmicort Flexhaler inhalerMoving to a higher level; Prior authorizationArnuity Ellipta, Flovent, or Qvar
    Segluromet tabletPrior authorizationSynjardy, Synjardy XR, or Xigduo XR
    Steglatro tabletMoving to a higher level; Prior authorizationFarxiga or Jardiance

    *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.