Alinia Tablets | No longer covered | nitazoxanide tablet |
Alphagan P 0.1% | Moving to Tier 4 | brimonidine 0.15% eye drops |
Alrex | No longer covered | azelastine drops; olopatadine drops |
Azopt | No longer covered | brinzolamide eye drops |
Bepreve | No longer covered | bepotastine eye drops |
Bynfezia | No longer covered | octreotide injection |
Calcipotriene Foam | No longer covered | calcipotriene cream |
Cipro HC | No longer covered | ciprofloxacin-dexamethasone ear drops |
Ciprofloxacin/Fluocinolone Otic (Brand) | No longer covered | ciprofloxacin-dexamethasone ear drops |
clemastine syrup | No longer covered | cetirizine |
Combigan | Moving to Tier 4 | betaxolol, brimonidine, levobunolol, or timolol drops |
DDAVP injection | Moving to Tier 3 | desmopressin injection |
Deferiprone tablet | Moving to Tier 3 | consult prescriber |
Desmopressin injection | Moving to Tier 3 | consult prescriber |
Ferriprox tablet | Moving to Tier 3 | deferiprone tablet |
Intelence tablet 100 mg & 200 mg | Moving to Tier 4 | etravirine tablet 100 mg & 200 mg |
Invokamet | No longer covered | Synjardy, Synjardy XR, Xigduo XR |
Invokamet XR | No longer covered | Synjardy, Synjardy XR, Xigduo XR |
Invokana | No longer covered | Farxiga, Jardiance |
Kaletra tablet | Moving to Tier 4 | lopinavir/ritonavir tablet |
Matulane capsule | Moving to Tier 3 | consult prescriber |
Otovel | No longer covered | ciprofloxacin-dexamethasone ear drops |
Perforomist nebulizer vial | Moving to Tier 4 | formoterol nebulizer vial |
Sucraid oral solution | Moving to Tier 3 | consult prescriber |
Sutent tablet | Moving to Tier 4 | sunitinib tablet |
Testopel pellets | Moving to Tier 3 | testosterone cypionate injection |
Thyrogen vial | Moving to Tier 3 | consult prescriber |
tizanidine capsules | No longer covered | tizanidine tablet |
Xyrem oral solution | Moving to Tier 3 | consult prescriber |
Xywav oral solution | Moving to Tier 3 | consult prescriber |
Zanaflex capsule | No longer covered | tizanidine tablet |
Zerviate | No longer covered | azelastine drops; olopatadine drops |
Zykadia | Moving to Tier 4 | consult prescriber |