| Drug Name |
Description of Change |
Cost-effective Alternatives |
| Acyclovir cream |
Moving to Tier 3 |
Acyclovir tablet |
| Asmanex inhaler & Asmanex HFA inhaler |
Moving to Tier 3 |
Flovent HFA inhaler |
| Beser Lotion |
No longer covered |
Fluticasone Cream |
| Betamethasone Valerate |
No longer covered |
Betamethasone Valerate Cream |
| BPO Towelette |
No longer covered |
Benzoyl Peroxide Gel |
| Clobetasol Emulsion Foam |
No longer covered |
Clobetasol Cream |
| Clobetasol Propionate Foam |
No longer covered |
Clobetasol Cream |
| Clocortolone Cream |
Moving To Tier 3 |
Fluocinolone Cream |
| Dapsone Gel and Dapsone Gel with Pump |
No longer covered |
Tretinoin Gel |
| Deferiprone tablet |
Moving to Tier 4 |
Consult doctor |
| Diflorasone cream and ointment |
No longer covered |
Betamethasone Valerate Cream |
| Dovato tablet |
Moving To Tier 3 |
Consult doctor |
| Doxycycline Hyclate Tablet |
No longer covered |
Doxycycline Monohydrate Tablet |
| Dutasteride-Tamsulosin capsule |
Moving To Tier 3 |
Tamsulosin capsule |
| Edular sublingual tablet |
No longer covered |
Zolpidem Tablet |
| Esbriet tablet 267 mg & 801 mg |
No longer covered |
Pirfenidone tablet 267 mg and 801 mg |
| Ferriprox tablet |
No longer covered |
Deferiprone tablet |
| Flurandrenolide lotion |
No longer covered |
Flurandrenolide cream |
| Fluticasone Propionate Lotion |
No longer covered |
Fluticasone Cream |
| Genvoya tablet |
Moving To Tier 3 |
Consult doctor |
| Halcinonide Cream |
No longer covered |
Betamethasone Valerate Cream |
| Hydrocortisone Lotion |
No longer covered |
Hydrocortisone Cream |
| Incruse Ellipta |
No longer covered |
Spiriva Respimat Inhaler |
| Ketoconazole Foam |
No longer covered |
Ketoconazole Cream |
| Ketodan Foam |
No longer covered |
Ketoconazole Cream |
| Menostar patch |
No longer covered |
Estradiol patch |
| Mesalamine enteric coated tablet |
Moving To Tier 3 |
Mesalamine enteric coated capsule |
| Nexavar tablet |
No longer covered |
Sorafenib tablet |
| Odefsey tablet |
Moving To Tier 3 |
Consult doctor |
| Ofloxacin tablet |
Moving To Tier |
Ciprofloxacin tablet |
| Oxycodone-Acetaminophen 2.5-300 Mg |
Moving To Tier 3 |
Oxycodone W/Acetaminophen 2.5-325 Mg |
| Paliperidone ER tablet |
Moving To Tier 3 |
Olanzapine tablet |
| Prezcobix tablet |
Moving To Tier 3 |
Consult doctor |
| Relexxii tablet |
No longer covered |
Methylphenidate ER capsule or tablet |
| Samsca Tablet |
No longer covere> |
Tolvaptan tablet |
| Scalacort lotion |
No longer covered |
Hydrocortisone Cream |
| Selenium Sulfide 2.3% Shampoo |
No longer covered |
Selenium Sulfide 2.25% Shampo> |
| Targretin gel |
No longer covered |
Bexarotene gel |
| Toviaz tablet |
No longer covered |
Fesoterodine tablet |
| Triamcinolone acetonide ointment |
No longer covered |
Triamcinolone acetonide cream |
| Triumeq tablet |
Moving To Tier 3 |
Consult doctor |
| Vimpat oral solution |
No longer covered |
Lacosamide oral solution |
| Zyflo Tablet |
No longer covered |
Zileuton Er Tablet |