| Drug Name |
Description of Change |
Cost-effective Alternatives |
Daliresp Tablet
|
No longer covered
|
Roflumilast Tablet
|
Dexilant 60 mg capsule
|
No longer covered
|
Dexlansoprazole 60 mg Capsule
|
Denavir Cream
|
No longer covered |
Penciclovir Cream
|
Divigel Gel Packet
|
No longer covered |
Estradiol Gel Packet
|
Gilenya Capsule
|
No longer covered |
Fingolimod Capsule
|
Selzentry 150 mg & 300 mg tablet
|
No longer covered |
Maraviroc Tablet |
Suprep Bowel Prep Kit
|
No longer covered |
Sod sul-potass sul-mag sul Solution
|
Vascepa 0.5gm Capsule
|
No longer covered
|
Icosapent Capsule
|