| Drug Name |
Description of Change |
Cost-effective Alternatives |
| Amicar solution |
Moving to a higher level |
aminocaproic acid solution |
| Diastat kit |
Moving to a higher level |
diazepam kit |
| Dyrenium capsule |
Moving to a higher level |
triamterene capsule |
| Ery-Tab 500 mg delayed-release tablet |
Moving to a higher level |
erythromycin base 500 mg delayed-release tablet |
| Firazyr syringe |
No longer covered |
icatibant syringe |
| Lyrica capsule |
Moving to a higher level |
pregabalin capsule |
| Lyrica solution |
No longer covered |
pregabalin solution |
| Noxafil delayed-release tablet |
No longer covered |
posaconazole delayed-release tablet |
| Orfadin 2 mg, 5 mg, 10 mg capsules |
Moving to a higher level |
nitisinone 2 mg, 5 mg, 10 mg capsules |
| Rozerem tablet |
No longer covered |
ramelteon tablet |