| Drug Name |
Description of Change |
Cost-effective Alternatives |
| Alvesco inhaler |
Prior authorization |
Arnuity Ellipta, Flovent, or Qvar |
| Asmanex HFA inhaler |
No longer covered |
Arnuity Ellipta, Flovent, or Qvar |
| Asmanex Twisthaler inhaler |
No longer covered |
Arnuity Ellipta, Flovent, or Qvar |
| Basaglar injectable |
No longer covered |
Lantus, Levemir, Toujeo, or Tresiba |
| Carafate oral suspension [Change Effective July 1, 2020] |
No longer covered |
sucralfate oral suspension |
| Depen tablet [Change Effective July 1, 2020] |
No longer covered |
penicillamine tablet |
| Invokamet tablet |
No longer covered |
Synjardy, Synjardy XR, or Xigduo XR |
| Invokamet XR extended-release tablet |
No longer covered |
Synjardy, Synjardy XR, or Xigduo XR |
| Invokana tablet |
No longer covered |
Farxiga or Jardiance |
| Jadenu tablet [Change Effective July 1, 2020] |
No longer covered |
deferasirox tablet |
| Kombiglyze XR extended-release tablet |
No longer covered |
Janumet, Janumet XR, Jentadueto, Jentadueto XR |
| Moxeza eye drops [Change Effective July 1, 2020] |
No longer covered |
moxifloxacin eye drops |
| NuvaRing contraceptive [Change Effective July 1, 2020] |
No longer covered |
etonogestrel/ethinyl estradiol contraceptive |
| Onglyza tablet |
No longer covered |
Januvia or Tradjenta |
| Pulmicort Flexhaler inhaler |
No longer covered |
Arnuity Ellipta, Flovent, or Qvar |
| Steglatro tablet |
No longer covered |
Farxiga or Jardiance |
| Travatan Z eye drops [Change Effective July 1, 2020] |
No longer covered |
travoprost eye drops |
| Zohydro extended-release capsule [Change Effective July 1, 2020] |
No longer covered |
hydrocodone extended-release capsule |