Drug List Changes

  • Preferred B3 drug list changes effective April 1, 2023

    Drug Name Description of Change Cost-effective Alternatives
    Daliresp Tablet
    Moving to Tier 3 Roflumilast Tablet
    Denavir Cream
    Moving to Tier 3 Penciclovir Cream
    Divigel Gel Packet
    Moving To Tier 3 Estradiol Gel Packet
    Gilenya Capsule
    Moving To Tier 3 Fingolimod Capsule
    Selzentry 150 mg & 300 mg Tablet
    Moving To Tier 3 Maraviroc Tablet
    Vascepa 0.5gm Capsule
    Moving To Tier 3 Icosapent Capsule
  • M4 drug list changes effective April 1, 2023

    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