| Drug Name |
Description of Change |
Cost-effective Alternatives |
| Aczone 7.5% gel |
No longer covered |
tretinoin gel |
| Apidra vial |
No longer covered |
Novolog vial |
| Apidra Solostar pen |
No longer covered |
Novolog pen |
| Atripla tablet |
No longer covered |
Consult a doctor |
| Benzoyl peroxide wash |
No longer covered |
benzepro topical towelette |
| Ciprodex ear drops |
No longer covered |
ciprofloxacin/dexamethasone ear drops |
| Colcrys tablet |
No longer covered |
colchicine tablet |
| Delstrigo tablet |
No longer covered |
Consult doctor |
| Demser capsule |
No longer covered |
metyrosine capsule |
| Emtriva capsule |
No longer covered |
emtricitabine capsule |
| Finacea 15% foam |
No longer covered |
azelaic acid 15% gel |
| Firdapse tablet |
No longer covered |
Ruzurgi tablet |
| Jadenu Sprinkle oral granules |
No longer covered |
deferasirox oral granules |
| Moviprep oral solution |
No longer covered |
polyethylene glycol oral solution |
| Mycophenolate suspension |
No longer covered |
mycophenolate capsule or mycophenolate tablet |
| Neulasta syringe |
No longer covered |
Udenyca syringe or Ziextenzo syringe |
| Nucynta tablet |
No longer covered |
Consult doctor |
| Praluent syringe |
No longer covered |
Repatha syringe |
| Pentasa capsule |
No longer covered |
mesalamine extended-release capsule |
| Proair Respiclick inhaler |
No longer covered |
albuterol HFA inhaler |
| Proctofoam-HC foam |
No longer covered |
hydrocortisone/pramoxine cream |
| Procysbi delayed-release capsule |
No longer covered |
Cystagon capsule |
| Procysbi delayed-release granules |
No longer covered |
Cystagon capsule |
| Qbrexza cloth |
No longer covered |
Drysol solution |
| Sulconazole cream |
No longer covered |
ketoconazole cream |
| Sulconazole solution |
No longer covered |
ketoconazole cream |
| Sulfacetamide/sulfur topical |
No longer covered |
metronidazole gel and azelaic acid gel |
| Tavalisse tablet |
No longer covered |
Promacta tablet or Doptelet tablet |
| Transderm Scop patch |
No longer covered |
scopolamine patch |
| Ventolin HFA inhaler |
No longer covered |
albuterol HFA inhaler |
| Zelapar orally disintegrating tablet |
No longer covered |
rasagiline tablet |