Drug List Changes

  • M4 Drug List Changes Effective August 1, 2020

    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