Drug List Changes

  • M4 Drug List Changes Effective January 1, 2020

    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