Drug List Changes

  • Effective July 1, 2025

    Preferred B3 drug list changes

    Drug Name Description of Change Cost-effective Alternatives
    ANDROGEL 1.62% (1.25G) GEL PACKETS Moving to Tier 3 testosterone 1.62% (1.25 g) packets
    BETIMOL 0.5% EYE DROPS Moving to Tier 3 timolol 0.5% eye drops
    ELIGARD SYRINGE KITS No longer covered Covered under medical benefit only.
    HUMIRA (ALL STRENGTHS & DOSAGE FORMS) Moving to Tier 3 adalimumab-adaz, adalimumab-adbm, adalimumab-ryvk, Cyltezo, Simlandi
    HYCODAN 5 MG-1.5 MG/5 ML SOLUTION Moving to Tier 3 hydrocodone/homatropine solution, promethazine/codeine syrup, promethazine/DM syrup
    LEUPROLIDE DEPOT No longer covered Covered under medical benefit only.
    LUPRON DEPOT/LUPRON DEPOT-PED No longer covered Covered under medical benefit only.
    NEXIUM 2.5 MG & 5 MG PACKETS Moving to Tier 3 omeprazole capsules, esomeprazole packets
    NYVEPRIA 6 MG/0.6 ML SYRINGES Moving to Tier 3 Fulphila, Udenyca
    PRIMAQUINE 26.3 MG TABLETS (BRAND) Moving to Tier 3 primaquine 26.3mg tablets (generic)
    VICTOZA 2-PAK & 3-PAK PENS Moving to Tier 3 liraglutide 2-pak & 3-pak pens

    M4 drug list changes

    Drug Name Description of Change Cost-effective Alternatives
    BETIMOL 0.5% EYE DROPS No longer covered timolol 0.5% eye drops
    ELIGARD SYRINGE KITS No longer covered Covered under medical benefit only.
    HUMIRA (ALL STRENGTHS & DOSAGE FORMS) No longer covered adalimumab-adaz, adalimumab-adbm, adalimumab-ryvk, Cyltezo, Simlandi
    LEUPROLIDE DEPOT No longer covered Covered under medical benefit only.
    LUPRON DEPOT/LUPRON DEPOT-PED No longer covered Covered under medical benefit only.
    MESNEX TABLETS No longer covered mesna tablets
    NYVEPRIA 6 MG/0.6 ML SYRINGES No longer covered Fulphila, Udenyca
    PRADAXA PELLET PACKS Moving to Tier 4 dabigatran capsules
    PRIMAQUINE 26.3 MG TABLETS (BRAND) No longer covered primaquine 26.3mg tablets (generic)
    VICTOZA 2-PAK & 3-PAK PENS No longer covered liraglutide 2-pak & 3-pak pens

    Effective April 1, 2025

    Preferred B3 drug list changes

    Drug Name Description of Change Cost-effective Alternatives
    ANALPRAM-HC 2.5 %-1 % CREAM Moving to Tier 3 hydrocortisone-pramoxine 2.5%-1% cream
    SPRYCEL TABLETS Moving to Tier 3 dasatinib tablets

    M4 drug list changes

    Drug Name Description of Change Cost-effective Alternatives
    isotretinoin capsules (select NDCs) No longer covered Accutane, Amnesteem, Claravis, Zenatane
    MIPLYFFA CAPSULES No longer covered AQNEURSA PACKETS
    PONVORY TABLETS No longer covered fingolimod capsules, dimethyl fumarate capsules
    SPRYCEL TABLETS No longer covered dasatinib tablets

    Effective March 1, 2025

    No changes