Drug List Changes

  • Effective September 1, 2024

    Preferred B3 drug list changes

    Drug Name Description of Change Cost-effective Alternatives
    No changes NA NA

    M4 drug list changes

    Drug Name Description of Change Cost-effective Alternatives
    Emflaza oral suspension
    		 No longer covered prednisone, deflazacort
    Folic acid 5mg capsules
    		 No longer covered folic acid tablets
    Folic acid vials
    		 No longer covered Covered under medical benefit
    Glucagon 1mg vials
    		 No longer covered glucagon 1mg emergency kit
    Nityr tablets
    		 No longer covered nitisinone capsules
    Oxistat 1% lotion
    		 No longer covered
    		 ciclopirox, clotrimazole, econazole, ketoconazole, nystatin
    R-tanna tablets
    		 No longer covered
    		 promethazine/phenylephrine
    Sulconazole 1% solution
    		 No longer covered
    		 ciclopirox, clotrimazole, econazole, ketoconazole, nystatin
    Zenzedi 2.5mg & 7.5mg tablets
    		 No longer covered
    		 dextroamphetamine tablets

    Effective October 1, 2024

    Preferred B3 drug list changes

    Drug name Description of change Cost-effective alternatives*
    Restasis Eye Drops Moving to Tier 3 cyclosporine eye drops

    M4 drug list changes

    Drug name Description of change Cost-effective alternatives*
    Akynzeo Capsules No longer covered granisetron tablets, ondansetron tablets
    Apomorphine/Apokyn Cartridges Covered under medical benefit -
    Bacitracin Vials Covered under medical benefit -
    Benztropine Ampules/Vials Covered under medical benefit -
    Bumetanide Vials Covered under medical benefit bumetanide tablets
    Buprenorphine Cartridges/Vials Covered under medical benefit -
    Carbaglu Tablets for Suspension No longer covered carglumic acid tablets
    Cefaclor ER Tablets No longer covered cefaclor capsules
    Clozapine ODT Tablets Moving to Tier 3 clozapine tablets
    Consensi Tablets No longer covered amlodipine tablets and celecoxib capsules
    Dexamethasone 1.5mg Dose Packs No longer covered dexamethasone tablets
    Emend Packets No longer covered aprepitant capsules, granisetron tablets, ondansetron tablets
    Fentanyl Ampules/Vials Covered under medical benefit -
    Fluphenazine Vials Covered under medical benefit -
    Glycopyrrolate 1.5mg Tablets No longer covered glycopyrrolate 1mg tablets
    Fosamax Plus D Tablets No longer covered alendronate tablets and vitamin D tablets
    Flurandrenolide Cream/Ointment No longer covered betamethasone, fluocinolone, triamcinolong topical products
    Hetlioz Capsules/Suspension No longer covered ramelteon tablets
    Hycodan Syrup No longer covered hydrocodone/homatropine syrup
    Ibuprofen-Famotidine Tablets No longer covered ibuprofen tablets and famotidine tablets
    Kalbitor Vials Covered under medical benefit -
    Kalydeco Packets/Tablets No longer covered Trikafta Packets/Tablets
    Ketorolac Cartridges/Vials Covered under medical benefit ketorolac tablets
    Korlym Tablets No longer covered mifepristone tablets
    Lacrisert Eye Inserts No longer covered cyclosporine eye drops
    Levorphanol Tablets No longer covered hydromorphone tablets, morphine tablets
    Lupaneta Packs No longer covered leuprolide injections and norethindrone tablets
    Luzu Cream No longer covered clotrimazole, econazole, ketoconazole, and nystatin creams
    Mesalamine Kits No longer covered mesalamine enemas
    Methadone Vials Covered under medical benefit -
    Metoclopramide ODT Tablets No longer covered metoclopramide tablets
    Metyrosine Capsules No longer covered phenoxybenzamine capsules
    Millipred Dose Packs No longer covered dexamethasone tablets
    Molindone Tablets Moving to Tier 3 olanzapine, quetiapine, and risperidone tablets
    Moxatag Tablets No longer covered amoxicillin capsules
    Myrbetriq Tablets No longer covered mirabegron tablets
    Naproxen-Esomeprazole Tablets No longer covered naproxen tablets and esomeprazole tablets
    Nicardipine Capsules Moving to Tier 3 amlodipine and nifedipine tablets
    Olanzapine Vials No longer covered risperidone ER vials
    Omeprazole-Sodium Bicarbonate Packets No longer covered omeprazole capsules
    Orphenadrine Vials Covered under medical benefit
    Oxycodone 2.5-300mg tablets No longer covered oxycodone 2.5-325mg tablets
    Prezista Tablets & Suspension No longer covered darunavir tablets
    Prochlorperazine Vials Covered under medical benefit -
    Restasis Eye Drops No longer covered cyclosporine eye drops
    Serostim Vials No longer covered Genotropin, Omnitrope
    Skyrizi Vials Covered under medical benefit Skyrizi Pens/Syringes
    Sympazan Films No longer covered clobazam tablets
    Temazepam 22.5mg Capsules No longer covered temazepam 15mg or 30mg capsules
    Trexall Tablets No longer covered methotrexate tablets
    Urelle Tablets No longer covered methenamine tablets
    Uro-SP No longer covered methenamine tablets
    Versacloz Suspension No longer covered clozapine tablets
    Xermelo Tablets No longer covered Somatuline Depot
    Zimhi Syringes No longer covered naloxone syringes