Drug List Changes

  • Preferred B3 drug list changes effective July 1, 2022

    Drug Name Description of Change Cost-effective Alternatives
    Cycloset 0.8 Mg Tablet Moving to Tier 3 meformin, glimperide, glipizide, or glyburide
    Exelderm 1 % Cream Moving to Tier 3 ciclopirox cream
    Exelderm 1 % Topical Solution Moving to Tier 3 ciclopirox topical solution
    Fenofibrate 150 Mg Capsule Brand Moving to Tier 3 fenofibrate generic
    Fenofibrate 160 Mg Tablet Brand Moving to Tier 3 fenofibrate generic
    Methylphenidate Er 72 Mg Tablet Brand Moving to Tier 3 methylphenidate generic
    Multaq Tablet Moving to Tier 3 amiodarone, dofetilide, flecainide, propafenone, or sotalol
    Narcan Nasal Spray Moving to Tier 3 naloxone nasal spray
    Noritate 1 % Cream Moving to Tier 3 metronidazole cream
    Plexion 9.8%-4.8% Cleanser Moving to Tier 3 sulfacetamide-sulfur cleanser
    Plexion 9.8%-4.8% Cream Moving to Tier 3 sulfacetamide-sulfur cream
    Plexion 9.8%-4.8% Lotion Moving to Tier 3 sulfacetamide-sulfur lotion
    Selrx 2.3 % Shampoo Moving to Tier 3 selenium sulfide shampoo
    Tazorac 0.05 % Cream And Gel Moving to Tier 3 tazarotene cream
    Tazorac 0.1 % Gel Moving to Tier 3 tazarotene cream
    Testosterone 50 Mg (1%) Gel In Packet Brand Moving to Tier 3 testosterone gel generic
    Theo-24 Capsule Moving to Tier 3 theophylline anhydrous ER tablet
    Trezix Capsule Moving to Tier 3 acetaminophen-caffeine-dihydrocodeine capsule
  • M4 drug list changes effective July 1, 2022

    Drug Name Description of Change Cost-effective Alternatives
    Cloderm Cream No longer covered clocortolone pivalate cream
    Fenofibrate 150 Mg Capsule Brand Moving to Tier 3 fenofibrate generic
    Fenofibrate 160 Mg Tablet Brand Moving to Tier 3 fenofibrate generic
    Ferriprox tablet No longer covered deferiprone tablet
    Narcan nasal spray No longer covered naloxone nasal spray