Preferred Drug List Changes July 2019 (Internal)

Drug name & route of administration	Members	Current Status	New Status	Preferred Alternative(s)	Communications	Notes
albuterol HFA inhaler	6,019	F	F-PA	Ventolin HFA, Proventil HFA, and Proair HFA	Members only	Generic equivalent (don’t need new Rx). Member co-pays may increase.
Basaglar injectable	1,408	F	F-PA	Lantus	Members only	May need new Rx, but standing orders are common
fluticasone/ salmeterol (generic AirDuo) inhaler	710	F	F-PA	Advair Diskus, Advair HFA, Dulera, and Symbicort	Providers and members	Needs new Rx. Member co-pays may increase.
fluticasone/ salmeterol (generic Advair Diskus) inhaler	279	F	F-PA	Advair Diskus	Members only	Generic equivalent (don’t need new Rx). Member co-pays may increase.
diclofenac gel topical	593	F	F-PA	Voltaren gel	Members only	Generic equivalent (don’t need new Rx). Member co-pays may increase.
guanfacine ER oral	547	F-QL	F-PA	Intuniv	Members only	Generic equivalent (don’t need new Rx). Member co-pays may increase.
Lyrica oral	507	F-ST-QL	F-PA	gabapentin, duloxetine, and Savella	Providers and members	Needs new Rx.
Humalog 100 unit pen injectable	282	F	F-PA	generic Humalog	None	this is a new generic equivalent, positive for member co-pays.
Humalog cartridge, 200 unit pen, 75-25 Mix, 50-50 Mix, HF pen injectable	92	F	F-PA	Novolog	Members only	May need new Rx, but standing orders are common
Admelog pen injectable	25	F	F-PA	Novolog	Members only	May need new Rx, but standing orders are common
Admelog vial injectable	4	F	F-PA	Novolog and Humalog vial	Members only	May need new Rx, but standing orders are common
Humulin NPH pen injectable	50	F	F-PA	Novolin	Members only	May need new Rx, but standing orders are common
Humulin 500 pen injectable	16	F	F-PA	Humulin vial and Novolin pen	Providers and members	Needs new Rx.
Qvar inhaler	466	F	F-PA	Asmanex, Flovent Diskus, Flovent HFA, and Pulmicort	Providers and members	Needs new Rx.
Trulicity injectable	291	F-QL	F-PA	Bydureon, Byetta, and Victoza	Providers and members	Needs new Rx.
Ozempic injectable	88	F-QL	F-PA	Bydureon, Byetta, and Victoza	Providers and members	Needs new Rx.
methylphenidate (generic Metadate CD) oral	231	F-QL	F-PA	Metadate CD	Members only	Generic equivalent (don’t need new Rx). Member co-pays may increase.
Methylphenidate (generic Ritalin LA) oral	85	F-QL	F-PA	Ritalin LA	Members only	Generic equivalent (don’t need new Rx). Member co-pays may increase.
Methylphenidate (Quillivant and Quillichew) oral	23	F-QL	F-PA	Metadate CD, Concerta, and Ritalin LA	Providers and members	Needs new Rx.
Incruse inhaler	259	F	F-PA	Spiriva and Tudorza	Providers and members	Needs new Rx.
Anoro inhaler	57	F	F-PA	Stiolto	Providers and members	Needs new Rx.
adapalene gel & cream topical	253	F	F-PA	Differin	Members only	Generic equivalent (don’t need new Rx). Member co-pays may increase.
azelastine eye drops ophthalmic	253	F	F-PA	ketotifen OTC and olopatadine	Providers and members	Need new Rx
desvenlafaxine oral	216	F	F-PA	venlafaxine	Providers and members	Need new Rx
tacrolimus ointment topical	205	F	F-PA	Protopic	Members only	Generic equivalent (don’t need new Rx). Member co-pays may increase.
True Metrix glucose test strips	~200	Covered	Not covered	Accu-Chek and Contour test strips	Members only	May need new Rx, but standing orders are common Will also need new glucose testing meters
Nicotrol oral, transdermal	150	F	F-PA	Nicotine gum, nicotine lozenge, and nicotine patch	Providers and members	Need new Rx
Dexmethylphenidate XR oral	171	F	F-PA	Focalin XR	Members only	Generic equivalent (don’t need new Rx). Member co-pays may increase.
Eliquis oral	119	F	F-PA	Pradaxa and Xarelto	Providers and members	Need new Rx
esomeprazole oral	102	F	F-PA	Omeprazole and pantoprazole	Providers and members	Need new Rx
moxifloxacin oral	7	F	F-PA	levofloxacin	Providers and members	Need new Rx. Limited mailing, for chronic use (n=1).
moxifloxacin eye drops ophthalmic	94	F	F-PA	Ciprofloxacin, and ofloxacin, and Vigamox	none	these are acute-use medications.
irbesartan oral	51	F	F-PA	Losartan and valsartan	Providers and members	Need new Rx
irbesartan/ HCTZ oral	9	F	F-PA	Losartan HCTZ and valsartan HCTZ	Providers and members	Need new Rx
olmesartan oral	17	F	F-PA	Losartan and valsartan	Providers and members	Need new Rx
olmesartan/ HCTZ oral	7	F	F-PA	Losartan HCTZ and valsartan HCTZ	Providers and members	Need new Rx
Valsartan/ sacubitril (Entresto) oral	28	F	F-PA	See the web	Providers and members	Need new Rx
modafinil oral	63	F	F-PA	Provigil	Members only	Generic equivalent (don’t need new Rx). Member co-pays may increase.
armodafinil oral	44	F	F-PA	Provigil	Providers and members	Need new Rx. Member co-pays may increase.
others