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Formulary Change(s)


CMS Formulary ID Effective Date Drug Name Change Description Reason Description Alternate Drugs And Tier
19585 06/01/2019 ZOVIRAX 5 % TOPICAL CREAM (G) BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT ACYCLOVIR 5 % TOPICAL CREAM (G)-5
19585 06/01/2019 FARESTON 60 MG ORAL TABLET BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT TOREMIFENE CITRATE 60 MG ORAL TABLET-5
19585 06/01/2019 RAPAMUNE 1 MG/ML ORAL SOLUTION BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT SIROLIMUS 1 MG/ML ORAL SOLUTION-5
19585 05/01/2019 INVANZ 1 G INJECTION VIAL BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT ERTAPENEM 1 G INJECTION VIAL-2
19585 05/01/2019 CIALIS 2.5 MG ORAL TABLET BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT TADALAFIL 2.5 MG ORAL TABLET-2
19585 05/01/2019 CIALIS 5 MG ORAL TABLET BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT TADALAFIL 5 MG ORAL TABLET-2
19585 05/01/2019 SPORANOX 10 MG/ML ORAL SOLUTION BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT ITRACONAZOLE 10 MG/ML ORAL SOLUTION-3
19585 05/01/2019 TORISEL FDN 30MG/3 INTRAVEN. VIAL BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT TEMSIROLIMUS FDN 30MG/3 INTRAVEN. VIAL-5
19585 05/01/2019 ONFI 2.5 MG/ML ORAL ORAL SUSP BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT CLOBAZAM 2.5 MG/ML ORAL ORAL SUSP-2
19585 05/01/2019 ONFI 20 MG ORAL TABLET BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT CLOBAZAM 20 MG ORAL TABLET-2
19585 05/01/2019 ONFI 10 MG ORAL TABLET BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT CLOBAZAM 10 MG ORAL TABLET-2
19585 05/01/2019 ANDROGEL 1.25G-1.62 TRANSDERM. GEL PACKET BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT TESTOSTERONE 1.25G-1.62 TRANSDERM. GEL PACKET-2
19585 05/01/2019 ANDROGEL 2.5G-1.62% TRANSDERM. GEL PACKET BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT TESTOSTERONE 2.5G-1.62% TRANSDERM. GEL PACKET-2
19585 05/01/2019 ANDROGEL 20.25/1.25 TRANSDERM. GEL MD PMP BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT TESTOSTERONE 20.25/1.25 TRANSDERM. GEL MD PMP-2
19585 05/01/2019 ALBENZA 200 MG ORAL TABLET BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT ALBENDAZOLE 200 MG ORAL TABLET-5
19585 05/01/2019 AMPYRA 10 MG ORAL TAB ER 12H BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT DALFAMPRIDINE ER 10 MG ORAL TAB ER 12H-5