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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)-4
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
19585 08/01/2019 ADCIRCA 20 MG ORAL TABLET BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT TADALAFIL 20 MG ORAL TABLET-5
19585 07/01/2019 RENAGEL 800 MG ORAL TABLET BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT SEVELAMER HCL 800 MG ORAL TABLET-2
19585 07/01/2019 MESTINON 60 MG/5 ML ORAL SYRUP BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT PYRIDOSTIGMINE BROMIDE 60 MG/5 ML ORAL SYRUP-2
19585 07/01/2019 RENAGEL 400 MG ORAL TABLET BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT SEVELAMER HCL 400 MG ORAL TABLET-2
19585 07/01/2019 TEKTURNA 300 MG ORAL TABLET BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT ALISKIREN 300 MG ORAL TABLET-2
19585 07/01/2019 RANEXA 500 MG ORAL TAB ER 12H BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT RANOLAZINE ER 500 MG ORAL TAB ER 12H-2
19585 07/01/2019 SUBOXONE 12 MG-3 MG SUBLINGUAL FILM BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT BUPRENORPHINE-NALOXONE 12 MG-3 MG SUBLINGUAL FILM-2
19585 07/01/2019 TEKTURNA 150 MG ORAL TABLET BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT ALISKIREN 150 MG ORAL TABLET-2
19585 07/01/2019 FLECTOR 1.3 % TRANSDERM. PATCH TD12 BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT DICLOFENAC EPOLAMINE 1.3 % TRANSDERM. PATCH TD12-2
19585 07/01/2019 SUBOXONE 8 MG-2 MG SUBLINGUAL FILM BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT BUPRENORPHINE-NALOXONE 8 MG-2 MG SUBLINGUAL FILM-2
19585 07/01/2019 SUBOXONE 4MG-1MG SUBLINGUAL FILM BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT BUPRENORPHINE-NALOXONE 4MG-1MG SUBLINGUAL FILM-2
19585 07/01/2019 SUBOXONE 2 MG-0.5MG SUBLINGUAL FILM BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT BUPRENORPHINE-NALOXONE 2 MG-0.5MG SUBLINGUAL FILM-2
19585 07/01/2019 RANEXA 1000 MG ORAL TAB ER 12H BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT RANOLAZINE ER 1000 MG ORAL TAB ER 12H-2
19585 07/01/2019 REMODULIN 5 MG/ML INJECTION VIAL BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT TREPROSTINIL 5 MG/ML INJECTION VIAL-5
19585 07/01/2019 REMODULIN 1 MG/ML INJECTION VIAL BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT TREPROSTINIL 1 MG/ML INJECTION VIAL-5
19585 07/01/2019 SABRIL 500 MG ORAL TABLET BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT VIGABATRIN 500 MG ORAL TABLET-5
19585 08/01/2019 SENSIPAR 30 MG ORAL TABLET BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT CINACALCET HCL 30 MG ORAL TABLET-5
19585 08/01/2019 SENSIPAR 90 MG ORAL TABLET BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT CINACALCET HCL 90 MG ORAL TABLET-5
19585 08/01/2019 SENSIPAR 60 MG ORAL TABLET BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT CINACALCET HCL 60 MG ORAL TABLET-5
19585 07/01/2019 LARTRUVO 500MG/50ML INTRAVEN. VIAL DELETION OF DRUG FROM FORMULARY REMOVAL OF DRUG FROM FORMULARY DUE TO NEW FDA WARNING
19585 07/01/2019 LARTRUVO 190MG/19ML INTRAVEN. VIAL DELETION OF DRUG FROM FORMULARY REMOVAL OF DRUG FROM FORMULARY DUE TO NEW FDA WARNING
19585 07/01/2019 REMODULIN 10 MG/ML INJECTION VIAL BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT TREPROSTINIL 10 MG/ML INJECTION VIAL-5
19585 07/01/2019 REMODULIN 2.5 MG/ML INJECTION VIAL BRAND DELETION, ADD NEWLY APPROVED GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT TREPROSTINIL 2.5 MG/ML INJECTION VIAL-5
19585 08/01/2019 CANASA 1000 MG RECTAL SUPP.RECT BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT MESALAMINE 1000 MG RECTAL SUPP.RECT-2
19585 08/01/2019 ELIDEL 1 % TOPICAL CREAM (G) BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT PIMECROLIMUS 1 % TOPICAL CREAM (G)-2
19585 09/01/2019 EXJADE 125 MG ORAL TAB DISPER BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT
19585 09/01/2019 EXJADE 500 MG ORAL TAB DISPER BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT
19585 09/01/2019 EXJADE 250 MG ORAL TAB DISPER BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT
19585 10/01/2019 LETAIRIS 10 MG ORAL TABLET BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT AMBRISENTAN 10 MG ORAL TABLET-5
19585 10/01/2019 TARCEVA 25 MG ORAL TABLET BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT ERLOTINIB HCL 25 MG ORAL TABLET-5
19585 10/01/2019 DELZICOL 400 MG ORAL CAP(DRTAB) BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT MESALAMINE DR 400 MG ORAL CAP(DRTAB)-2
19585 10/01/2019 LETAIRIS 5 MG ORAL TABLET BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT AMBRISENTAN 5 MG ORAL TABLET-5
19585 10/01/2019 TARCEVA 100 MG ORAL TABLET BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT ERLOTINIB HCL 100 MG ORAL TABLET-5
19585 10/01/2019 WELCHOL 625 MG ORAL TABLET BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT COLESEVELAM HCL 625 MG ORAL TABLET-2
19585 10/01/2019 VOLTAREN 1 % TOPICAL GEL (GRAM) BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT DICLOFENAC SODIUM 1 % TOPICAL GEL (GRAM)-2
19585 10/01/2019 TARCEVA 150 MG ORAL TABLET BRAND DELETION, ADD FRF GENERIC REMOVAL OF BRAND NAME DRUG FROM FORMULARY DUE TO ADDITION OF NEW GENERIC EQUIVALENT ERLOTINIB HCL 150 MG ORAL TABLET-5