JADENU SPRKL GRA 360MG NF 2 Formulary Enhancement N/A JADENU SPRKL GRA 90MG NF 2 Formulary Enhancement N/A LIDOCAINE INJ 0.5% NF 1 Formulary Enhancement N/A Lynparza TAB 100 MG NF 2 + PA2 + LA Formulary Enhancement N/A Lynparza TAB 150 MG NF 2 + PA2 + LA Formulary Enhancement N/A Mavyret TAB 100-40 MG NF 2 + PA1 Formulary Enhancement N/A MEROPENEM INJ 1GM NF 1 Formulary Enhancement N/A MOXIFLOXACIN SOL 0.5% NF 1 Formulary Enhancement N/A Nerlynx TAB 40 MG NF 2 + PA2 + LA Formulary Enhancement N/A Ondansetron HCl TAB 4 MG 1 + QL 60 + BD 1 + QL 90 + BD Formulary Enhancement N/A Ondansetron HCl TAB 8 MG 1 + QL 60 + BD 1 + QL 90 + BD Formulary Enhancement N/A Ondansetron TAB DISPERSIBLE 4 MG 1 + QL 60 + BD 1 + QL 90 + BD Formulary Enhancement N/A Ondansetron TAB DISPERSIBLE 8 MG 1 + QL 60 + BD 1 + QL 90 + BD Formulary Enhancement N/A ORFADIN CAP 20MG NF 2 Formulary Enhancement N/A Radicava SOL 30 MG/100ML IV NF 2 + PA1 Formulary Enhancement N/A SYNDROS SOL 5MG/ML NF 2 + QL 120 + BD Formulary Enhancement N/A Vigabatrin PACK 500 MG NF 2 + LA Formulary Enhancement N/A Vyxeos SUSP RECON 100-44 MG IV NF 2 + PA2 Formulary Enhancement N/A XATMEP SOL 2.5MG/ML NF 2 + BD Formulary Enhancement N/A Zytiga TAB 500 MG NF 2 + PA2 Formulary Enhancement N/A EFFECTIVE 03/01/2018
Ethynodiol Diac-Eth Estradiol TABLET 1-35 MG-MCG Oral NF 1 Formulary Enhancement N/A Fosamprenavir Calcium TABLET 700 MG Oral NF 1 Formulary Enhancement N/A Glatiramer Acetate Solution Prefilled Syringe 20 MG/ML Subcutaneous NF 2 + PA1 Formulary Enhancement N/A Glatiramer Acetate Solution Prefilled Syringe 40 MG/ML Subcutaneous NF 2 + PA1 Formulary Enhancement N/A Gocovri CAPSULE EXTENDED RELEASE 24 HOUR 137 MG Oral NF 2 + PA1 Formulary Enhancement N/A Gocovri CAPSULE EXTENDED RELEASE 24 HOUR 68.5 MG Oral NF 2 + PA1 Formulary Enhancement N/A Haloperidol Decanoate SOLUTION 100 MG/ML Intramuscular 1 ML NF 1 Formulary Enhancement N/A Havrix SUSPENSION 1440 EL U/ML Intramuscular (prefilled syringe) NF 2 Formulary Enhancement N/A Havrix SUSPENSION 720 EL U/0.5ML Intramuscular (prefilled syringe) NF 2 Formulary Enhancement N/A Juluca TABLET 50-25 MG Oral NF 2 Formulary Enhancement N/A Kadcyla SOLUTION RECONSTITUTED 160 MG Intravenous NF 2 Formulary Enhancement N/A Klor-Con PACKET 20 MEQ Oral NF 1 Formulary Enhancement N/A Lartruvo SOLUTION 190 MG/19ML Intravenous NF 2 + PA2 Formulary Enhancement N/A Levonorgest-Eth Est & Eth Est TABLET 42-21-21-7 DAYS Oral NF 1 Formulary Enhancement N/A Levo-T TABLET 100 MCG ORAL NF 1 Formulary Enhancement N/A
Opdivo SOLUTION 100 MG/10ML Intravenous NF 2 + PA2 Formulary Enhancement N/A Oseltamivir Phosphate SUSPENSION RECONSTITUTED 6 MG/ML Oral NF 1 Formulary Enhancement N/A Oxaliplatin SOLUTION RECONSTITUTED 100 MG Intravenous NF 1 + BD Formulary Enhancement N/A PARoxetine Mesylate CAPSULE 7.5 MG Oral NF 1 Formulary Enhancement N/A PEG 3350/Electrolytes SOLUTION RECONSTITUTED 240 GM ORAL NF 1 Formulary Enhancement N/A Phrenilin Forte CAPSULE 50-300-40 MG Oral NF 1 Formulary Enhancement N/A Piperacillin Sod-Tazobactam So SOLUTION RECONSTITUTED 2.25 (2-0.25) GM Intravenous NF 1 Formulary Enhancement N/A Primsol SOL 50 MG/5ML 2 NF CMS Required Deletion N/A Rexulti TABLET 0.25 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rexulti TABLET 0.5 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rexulti TABLET 1 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rexulti TABLET 2 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rexulti TABLET 3 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rexulti TABLET 4 MG ORAL 2 + PA2 2 Formulary Enhancement N/A Rituxan SOLUTION 100 MG/10ML Intravenous NF 2 Formulary Enhancement N/A Scopolamine Patch 72 Hour 1 MG/3DAYS Transdermal NF 1 Formulary Enhancement N/A
Zenchent FE TAB CHEWABLE 0.4-35 MG-MCG 1 NF CMS Required Deletion N/A Zenpep CAPSULE DELAYED RELEASE PARTICLES UNIT Oral NF 2 Formulary Enhancement N/A EFFECTIVE 04/01/2018 Altavera TABLET 0.15-30 MG-MCG ORAL NF 1 Formulary Enhancement N/A Alunbrig TABLET 180 MG Oral NF 2 + PA2 Formulary Enhancement N/A Alunbrig TABLET 90 MG Oral NF 2 + PA2 Formulary Enhancement N/A Alunbrig Tablet Therapy Pack 90 & 180 MG Oral NF 2 + PA2 Formulary Enhancement N/A Atazanavir Sulfate CAPSULE 150 MG Oral NF 1 Formulary Enhancement N/A Atazanavir Sulfate CAPSULE 200 MG Oral NF 1 Formulary Enhancement N/A Atazanavir Sulfate CAPSULE 300 MG Oral NF 1 Formulary Enhancement N/A Calcipotriene CREAM 0.005 % EXTERNAL NF 1 Formulary Enhancement N/A Calcipotriene OINTMENT 0.005 % EXTERNAL NF 1 Formulary Enhancement N/A Carvedilol Phosphate ER CAPSULE EXTENDED RELEASE 24 HOUR 10 MG Oral NF 1 Formulary Enhancement N/A Carvedilol Phosphate ER CAPSULE EXTENDED RELEASE 24 HOUR 20 MG Oral NF 1 Formulary Enhancement N/A
Carvedilol Phosphate ER CAPSULE EXTENDED RELEASE 24 HOUR 40 MG Oral NF 1 Formulary Enhancement N/A Doripenem SOLUTION RECONSTITUTED 500 MG Intravenous NF 2 Formulary Enhancement N/A Eliquis Starter Pack TABLET 5 MG Oral NF 2 Formulary Enhancement N/A Enskyce TABLET 0.15-30 MG-MCG ORAL NF 1 Formulary Enhancement N/A Estradiol CREAM 0.1 MG/GM Vaginal NF 1 Formulary Enhancement N/A Herceptin SOLUTION RECONSTITUTED 150 MG Intravenous NF 2 + BD Formulary Enhancement N/A Kurvelo TABLET 0.15-30 MG-MCG ORAL NF 1 Formulary Enhancement N/A Levalbuterol HCl Nebulization Solution 0.63 MG/3ML Inhalation NF 1 + BD Formulary Enhancement N/A Levocetirizine Dihydrochloride TABLET 5 MG Oral NF 1 Formulary Enhancement N/A Levonorgestrel-Ethinyl Estrad TABLET 0.15-30 MG-MCG ORAL NF 1 Formulary Enhancement N/A Lidocaine Viscous SOLUTION 2 % Mouth/Throat NF 1 Formulary Enhancement N/A MedroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular NF 1 Formulary Enhancement N/A Roweepra XR Tablet Extended Release 24 Hour 500 MG Oral NF 1 Formulary Enhancement N/A
Cancidas SOLUTION RECONSTITUTED 70 MG Intravenous 2 NF Formulary Update caspofungin acetate 70 mg, 2 Copaxone Solution Prefilled Syringe 20 MG/ML Subcutaneous 2 + PA1 NF Formulary Update glatiramer acetate 20 mg/ml, 2 + PA1 Copaxone Solution Prefilled Syringe 40 MG/ML Subcutaneous 2 + PA1 NF Formulary Update glatiramer acetate 40 mg/ml, 2 + PA1 Cosmegen SOLUTION RECONSTITUTED 0.5 MG Intravenous 2 + BD NF Formulary Update dactinomycin 0.5 mg, 1 + BD Didanosine CAPSULE DELAYED RELEASE 125 MG Oral 1 NF CMS Required Deletion N/A TABLET 125 MCG Oral NF 1 Formulary Enhancement N/A TABLET 250 MCG Oral NF 1 Formulary Enhancement N/A Efavirenz CAPSULE 200 MG Oral NF 1 Formulary Enhancement N/A Efavirenz TABLET 600 MG Oral NF 1 Formulary Enhancement N/A Endari PACKET 5 GM Oral NF 2 + QL 180 + PA1 + LA Formulary Enhancement N/A Erleada TABLET 60 MG Oral NF 2 + PA2 + LA Formulary Enhancement N/A Gentamicin Sulfate SOLUTION 10 MG/ML Intravenous 1 NF CMS Required Deletion N/A Haloperidol Lactate SOLUTION 5 MG/ML Injection (1 ml Prefilled Syringe) NF 1 Formulary Enhancement N/A
Nitrofurantoin Monohyd Macro CAPSULE 100 MG Oral 1 + PA1 1 Formulary Enhancement N/A Relpax TABLET 20 MG Oral 2 + QL 9 NF Formulary Update eletriptan 20 mg,1 + QL 9 Relpax TABLET 40 MG Oral 2 + QL 9 NF Formulary Update eletriptan 40 mg, 1 + QL 9 Renvela TABLET 800 MG Oral 2 NF Formulary Update sevelamer carbonate 800 mg, 1 Sabril PACKET 500 MG Oral 2 NF Formulary Update vigabatrin 50 mg/ml, 2 Sustiva CAPSULE 50 MG Oral 2 NF Formulary Update efavirenz 50 mg, 1 Symdeko Tablet Therapy Pack 100-150 & 150 MG Oral NF 2 + PA1 + LA Formulary Enhancement N/A Transderm-Scop (1.5 MG) Patch 72 Hour 1 MG/3DAYS Transdermal 2 NF Formulary Update scopolamine 0.0139 mg/hr, 1 Trientine HCl CAPSULE 250 MG Oral NF 1 Formulary Enhancement N/A Trisenox SOLUTION 10 MG/10ML Intravenous 2 + BD NF CMS Required Deletion N/A Videx EC CAPSULE DELAYED RELEASE 125 MG Oral NF 2 Formulary Enhancement N/A Vigamox SOLUTION 0.5 % Ophthalmic 2 NF Formulary Update moxifloxacin 5 mg/ml, 1 Zenpep CAPSULE DELAYED RELEASE PARTICLES UNIT Oral NF 2 Formulary Enhancement N/A