LIDOCAINE INJ 0.5% NF 1 Formulary Enhancement N/A Lynparza TAB 100 MG NF 1 + PA2 + LA Formulary Enhancement N/A Lynparza TAB 150 MG NF 1 + PA2 + LA Formulary Enhancement N/A Mavyret TAB 100-40 MG NF 1 + 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 1 + 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 1 Formulary Enhancement N/A Radicava SOL 30 MG/100ML IV NF 1 + PA1 Formulary Enhancement N/A SYNDROS SOL 5MG/ML NF 1 + QL 120 + BD Formulary Enhancement N/A Vigabatrin PACK 500 MG NF 1 + LA Formulary Enhancement N/A Vyxeos SUSP RECON 100-44 MG IV NF 1 + PA2 Formulary Enhancement N/A XATMEP SOL 2.5MG/ML NF 1 + BD Formulary Enhancement N/A Zytiga TAB 500 MG NF 1 + PA2 Formulary Enhancement N/A EFFECTIVE 03/01/2018 Adacel SUSPENSION 5-2-15.5 Intramuscular (prefilled syringe) NF 1 Formulary Enhancement N/A
Alunbrig Tablet Therapy Pack 90 & 180 MG Oral NF 1+ 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 1 Formulary Enhancement N/A Eliquis Starter Pack TABLET 5 MG Oral NF 1 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 1+ 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 Roweepra XR Tablet Extended Release 24 Hour 750 MG Oral NF 1 Formulary Enhancement N/A Selzentry SOLUTION 20 MG/ML Oral NF 1 Formulary Enhancement N/A Shingrix SUSPENSION RECONSTITUTED 50 MCG Intramuscular NF 1 Formulary Enhancement N/A Tacrolimus OINTMENT 0.03 % EXTERNAL NF 1 Formulary Enhancement N/A Tacrolimus OINTMENT 0.1 % EXTERNAL NF 1 Formulary Enhancement N/A
Tenofovir Disoproxil Fumarate TABLET 300 MG Oral NF 1 Formulary Enhancement N/A Zenpep CAPSULE DELAYED RELEASE PARTICLES 20000 UNIT Oral 1 NF CMS Required Deletion N/A Zenpep CAPSULE DELAYED RELEASE PARTICLES 40000-126000 UNIT Oral NF 1 Formulary Enhancement N/A EFFECTIVE 05/01/2018 Abacavir Sulfate SOLUTION 20 MG/ML Oral NF 1 Formulary Enhancement N/A Biktarvy TABLET 50-200-25 MG Oral NF 1 + QL 30 Formulary Enhancement N/A Brisdelle CAPSULE 7.5 MG Oral 1 NF Formulary Update paroxetine mesylate 7.5 mg, 1 Cancidas SOLUTION RECONSTITUTED 50 MG Intravenous 1 NF Formulary Update caspofungin acetate 50 mg, 1 Cancidas SOLUTION RECONSTITUTED 70 MG Intravenous 1 NF Formulary Update caspofungin acetate 70 mg, 1 Copaxone Solution Prefilled Syringe 20 MG/ML Subcutaneous 1 + PA1 NF Formulary Update glatiramer acetate 20 mg/ml, 1 + PA1 Copaxone Solution Prefilled Syringe 40 MG/ML Subcutaneous 1 + PA1 NF Formulary Update glatiramer acetate 40 mg/ml, 1 + PA1
Memantine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 21 MG Oral NF 1 Formulary Enhancement N/A Memantine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 28 MG Oral NF 1 Formulary Enhancement N/A Memantine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 7 MG Oral NF 1 Formulary Enhancement N/A Methotrexate Sodium SOLUTION 250 MG/10ML INJECTION NF 1 + BD Formulary Enhancement N/A Naloxone HCl Solution Cartridge 0.4 MG/ML Injection NF 1 Formulary Enhancement N/A Nitrofurantoin Macrocrystal CAPSULE 100 MG Oral 1 + PA1 1 Formulary Enhancement N/A Nitrofurantoin Macrocrystal CAPSULE 25 MG ORAL 1 + PA1 1 Formulary Enhancement N/A Nitrofurantoin Macrocrystal Capsule 50 MG Oral 1 + PA1 1 Formulary Enhancement N/A Nitrofurantoin Monohyd Macro CAPSULE 100 MG Oral 1 + PA1 1 Formulary Enhancement N/A Relpax TABLET 20 MG Oral 1 + QL 9 NF Formulary Update eletriptan 20 mg, 1 + QL 9 Relpax TABLET 40 MG Oral 1 + QL 9 NF Formulary Update eletriptan 40 mg, 1 + QL 9 Renvela TABLET 800 MG Oral 1 NF Formulary Update sevelamer carbonate 800 mg, 1
Sabril PACKET 500 MG Oral 1 NF Formulary Update vigabatrin 50 mg/ml, 1 Sustiva CAPSULE 50 MG Oral 1 NF Formulary Update efavirenz 50 mg, 1 Symdeko Tablet Therapy Pack 100-150 & 150 MG Oral NF 1 + PA1 + LA Formulary Enhancement N/A Transderm-Scop (1.5 MG) 72 Hour 1 MG/3DAYS Transdermal 1 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 1 + BD NF CMS Required Deletion N/A Videx EC CAPSULE DELAYED RELEASE 125 MG Oral NF 1 Formulary Enhancement N/A Vigamox SOLUTION 0.5 % Ophthalmic 1 NF Formulary Update moxifloxacin 5 mg/ml, 1 Zenpep CAPSULE DELAYED RELEASE PARTICLES 25000-79000 UNIT Oral NF 1 Formulary Enhancement N/A Zenpep CAPSULE DELAYED RELEASE PARTICLES 5000-24000 UNIT Oral NF 1 Formulary Enhancement N/A EFFECTIVE 06/01/2018 Abilify Maintena Suspension Reconstituted ER 400 MG Intramuscular NF 1 Formulary Enhancement N/A Alimta SOLUTION RECONSTITUTED 100 MG Intravenous NF 1 Formulary Enhancement N/A Daliresp Tablet 250 MCG Oral NF 1 Formulary Enhancement N/A
Zenpep CAPSULE DELAYED RELEASE PARTICLES 40000-136000 UNIT Oral 1 NF CMS Required Deletion N/A Zmax SUSPENSION RECONSTITUTED 2 GM ORAL 1 NF CMS Required Deletion N/A EFFECTIVE 07/01/2018 Benznidazole TABLET 100 MG Oral NF 1 Formulary Enhancement N/A Benznidazole TABLET 12.5 MG Oral NF 1 Formulary Enhancement N/A Cetraxal SOLUTION 0.2 % OTIC NF 1 Formulary Enhancement N/A Clopidogrel Bisulfate TABLET 300 MG Oral 1 NF CMS Required Deletion N/A Gildagia TABLET 0.4-35 MG-MCG Oral 1 NF CMS Required Deletion N/A Humira Pediatric Crohns Prefilled Syringe Kit 80 MG/0.8ML & 40MG/0.4ML Subcutaneous NF 1 Formulary Enhancement N/A Humira Pediatric Crohns Prefilled Syringe Kit 80 MG/0.8ML Subcutaneous NF 1 Formulary Enhancement N/A Humira Pen Pen-Injector Kit 40 MG/0.4ML Subcutaneous NF 1 Formulary Enhancement N/A Humira Prefilled Syringe Kit 10 MG/0.1ML Subcutaneous NF 1 Formulary Enhancement N/A Humira Prefilled Syringe Kit 40 MG/0.4ML Subcutaneous NF 1 Formulary Enhancement N/A Intrarosa INSERT 6.5 MG Vaginal NF 1 + PA1 Formulary Enhancement N/A
Zenpep Capsule Delayed Release Particles UNIT Oral NF 1 Formulary Enhancement N/A Ziagen SOLUTION 20 MG/ML Oral 1 NF Formulary Update abacavir 20 mg/ml, 1 EFFECTIVE 08/01/2018 Auryxia TABLET 1 GM 210 MG(Fe) ORAL NF 1 Formulary Enhancement N/A Baclofen Tablet 5 MG Oral NF 1 Formulary Enhancement N/A Ciprofloxacin HCl SOLUTION 0.2 % OTIC NF 1 Formulary Enhancement N/A Ciprofloxacin SOLUTION 400 MG/40ML Intravenous 1 NF CMS Required Deletion N/A Estarylla Tablet 0.25-35 MG-MCG Oral NF 1 Formulary Enhancement N/A Fiasp FlexTouch Solution Pen-injector 100 UNIT/ML Subcutaneous NF 1 Formulary Enhancement N/A Fiasp SOLUTION 100 UNIT/ML Subcutaneous NF 1 Formulary Enhancement N/A Gabitril Tablet 12 MG Oral 1 NF Formulary Update tiagabine hydrochloride 12 mg, 1 Gabitril Tablet 16 MG Oral 1 NF Formulary Update tiagabine hydrochloride 16 mg, 1 Humira Prefilled Syringe Kit 20 MG/0.2ML Subcutaneous NF 1 Formulary Enhancement N/A LaMICtal Starter KIT 25 (35) MG Oral 1 NF Formulary Update lamotrigine starter kit 25 mg, 1