Lartruvo SOLUTION 190 MG/19ML Intravenous NF 4 + PA2 Formulary Enhancement N/A Levonorgest-Eth Est & Eth Est TABLET 42-21-21-7 DAYS Oral NF 2 Formulary Enhancement N/A Levo-T TABLET 100 MCG ORAL NF 1 Formulary Enhancement N/A Levo-T TABLET 112 MCG ORAL NF 1 Formulary Enhancement N/A Levo-T TABLET 125 MCG ORAL NF 1 Formulary Enhancement N/A Levo-T TABLET 137 MCG ORAL NF 1 Formulary Enhancement N/A Levo-T TABLET 150 MCG ORAL NF 1 Formulary Enhancement N/A Levo-T TABLET 175 MCG ORAL NF 1 Formulary Enhancement N/A Levo-T TABLET 200 MCG ORAL NF 1 Formulary Enhancement N/A Levo-T TABLET 25 MCG ORAL NF 1 Formulary Enhancement N/A Levo-T TABLET 300 MCG ORAL NF 1 Formulary Enhancement N/A Levo-T TABLET 50 MCG ORAL NF 1 Formulary Enhancement N/A Levo-T TABLET 75 MCG ORAL NF 1 Formulary Enhancement N/A Levo-T TABLET 88 MCG ORAL NF 1 Formulary Enhancement N/A Lomedia 24 FE TAB 1-20 2 NF CMS Required Deletion N/A Lupron Depot-Ped (3-Month) KIT 30 MG (Ped) Intramuscular NF 4 Formulary Enhancement N/A Menomune INJECTABLE SQ 4 NF CMS Required Deletion N/A Methotrexate Sodium (PF) SOLUTION 250 MG/10ML INJECTION NF 2 + BD Formulary Enhancement N/A Morphine Sulfate SOLUTION 5 MG/ML INJECTION NF 3 Formulary Enhancement N/A Mylotarg SOLUTION RECONSTITUTED 4.5 MG Intravenous NF 5 + PA2 + LA Formulary Enhancement N/A
Erleada TABLET 60 MG Oral NF 5 + 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 2 Formulary Enhancement N/A ISOtretinoin CAPSULE 10 MG Oral NF 2 Formulary Enhancement N/A ISOtretinoin CAPSULE 20 MG Oral NF 2 Formulary Enhancement N/A ISOtretinoin CAPSULE 30 MG Oral NF 2 Formulary Enhancement N/A ISOtretinoin CAPSULE 40 MG Oral NF 2 Formulary Enhancement N/A Lexiva TABLET 700 MG Oral 5 NF Formulary Update fosamprenavir 700 mg, 5 Memantine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 14 MG Oral NF 3 Formulary Enhancement N/A Memantine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 21 MG Oral NF 3 Formulary Enhancement N/A Memantine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 28 MG Oral NF 3 Formulary Enhancement N/A Memantine HCl ER CAPSULE EXTENDED RELEASE 24 HOUR 7 MG Oral NF 3 Formulary Enhancement N/A Methotrexate Sodium SOLUTION 250 MG/10ML INJECTION NF 2 + BD Formulary Enhancement N/A Naloxone HCl Solution Cartridge 0.4 MG/ML Injection NF 1 Formulary Enhancement N/A
Vigamox SOLUTION 0.5 % Ophthalmic 3 NF Formulary Update moxifloxacin 5 mg/ml, 3 Zenpep CAPSULE DELAYED RELEASE PARTICLES 25000-79000 UNIT Oral NF 3 Formulary Enhancement N/A Zenpep CAPSULE DELAYED RELEASE PARTICLES UNIT Oral NF 3 Formulary Enhancement N/A EFFECTIVE 06/01/2018 Abilify Maintena Suspension Reconstituted ER 400 MG Intramuscular NF 4 Formulary Enhancement N/A Alimta SOLUTION RECONSTITUTED 100 MG Intravenous NF 5 Formulary Enhancement N/A Daliresp Tablet 250 MCG Oral NF 3 Formulary Enhancement N/A Estrace CREAM 0.1 MG/GM Vaginal 3 NF Formulary Update estradiol 0.1 mg/ml, 3 Fabrazyme SOLUTION RECONSTITUTED 5 MG Intravenous NF 5 + BD Formulary Enhancement N/A Gengraf CAPSULE 50 MG ORAL 2 + BD NF CMS Required Deletion N/A Hydrocortisone Ace-Pramoxine CREAM 1-1 % Rectal NF 2 Formulary Enhancement N/A IBU TABLET 600 MG Oral NF 1 Formulary Enhancement N/A IBU TABLET 800 MG Oral NF 1 Formulary Enhancement N/A Ilaris (150mg Delivered) SOLUTION RECONSTITUTED 180 MG Subcutaneous 5 NF CMS Required Deletion N/A Imbruvica CAPSULE 70 MG Oral NF 5 + PA2 Formulary Enhancement N/A Imbruvica TABLET 140 MG Oral NF 5 + PA2 Formulary Enhancement N/A
Imbruvica TABLET 280 MG Oral NF 5 + PA2 Formulary Enhancement N/A Imbruvica TABLET 420 MG Oral NF 5 + PA2 Formulary Enhancement N/A Imbruvica TABLET 560 MG Oral NF 5 + PA2 Formulary Enhancement N/A Intron A SOLUTION 10000000 UNIT/ML INJECTION NF 5 Formulary Enhancement N/A Kelnor 1/50 Tablet 1-50 MG-MCG Oral NF 2 Formulary Enhancement N/A Keytruda SOLUTION RECONSTITUTED 50 MG Intravenous 5 + PA2 NF CMS Required Deletion N/A LamoTRIgine Starter Kit-Blue KIT 25 (35) MG Oral NF 4 Formulary Enhancement N/A LamoTRIgine Starter Kit-Green KIT 25 (84)-100(14) MG Oral NF 4 Formulary Enhancement N/A LamoTRIgine Starter Kit-Orange KIT 25 (42)-100 (7) MG Oral NF 4 Formulary Enhancement N/A LEVOleucovorin Calcium SOLUTION RECONSTITUTED 50 MG Intravenous NF 3 + BD Formulary Enhancement N/A Makena Solution Auto-injector 275 MG/1.1ML Subcutaneous NF 5 Formulary Enhancement N/A Nevirapine SUSPENSION 50 MG/5ML Oral 3 NF CMS Required Deletion N/A Oxycodone-Acetaminophen SOLUTION 5-325 MG/5ML ORAL 2 + QL 1800 NF CMS Required Deletion N/A Reyataz CAPSULE 150 MG Oral 5 NF Formulary Update atazanavir 150 mg, 4 Reyataz CAPSULE 200 MG Oral 5 NF Formulary Update atazanavir 200 mg, 4 Reyataz CAPSULE 300 MG Oral 5 NF Formulary Update atazanavir 300 mg, 5