Effective Date: Jan. 1, 2025
The tables below describe all formulary changes going into effect for our Medicare and Medicaid members in 2025. For our Commercial members, these tables highlight the most highly impacted drugs. For a comprehensive listing of all plans see: 2025 Summary Lines of Business, Networks & Benefit Plans.
See the applicable 2025 plan formularies for all coverage rules:
Note: Affected members were notified of these changes separately.
Medicare Advantage Plans Step Therapy Added in 2025 | |
|---|---|
Drug | Alternative(s) |
FANAPT 1 MG | RISPERIDONE, LURASIDONE, ARIPIPRAZOLE |
FANAPT 10 MG | RISPERIDONE, LURASIDONE, ARIPIPRAZOLE |
FANAPT 12 MG | RISPERIDONE, LURASIDONE, ARIPIPRAZOLE |
FANAPT 2 MG | RISPERIDONE, LURASIDONE, ARIPIPRAZOLE |
FANAPT 4 MG | RISPERIDONE, LURASIDONE, ARIPIPRAZOLE |
FANAPT 6 MG | RISPERIDONE, LURASIDONE, ARIPIPRAZOLE |
FANAPT TITRATION PACK | RISPERIDONE, LURASIDONE, ARIPIPRAZOLE |
RELISTOR 12 MG/0.6 ML VIAL | SYMPROIC |
RELISTOR 12 MG/0.6 ML SYRINGE | SYMPROIC |
RELISTOR 8 MG/0.4 ML SYRINGE | SYMPROIC |
FLUTICASONE PROP HFA 44 MCG | BUDESONIDE, PULMICORT, ASMANEX |
FLUTICASONE PROP HFA 110 MCG | BUDESONIDE, PULMICORT, ASMANEX |
FLUTICASONE PROP HF 220 MCG | BUDESONIDE, PULMICORT, ASMANEX |
Medicare Advantage Plans Drugs Moving to Non-Formulary in 2025 | |
|---|---|
Drug | Alternative(s) |
ADALIMUMAB-ADAZ(CF) 40 MG SYRG | HUMIRA, ENBREL, STELARA |
ADALIMUMAB-ADAZ(CF) PEN 40 MG | HUMIRA, ENBREL, STELARA |
ADALIMUMAB-ADBM(CF) 10 MG SYRG | HUMIRA, ENBREL, STELARA |
ADALIMUMAB-ADBM(CF) 20 MG SYRG | HUMIRA, ENBREL, STELARA |
ADALIMUMAB-ADBM(CF) 40 MG SYRG | HUMIRA, ENBREL, STELARA |
ADALIMUMAB-ADBM(CF) CRHN 40MG | HUMIRA, ENBREL, STELARA |
ADALIMUMAB-ADBM(CF) PEN 40 MG | HUMIRA, ENBREL, STELARA |
ADALIMUMAB-ADBM(CF) PS-UV 40MG | HUMIRA, ENBREL, STELARA |
ALREX 0.2% EYE DROPS | LOTEPREDNOL ETABONATE 0.2% EYE DROPS, LOTEPREDNOL ETABONATE 0.5% EYE DROPS |
APOKYN 30 MG/3 ML CARTRIDGE | BENZTROPINE, AMANTADINE, CARBIDOPA-LEVODOPA |
APOMORPHINE 30 MG/3 ML CARTRDG | BENZTROPINE, AMANTADINE, CARBIDOPA-LEVODOPA |
AZASITE 1% EYE DROPS | CIPROFLOXACIN EYE DROP, ERYTHROMYCIN EYE OINTMENT, MOXIFLOXACIN EYE DROP |
BEPOTASTINE 1.5% EYE DROP | OLOPATADINE EYE DROPS, AZELASTINE EYE DROPS |
BESIVANCE 0.6% SUSP | CIPROFLOXACIN EYE DROP, ERYTHROMYCIN EYE OINTMENT, MOXIFLOXACIN EYE DROP |
BICILLIN C-R 1.2 MILLION UNIT | BICILLIN L-A, AMPICILLIN, NAFCILLIN |
BICILLIN C-R 900-300 SYRINGE | BICILLIN L-A, AMPICILLIN, NAFCILLIN |
BROMSITE 0.075% EYE DROPS | BROMFENAC EYE DROPS, KETOROLAC OPHTHALMIC SOLUTION, DEXAMETHASONE EYE DROP |
CALCITRIOL 3 MCG/G OINTMENT | CALCIPOTRIENE, TAZAROTENE |
CEFACLOR ER 500 MG TABLET | CEFACLOR CAPSULE/SUSPENSION, CEFUROXIME |
CHENODAL 250 MG TABLET | URSODIOL |
CHOLBAM 250 MG CAPSULE | URSODIOL |
CHOLBAM 50 MG CAPSULE | URSODIOL |
CIMETIDINE 200 MG TABLET | FAMOTIDINE, NIZATIDINE |
CIMETIDINE 300 MG TABLET | FAMOTIDINE, NIZATIDINE |
CIMETIDINE 300 MG/5 ML SOLN | FAMOTIDINE, NIZATIDINE |
CIMETIDINE 400 MG TABLET | FAMOTIDINE, NIZATIDINE |
CIMETIDINE 400 MG/6.67 ML SOLN | FAMOTIDINE, NIZATIDINE |
CIMETIDINE 800 MG TABLET | FAMOTIDINE, NIZATIDINE |
CLODAN 0.05% SHAMPOO | CICLODAN 8% SOLUTION, CICLOPIROX, KETOCONAZOLE |
CORLANOR 5 MG/5 ML ORAL SOLN | CORLANOR TABLETS |
DESONIDE 0.05% GEL | DESONIDE 0.05% OINTMENT, DESONIDE 0.05% CREAM |
DESONIDE 0.05% LOTION | DESONIDE 0.05% OINTMENT, DESONIDE 0.05% CREAM |
DESRX 0.05% GEL | DESONIDE, BETAMETHASONE |
DIGOXIN 62.5 MCG TABLET | DIGOXIN 125 MCG TABLET, DIGOXIN 250 MCG TABLET |
DIPHENHYDRAMINE 12.5 MG/5 ML CUP | HYDROXYZINE, PROMETHAZINE |
DIPHENHYDRAMINE 25 MG/10 ML CUP | HYDROXYZINE, PROMETHAZINE |
E.E.S. 400 MG TABLET | ERYTHROMYCIN, AZITHROMYCIN, CLARITHROMYCIN |
ELETRIPTAN HBR 20 MG TABLET | SUMATRIPTAN, RIZATRIPTAN, NARATRIPTAN |
ELETRIPTAN HBR 40 MG TABLET | SUMATRIPTAN, RIZATRIPTAN, NARATRIPTAN |
EMEND 125 MG POWDER PACKET | APREPITANT, FOSAPREPITANT |
EPCLUSA 150-37.5 MG PELLET PKT | SOFOSBUVIR-VELPATASVIR, LEDIPASVIR-SOFOSBUVIR |
EPCLUSA 200 MG-50 MG TABLET | SOFOSBUVIR-VELPATASVIR, LEDIPASVIR-SOFOSBUVIR |
EPCLUSA 200-50 MG PELLET PACK | SOFOSBUVIR-VELPATASVIR, LEDIPASVIR-SOFOSBUVIR |
EPCLUSA 400 MG-100 MG TABLET | SOFOSBUVIR-VELPATASVIR, LEDIPASVIR-SOFOSBUVIR |
FESOTERODINE ER 4 MG TABLET | TOLTERODINE TARTRATE, OXYBUTYNIN, SOLIFENACIN |
FESOTERODINE ER 8 MG TABLET | TOLTERODINE TARTRATE, OXYBUTYNIN, SOLIFENACIN |
FIRDAPSE 10 MG TABLET | DALFAMPRIDINE |
FLAVOXATE HCL 100 MG TABLET | OXYBUTYNIN, TOLTERODINE, TROSPIUM CHLORIDE |
FLUOXETINE DR 90 MG CAPSULE | FLUOXETINE CAPSULE, CITALOPRAM, SERTRALINE |
FLUOXETINE HCL 10 MG TABLET | FLUOXETINE CAPSULE, CITALOPRAM, SERTRALINE |
FLUOXETINE HCL 20 MG TABLET | FLUOXETINE CAPSULE, CITALOPRAM, SERTRALINE |
FLUVOXAMINE ER 100 MG CAPSULE | FLUVOXAMINE MALEATE TABLETS, FLUOXETINE CAPSULE, CITALOPRAM |
FLUVOXAMINE ER 150 MG CAPSULE | FLUVOXAMINE MALEATE TABLETS, FLUOXETINE CAPSULE, CITALOPRAM |
FOLOTYN 20 MG/ML VIAL | PRALATREXATE, METHOTREXATE |
FOLOTYN 40 MG/2 ML VIAL | PRALATREXATE, METHOTREXATE |
FOSAMAX PLUS D 70 MG-2800 UNIT | ALENDRONATE, IBANDRONATE, RISEDRONATE |
FOSAMAX PLUS D 70 MG-5600 UNIT | ALENDRONATE, IBANDRONATE, RISEDRONATE |
GLYCOPYRROLATE 1.5 MG TABLET | GLYCOPYRROLATE 1 MG TABET, GLYCOPYRROLATE 2 MG TABLET |
GRALISE ER 300 MG TABLET | GABAPENTIN ER TABLET, PREGABALIN CAPSULE |
GRALISE ER 450 MG TABLET | GABAPENTIN ER TABLET, PREGABALIN CAPSULE |
GRALISE ER 600 MG TABLET | GABAPENTIN ER TABLET, PREGABALIN CAPSULE |
GRALISE ER 750 MG TABLET | GABAPENTIN ER TABLET, PREGABALIN CAPSULE |
GRALISE ER 900 MG TABLET | GABAPENTIN ER TABLET, PREGABALIN CAPSULE |
HALAVEN 1 MG/2 ML VIAL | ERIBULIN MESYLATE |
HARVONI 33.75-150 MG PELLET PK | LEDIPASVIR-SOFOSBUVIR, SOFOSBUVIR-VELPATASVIR |
HARVONI 45-200 MG PELLET PACKT | LEDIPASVIR-SOFOSBUVIR, SOFOSBUVIR-VELPATASVIR |
HARVONI 45-200 MG TABLET | LEDIPASVIR-SOFOSBUVIR, SOFOSBUVIR-VELPATASVIR |
HARVONI 90-400 MG TABLET | LEDIPASVIR-SOFOSBUVIR, SOFOSBUVIR-VELPATASVIR |
HYDROCODONE-ACETAMINOPHEN 10-300 MG | HYDROCODONE-ACETAMINOPHEN 10-325 MG, HYDROCODONE-ACETAMINOPHEN 7.5-325 MG, HYDROCODONE-ACETAMINOPHEN 5-325 MG |
HYDROCODONE-ACETAMINOPHEN 5-300 MG | HYDROCODONE-ACETAMINOPHEN 5-325 MG, HYDROCODONE-ACETAMINOPHEN 7.5-325 MG, HYDROCODONE-ACETAMINOPHEN 10-325 MG |
HYDROCODONE-ACETAMINOPHEN 7.5-300 | HYDROCODONE-ACETAMINOPHEN 7.5-325 MG, HYDROCODONE-ACETAMINOPHEN 5-325 MG, HYDROCODONE-ACETAMINOPHEN 10-325 MG |
HYDROCODONE-IBUPROFEN 10-200 | HYDROCODONE-IBUPROFEN 7.5-200, HYDROCODONE-ACETAMINOPHEN |
HYDROCODONE-IBUPROFEN 5-200 MG | HYDROCODONE-IBUPROFEN 7.5-200, HYDROCODONE-ACETAMINOPHEN |
HYRIMOZ(CF) 10 MG/0.1 ML SYRNG | HUMIRA, ENBREL, STELARA |
HYRIMOZ(CF) 20 MG/0.2 ML SYRNG | HUMIRA, ENBREL, STELARA |
HYRIMOZ(CF) 40 MG/0.4 ML SYRNG | HUMIRA, ENBREL, STELARA |
HYRIMOZ(CF) PEDI CROHN 80 MG | HUMIRA, ENBREL, STELARA |
HYRIMOZ(CF) PEDI CROHN 80-40 MG | HUMIRA, ENBREL, STELARA |
HYRIMOZ(CF) PEN 40 MG/0.4 ML | HUMIRA, ENBREL, STELARA |
HYRIMOZ(CF) PEN 80 MG/0.8 ML | HUMIRA, ENBREL, STELARA |
HYRIMOZ(CF) PEN CROHN-UC 80 MG | HUMIRA, ENBREL, STELARA |
HYRIMOZ(CF) PEN PSORIA 80-40 MG | HUMIRA, ENBREL, STELARA |
IMIPRAMINE PAMOATE 100 MG CAP | IMIPRAMINE TABLET, TRIMIPRAMINE MALEATE CAP |
IMIPRAMINE PAMOATE 125 MG CAP | IMIPRAMINE TABLET, TRIMIPRAMINE MALEATE CAP |
IMIPRAMINE PAMOATE 150 MG CAP | IMIPRAMINE TABLET, TRIMIPRAMINE MALEATE CAP |
IMIPRAMINE PAMOATE 75 MG CAP | IMIPRAMINE TABLET, TRIMIPRAMINE MALEATE CAP |
INSULIN GLARGINE 100 UNIT/ML | LANTUS VIAL, LANTUS SOLOSTAR, TOUJEO SOLOSTAR |
INSULIN GLARGINE SOLOSTAR U100 | LANTUS VIAL, LANTUS SOLOSTAR, TOUJEO SOLOSTAR |
ISOTRETINOIN 25 MG CAPSULE | ISOTRETINOIN 20 MG CAPSULE, ISOTRETINOIN 30 MG CAPSULE, ISOTRETINOIN 40 MG CAPSULE |
ISOTRETINOIN 35 MG CAPSULE | ISOTRETINOIN 20 MG CAPSULE, ISOTRETINOIN 30 MG CAPSULE, ISOTRETINOIN 40 MG CAPSULE |
IVERMECTIN 1% CREAM | AZELAIC ACID 15% GEL, TOPICAL METRONIDAZOLE |
JUXTAPID 10 MG CAPSULE | STATIN MEDICATIONS, REPATHA |
JUXTAPID 20 MG CAPSULE | STATIN MEDICATIONS, REPATHA |
JUXTAPID 30 MG CAPSULE | STATIN MEDICATIONS, REPATHA |
JUXTAPID 5 MG CAPSULE | STATIN MEDICATIONS, REPATHA |
KORLYM 300 MG TABLET | MIFEPRISTONE 300 MG TABLET |
LAMOTRIGINE ODT KIT (BLUE) | LAMOTRIGINE ODT, LAMOTRIGINE, LAMOTRIGINE ER |
LAMOTRIGINE ODT KIT (GREEN) | LAMOTRIGINE ODT, LAMOTRIGINE, LAMOTRIGINE ER |
LAMOTRIGINE ODT KIT (ORANGE) | LAMOTRIGINE ODT, LAMOTRIGINE, LAMOTRIGINE ER |
LAMOTRIGINE TAB START KIT-BLUE | LAMOTRIGINE ODT, LAMOTRIGINE, LAMOTRIGINE ER |
LAMOTRIGINE TAB START KT-GREEN | LAMOTRIGINE ODT, LAMOTRIGINE, LAMOTRIGINE ER |
LAMOTRIGINE TAB START KT-ORANG | LAMOTRIGINE ODT, LAMOTRIGINE, LAMOTRIGINE ER |
LEUKINE 250 MCG VIAL | RELEUKO, FULPHILA, NIVESTYM |
LEVALBUTEROL 0.31 MG/3 ML SOL | ALBUTEROL SOLUTION, ALBUTEROL INHALER |
LEVALBUTEROL 0.63 MG/3 ML SOL | ALBUTEROL SOLUTION, ALBUTEROL INHALER |
LEVALBUTEROL 1.25 MG/3 ML SOL | ALBUTEROL SOLUTION, ALBUTEROL INHALER |
LEVALBUTEROL CONC 1.25 MG/0.5 | ALBUTEROL SOLUTION, ALBUTEROL INHALER |
LEVONO-E ESTRAD 0.15-0.03-0.01 | LEVONOR-E ESTRAD 0.1-0.02-0.01, LEVONOR-ETH ESTRAD 0.1-0.02 |
LEVONOR-ETH ESTRA 0.09-0.02 MG | LEVONOR-ETH ESTRAD 0.1-0.02, LEVONOR-E ESTRAD 0.1-0.02-0.01 |
MENEST 0.3 MG TABLET | ESTRADIOL, PREMARIN, MIMVEY |
MENEST 0.625 MG TABLET | ESTRADIOL, PREMARIN, MIMVEY |
MENEST 1.25 MG TABLET | ESTRADIOL, PREMARIN, MIMVEY |
MENEST 2.5 MG TABLET | ESTRADIOL, PREMARIN, MIMVEY |
METOPROLOL TARTRATE 37.5 MG TB | METOPROLOL 25 MG TAB, METOPROLOL 50 MG TAB, METOPROLOL 100 MG TAB |
METOPROLOL TARTRATE 75 MG TAB | METOPROLOL 25 MG TAB, METOPROLOL 50 MG TAB, METOPROLOL 100 MG TAB |
MOVANTIK 12.5 MG TABLET | SYMPROIC, RELISTOR |
MOVANTIK 25 MG TABLET | SYMPROIC, RELISTOR |
MOZOBIL 24 MG/1.2 ML VIAL | PLERIXAFOR |
NAFTIFINE HCL 1% CREAM | NAFTIFINE GEL, TOPICAL KETOCONAZOLE, TOPICAL NYSTATIN |
NAFTIFINE HCL 2% CREAM | NAFTIFINE GEL, TOPICAL KETOCONAZOLE, TOPICAL NYSTATIN |
NISOLDIPINE ER 17 MG TABLET | AMLODIPINE, FELODIPINE ER, NIFEDIPINE ER |
NISOLDIPINE ER 20 MG TABLET | AMLODIPINE, FELODIPINE ER, NIFEDIPINE ER |
NISOLDIPINE ER 25.5 MG TABLET | AMLODIPINE, FELODIPINE ER, NIFEDIPINE ER |
NISOLDIPINE ER 30 MG TABLET | AMLODIPINE, FELODIPINE ER, NIFEDIPINE ER |
NISOLDIPINE ER 34 MG TABLET | AMLODIPINE, FELODIPINE ER, NIFEDIPINE ER |
NISOLDIPINE ER 40 MG TABLET | AMLODIPINE, FELODIPINE ER, NIFEDIPINE ER |
NISOLDIPINE ER 8.5 MG TABLET | AMLODIPINE, FELODIPINE ER, NIFEDIPINE ER |
OLANZAPINE-FLUOXETINE 12-25 MG | OLANZAPINE; FLUOXETINE (SEPARATE) |
OLANZAPINE-FLUOXETINE 12-50 MG | OLANZAPINE; FLUOXETINE (SEPARATE) |
OLANZAPINE-FLUOXETINE 3-25 MG | OLANZAPINE; FLUOXETINE (SEPARATE) |
OLANZAPINE-FLUOXETINE 6-25 MG | OLANZAPINE; FLUOXETINE (SEPARATE) |
OLANZAPINE-FLUOXETINE 6-50 MG | OLANZAPINE; FLUOXETINE (SEPARATE) |
OMNIPOD CLASSIC PDM KIT (GEN 3) | OMNIPOD 5, OMNIPOD GO, OMNIPOD DASH |
OMNIPOD CLASSIC PODS (GEN3) 5-PK | OMNIPOD 5, OMNIPOD GO, OMNIPOD DASH |
PEG3350 100-7.5-2.691-1.01-5.9 | GAVILYTE-C, GAVILYTE-G, PEG-3350 AND ELECTROLYTES SOLUTION |
PENTASA 250 MG CAPSULE | MESALAMINE, SULFASALAZINE, BALSALAZIDE |
PERSERIS ER 120 MG SYRINGE KIT | RISPERIDONE, LURASIDONE, ZIPRASIDONE |
PERSERIS ER 90 MG SYRINGE KIT | RISPERIDONE, LURASIDONE, ZIPRASIDONE |
PHOSPHOLINE IODIDE 0.125% DROP | BRIMONIDINE, TIMOLOL, LATANOPROST |
PLASMA-LYTE A PH 7.4 SOLUTION | ISOLYTE S IV SOLUTION PH 7.4, MULTIPLE ELECTROYLTES T1 PH 7.4 |
PROLENSA 0.07% EYE DROPS | BROMFENAC EYE DROPS, KETOROLAC OPHTHALMIC SOLUTION PREDNISOLONE EYE DROP |
QTERN 10 MG-5 MG TABLET | GLYXAMBI, FARXIGA |
QTERN 5 MG-5 MG TABLET | GLYXAMBI, FARXIGA |
RECTIV 0.4% OINTMENT | NITROGLYCERIN 4% OINTMENT |
RISPERDAL CONSTA 12.5 MG VIAL | RISPERIDONE ER VIAL, ZIPRASIDONE VIAL, INVEGA |
RISPERDAL CONSTA 25 MG VIAL | RISPERIDONE ER VIAL, ZIPRASIDONE VIAL, INVEGA |
RISPERDAL CONSTA 37.5 MG VIAL | RISPERIDONE ER VIAL, ZIPRASIDONE VIAL, INVEGA |
RISPERDAL CONSTA 50 MG VIAL | RISPERIDONE ER VIAL, ZIPRASIDONE VIAL, INVEGA |
SILODOSIN 4 MG CAPSULE | TAMSULOSIN, ALFUZOSIN ER |
SILODOSIN 8 MG CAPSULE | TAMSULOSIN, ALFUZOSIN ER |
SIMLANDI(CF) AI 40 MG/0.4 ML | HUMIRA, ENBREL, STELARA |
SUBVENITE TAB START KIT (BLUE) | SUBVENITE 25 MG TABLET, SUBVENITE 100 MG TABLET, SUBVENITE 150 MG TABLET |
SUBVENITE TAB START KIT(GREEN) | SUBVENITE 25 MG TABLET, SUBVENITE 100 MG TABLET, SUBVENITE 150 MG TABLET |
SUBVENITE TAB START KT(ORANGE) | SUBVENITE 25 MG TABLET, SUBVENITE 100 MG TABLET, SUBVENITE 150 MG TABLET |
TAFLUPROST 0.0015% EYE DROP | LATANOPROST EYE DROPS, TRAVOPROST EYE DROP |
TALTZ 20 MG/0.25 ML SYRINGE | HUMIRA, ENBREL, STELARA |
TALTZ 40 MG/0.5 ML SYRINGE | HUMIRA, ENBREL, STELARA |
TALTZ 80 MG/ML AUTOINJ (2-PK) | HUMIRA, ENBREL, STELARA |
TALTZ 80 MG/ML AUTOINJ (3-PK) | HUMIRA, ENBREL, STELARA |
TALTZ 80 MG/ML AUTOINJECTOR | HUMIRA, ENBREL, STELARA |
TALTZ 80 MG/ML SYRINGE | HUMIRA, ENBREL, STELARA |
TARINA 24 FE 1 MG-20 MCG TAB | TARINA FE 1-20 EQ TABLET, LARIN FE, TRI-LOW SPRINTEC |
TESTOSTERONE 10 MG GEL PUMP | TESTOSTERONE 1.62% GEL PUMP, TESTOSTERONE CYPIONATE |
THEO-24 ER 100 MG CAPSULE | THEOPHYLLINE, ELIXOPHYLLIN |
THEO-24 ER 200 MG CAPSULE | THEOPHYLLINE, ELIXOPHYLLIN |
THEO-24 ER 300 MG CAPSULE | THEOPHYLLINE, ELIXOPHYLLIN |
THEO-24 ER 400 MG CAPSULE | THEOPHYLLINE, ELIXOPHYLLIN |
VANCOMYCIN HCL 100 GM SMARTPAK | VANCOMYCIN VIALS |
VANDAZOLE VAGINAL 0.75% GEL | METRONIDAZOLE VAGINAL GEL, CLINDAMYCIN VAGINAL GEL |
VECAMYL 2.5 MG TABLET | LISINOPRIL |
VEKLURY 100 MG VIAL | PAXLOVID |
V-GO 20 DISPOSABLE DEVICE | OMNIPOD, CEQUR SIMPLICITY |
V-GO 30 DISPOSABLE DEVICE | OMNIPOD, CEQUR SIMPLICITY |
V-GO 40 DISPOSABLE DEVICE | OMNIPOD, CEQUR SIMPLICITY |
VIIBRYD 10-20 MG STARTER PACK | VILAZODONE |
VIOKACE 10,440-39,150 UNIT TAB | CREON, ZENPEP |
VIOKACE 20,880-78,300 UNITS TB | CREON, ZENPEP |
VOTRIENT 200 MG TABLET | PAZOPANIB |
XATMEP 2.5 MG/ML ORAL SOLUTION | METHOTREXATE, JYLAMVO |
ZARXIO 300 MCG/0.5 ML SYRINGE | RELEUKO, NIVESTYM, FULPHILA |
ZARXIO 480 MCG/0.8 ML SYRINGE | RELEUKO, NIVESTYM, FULPHILA |
ZEGALOGUE 0.6 MG/0.6 ML SYRING | BAQSIMI, GVOKE |
ZEGALOGUE 0.6 MG/0.6 ML AUTOINJ | BAQSIMI, GVOKE |
ZIEXTENZO 6 MG/0.6 ML SYRINGE | RELEUKO,FULPHILA , NIVESTYM |
ZOLMITRIPTAN 2.5 MG ODT | SUMATRIPTAN, RIZATRIPTAN, NARATRIPTAN |
ZOLMITRIPTAN 2.5 MG TABLET | SUMATRIPTAN, RIZATRIPTAN, NARATRIPTAN |
ZOLMITRIPTAN 5 MG ODT | SUMATRIPTAN, RIZATRIPTAN, NARATRIPTAN |
SUMATRIPTAN, RIZATRIPTAN, NARATRIPTAN | |
Medicare Advantage Plans New Tier 5 Drugs |
|---|
CINACALCET HCL 90 MG |
COLISTIMETHATE 150 MG VIAL |
DIAZOXIDE 50 MG/ML ORAL SUSP |
EMTRICITBINE-TENOFV 100 MG-150 MG |
Medicare Advantage Plans New Preauthorization Requirements for Listed Drugs in 2025 | ||
|---|---|---|
ADVOCATE ALCOHOL 70% PREP PADS | BD UF MINI PEN NEEDLE 5 MM X 31 G | PHARM CHOICE ALCOHOL PREP PADS |
ALCOHOL 70% PADS | BD UF NANO PEN NEEDLE 4 MM X 32 G | PREP EASE ALCOHOL PADS |
ALCOHOL 70% PREP PADS | BD UF ORIG PEN NDL 12.7 MM X 29 G | PRO COMFORT ALCOHOL 70% PADS |
ALCOHOL 70% SWABS | BD UF SHORT PEN NEEDLE 8 MM X 31 G | PURE COMFORT ALCOHOL 70% PADS |
ALCOHOL 70% WIPES | BD VEO INS 0.3 ML 6 MM X 31 G (1/2) | QC ALCOHOL 70% SWABS |
ALCOHOL PREP PADS | BD VEO INS SYRING 1 ML 6 MM X 31 G | RA ALCOHOL SWABS |
ALCOHOL SWAB | BD VEO INS SYRN 0.3 ML 6 MM X 31 G | RA GAUZE PADS 2" X 2" |
ALCOHOL SWABS | BD VEO INS SYRN 0.5 ML 6 MM X 31 G | RA ISOPROPYL ALCOHOL 70% WIPES |
BAND-AID GAUZE PADS 2" X 2" | BORDERED GAUZE 2" X 2" | RA STERILE PADS 2" X 2" |
BD AUTOSHIELD DUO NDL 5 MM X 30 G | CARETOUCH ALCOHOL 70% PREP PAD | RELEUKO 300 MCG/0.5 ML SYRINGE |
BD ECLIPSE 30 G X 1/2" SYRINGE | COSENTYX 125 MG/5 ML VIAL | RELEUKO 300 MCG/ML VIAL |
BD INS SYR 0.3 ML 8 MM X 31 G (1/2) | COSENTYX 150 MG/ML SYRINGE | RELEUKO 480 MCG/0.8 ML SYRINGE |
BD INS SYR U-500 ½ ML 6 MM X 31 G | COSENTYX 300 MG DOSE-2 SYRINGE | RELEUKO 480 MCG/1.6 ML VIAL |
BD INS SYR UF 0.3 ML 12.7 MM X 30 G | COSENTYX 75 MG/0.5 ML SYRINGE | RELION ALCOHOL 70% SWABS |
BD INS SYR UF 0.5 ML 12.7 MM X 30 G | COSENTYX SENSOREADY 150 MG PEN | SAPS ALCOHOL 70% PREP PADS |
BD INS SYRN UF 1 ML 12.7 MM X 30 G | COSENTYX SNRDY 300 MG DOSE-2PEN | SM ALCOHOL 70% PREP PADS |
BD INS SYRN UF 1 ML 30 G X 12.7 MM | COSENTYX UNOREADY 300 MG PEN | SM STERILE PADS 2" X 2" |
BD INS SYRNG 0.3 ML 29 G X 12.7 MM | CURITY ALCOHOL PREPS | SOFOSBUVIR-VELPATASVIR 400-100 |
BD INS SYRNG 0.5 ML 29 G X 12.7 MM | CURITY GAUZE SPONGES | SOTYKTU 6 MG TABLET |
BD INS SYRNG UF 0.3 ML 8 MM X 31 G | CURITY GUAZE PADS | STERILE GAUZE PADS 2" X 2" |
BD INS SYRNG UF 0.5 ML 8 MM X 31 G | CVS ALCOHOL 70% PREP PADS | STERILE PADS 2" X 2" |
BD INSULIN SYR 0.5 ML 28 G X 1/2" | CVS GAUZE PADS 2" X 2" | SURE COMFORT ALCOHOL PREP PADS |
BD INSULIN SYR 1 ML 25 G X 1" | CVS ISOPROPYL ALCOHOL 70% WIPE | SURE-PREP ALCOHOL PREP PADS |
BD INSULIN SYR 1 ML 25 G X 5/8" | DERMACEA 2" X 2" GAUZE | SWI ALCOHOL 70% PREP PADS |
BD INSULIN SYR 1 ML 26 G X 1/2" | DERMACEA GAUZE 2" X 2" SPONGE | TADALAFIL 2.5 MG TABLET |
BD INSULIN SYR 1 ML 27 G X 12.7MM | DERMACEA NON-WOVEN 2" X 2" SPNGE | TADALAFIL 5 MG TABLET |
BD INSULIN SYR 1 ML 27 G X 5/8" | DROPSAFE ALCOHOL 70% PREP PADS | TREMFYA 100 MG/ML INJECTOR |
BD INSULIN SYR 1 ML 28 G X 1/2" | EASY COMFORT ALCOHOL 70% PAD | TREMFYA 100 MG/ML SYRINGE |
BD INSULIN SYR 1 ML 29 G X 12.7 MM | EASY TOUCH ALCOHOL 70% PADS | TRUE COMFORT ALCOHOL 70% PADS |
BD INSULIN SYR UF 1 ML 8 MM X 31 G | ESTRADIOL 0.06% 1.25 G GEL PUMP | TRUE COMFORT PRO ALCOHOL PADS |
BD INSULIN SYRINGE 1 ML | FIFTY50 ALCOHOL PREP PADS | ULTILET ALCOHOL STERL SWAB |
BD LUER-LOK SYRINGE 1 ML | FULPHILA 6 MG/0.6 ML SYRINGE | VERSALON ALL PURPOSE SPONGE |
BD NANO 2 GEN PEN NDL 32 G 4 MM | GAUZE PADS 2" X 2" | VOWST CAPSULE |
BD SAFETGLD INS 0.3 ML 29 G 13 MM | GNP ALCOHOL SWAB | WEBCOL ALCOHOL PREPS |
BD SAFETGLD INS 0.5 ML 13 MM X 29 G | HEB INCONTROL ALCOHOL 70% PADS | XIFAXAN 200 MG TABLET |
BD SAFETYGLD INS 0.3 ML 31G 8 MM | HM ALCOHOL 70% PREP PADS | XIFAXAN 550 MG TABLET |
BD SAFETYGLD INS 0.5 ML 30 G 8 MM | IV PREP ANTISEPTIC WIPES | YUFLYMA(CF) 20 MG/0.2 ML SYRNG |
BD SAFETYGLD INS 1 ML 29 G 13 MM | LEDIPASVIR-SOFOSBUVIR 90-400 MG | YUFLYMA(CF) 40 MG/0.4 ML SYRNG |
BD SAFETYGLID INS 1 ML 6 MM X 31 G | LISCO SPONGES | YUFLYMA(CF) 40 MG/0.4 ML AUTOINJ |
BD SAFETYGLIDE SYRINGE 27 G X 5/8 | LIVTENCITY 200 MG TABLET | YUFLYMA(CF) 80 MG/0.8 ML AUTOINJ |
BD SAFTYGLD INS 0.3 ML 6 MM X 31 G | MAVYRET 100-40 MG TABLET | YUFLYMA(CF) AI CROHNS-UC-HS 80 |
BD SAFTYGLD INS 0.5 ML 6 MM X 31 G | MAVYRET 50-20 MG PELLET PACKET | PHARM CHOICE ALCOHOL PREP PADS |
BD SAFTYGLD INS 0.5 ML 29 G 13 MM | NOVOFINE 32 G NEEDLES | PREP EASE ALCOHOL PADS |
BD SINGLE USE SWAB | NOVOFINE AUTOCOVER 30 G NEEDLE | PRO COMFORT ALCOHOL 70% PADS |
BD UF MICRO PEN NEEDLE 6 MM X 32 G | NOVOFINE PLUS PEN NDL 32 G X 1/6" | PURE COMFORT ALCOHOL 70% PADS |
Medicare Advantage Members New Quantity Limits for 2025 | |
|---|---|
Drug | Amount/Frequency |
ADEMPAS TABLET | 90/MONTH |
ALINIA 500 MG TABLET | 12/MONTH |
AMBRISENTAN TABLET | 30/MONTH |
BOSENTAN TABLET | 60/MONTH |
BOSULIF 100 MG CAPSULE | 180/MONTH |
BOSULIF 50 MG CAPSULE | 330/MONTH |
DABIGATRAN ETEXILATE CP | 60/MONTH |
ELIQUIS TABLET | 60/MONTH |
ELIQUIS DVT-PE TREAT START 5 MG | 74/6 MONTHS |
ELYXYB 120 MG/4.8 ML SOLUTION | 57.6/21 DAYS |
FRUZAQLA 5 MG CAPSULE | 21/21 DAYS |
ISTURISA 5 MG TABLET | 360/MONTH |
LETAIRIS 10 MG TABLET | 30/MONTH |
LETAIRIS 5 MG TABLET | 30/MONTH |
LIQREV 10 MG/ML ORAL SUSP | 244.2 ML/MONTH |
LUMAKRAS 120 MG TABLET | 240/MONTH |
LUMAKRAS 320 MG TABLET | 90/MONTH |
LYTGOBI 12 MG DOSE (3 X 4 MG TB) | 90/MONTH |
LYTGOBI 16 MG DOSE (4 X 4 MG TB) | 120/MONTH |
LYTGOBI 20 MG DOSE (5 X 4 MG TB) | 150/MONTH |
MIEBO 100% EYE DROP | 12 ML/MONTH |
NITAZOXANIDE 500 MG TABLET | 12/MONTH |
OPSUMIT 10 MG TABLET | 30/MONTH |
ORENITRAM ER 0.125 MG TABLET | 90/MONTH |
ORENITRAM ER 0.25 MG TABLET | 90/MONTH |
ORENITRAM ER 1 MG TABLET | 90/MONTH |
ORENITRAM ER 2.5 MG TABLET | 90/MONTH |
ORENITRAM ER 5 MG TABLET | 24/DAY |
ORENITRAM MONTH 1 TITRATION KT | 168/180DAY |
ORENITRAM MONTH 2 TITRATION KT | 336/180DAYS |
ORENITRAM MONTH 3 TITRATION KT | 252/180DAYS |
PIQRAY 200 MG DAILY DOSE PACK | 30/MONTH |
PIQRAY 250 MG DAILY DOSE PACK | 60/MONTH |
PIQRAY 300 MG DAILY DOSE PACK | 60/MONTH |
POMALYST CAPSULE | 21/21DAYS |
PRADAXA 110 MG CAPSULE | 60/MONTH |
PRADAXA 110 MG PELLET PACK | 120/MONTH |
PRADAXA 150 MG CAPSULE | 60/MONTH |
PRADAXA 150 MG PELLET PACK | 60/MONTH |
PRADAXA 20 MG PELLET PACK | 60/MONTH |
PRADAXA 30 MG PELLET PACK | 120/MONTH |
PRADAXA 40 MG PELLET PACK | 120/MONTH |
PRADAXA 50 MG PELLET PACK | 120/MONTH |
PRADAXA 75 MG CAPSULE | 60/MONTH |
SAVAYSA TABLET | 30/MONTH |
SOTYKTU 6 MG TABLET | 30/MONTH |
TRACLEER 125 MG TABLET | 60/MONTH |
TRACLEER 32 MG TABLET FOR SUSP | 120/MONTH |
TRACLEER 62.5 MG TABLET | 60/MONTH |
TRUQAP 160 MG TABLET | 64/21DAYS |
TRUQAP 200 MG TABLET | 64/21DAYS |
TYVASO 1.74 MG/2.9 ML SOLUTION | 81.2 ML/28DAYS |
TYVASO DPI 16 MCG CARTRIDGE | 4/DAY |
TYVASO DPI 16-32 MCG TITR KIT | 196/180DAYS |
TYVASO DPI 16-32-48 MCG TITRAT | 252/180DAYS |
TYVASO DPI 32 MCG CARTRIDGE | 4/DAY |
TYVASO DPI 32-48 MCG MAINT KIT | 8/DAY |
TYVASO DPI 48 MCG CARTRIDGE | 4/DAY |
TYVASO DPI 64 MCG CARTRIDGE | 4/DAY |
TYVASO INHALATION REFILL KIT | 2.9/DAY |
TYVASO INHALATION STARTER KIT | 81.2/180 DAYS |
TYVASO INSTITUTIONAL START KIT | 11.6/180 DAYS |
UPTRAVI 1,000 MCG TABLET | 60/MONTH |
UPTRAVI 1,200 MCG TABLET | 60/MONTH |
UPTRAVI 1,400 MCG TABLET | 60/MONTH |
UPTRAVI 1,600 MCG TABLET | 60/MONTH |
UPTRAVI 200 MCG TABLET | 60/MONTH |
UPTRAVI 200-800 TITRATION PACK | 200/180 DAYS |
UPTRAVI 400 MCG TABLET | 60/MONTH |
UPTRAVI 600 MCG TABLET | 60/MONTH |
UPTRAVI 800 MCG TABLET | 60/MONTH |
VENTAVIS SOLUTION | 9/DAY |
VTAMA 1% CREAM | 60/23 DAYS |
XARELTO 1 MG/ML SUSPENSION | 27.68/DAY |
XARELTO 10 MG TABLET | 30/MONTH |
XARELTO 15 MG TABLET | 30/MONTH |
XARELTO 2.5 MG TABLET | 60/MONTH |
XARELTO 20 MG TABLET | 30/MONTH |
XARELTO DVT-PE TREAT START 30D | 51/180 DAYS |
ZORYVE 0.3% CREAM | 60/23 DAYS |
ZURZUVAE 20 MG CAPSULE | 28/265 DAYS |
ZURZUVAE 25 MG CAPSULE | 28/365 DAYS |
ZURZUVAE 30 MG CAPSULE | 14/365 DAYS |
Medicare Advantage Plans Drugs Removed from Formulary in 2025 |
|---|
ADALIMUMAB-ADAZ (CF) 40 MG SYRG |
ADALIMUMAB-ADAZ (CF) PEN 40 MG |
ADALIMUMAB-ADBM (CF) 10 MG SYRG |
ADALIMUMAB-ADBM (CF) 20 MG SYRG |
ADALIMUMAB-ADBM (CF) 40 MG SYRG |
ADALIMUMAB-ADBM (CF) CRHN 40 MG |
ADALIMUMAB-ADBM (CF) PEN 40 MG |
ADALIMUMAB-ADBM (CF) PS-UV 40 MG |
AFLURIA TRIVA 2024-25 (3 YR UP) |
AFLURIA TRIVALENT 2024-25 VIAL |
ALREX 0.2% EYE DROPS |
APOKYN 30 MG/3 ML CARTRIDGE |
APOMORPHINE 30 MG/3 ML CARTRDG |
AZASITE 1% EYE DROPS |
BEPOTASTINE 1.5% EYE DROP |
BESIVANCE 0.6% SUSP |
BICILLIN C-R 1.2 MILLION UNIT |
BICILLIN C-R 900-300 SYRINGE |
BROMSITE 0.075% EYE DROPS |
CALCITRIOL 3 MCG/G OINTMENT |
CALCIUM ACETATE 667 MG CAPSULE |
CALCIUM ACETATE 667 MG GELCAP |
CALCIUM ACETATE 667 MG TABLET |
CEFACLOR ER 500 MG TABLET |
CHENODAL 250 MG TABLET |
CHOLBAM 250 MG CAPSULE |
CHOLBAM 50 MG CAPSULE |
CIMETIDINE 200 MG TABLET |
CIMETIDINE 300 MG TABLET |
CIMETIDINE 300 MG/5 ML SOLUTION |
CIMETIDINE 400 MG TABLET |
CIMETIDINE 400 MG/6.67 ML SOLUTION |
CIMETIDINE 800 MG TABLET |
CLODAN 0.05% SHAMPOO |
COMIRNATY 2024-25(12Y UP) SYRG |
CORLANOR 5 MG/5 ML ORAL SOLUTION |
DESONIDE 0.05% GEL |
DESONIDE 0.05% LOTION |
DESRX 0.05% GEL |
DIGOXIN 62.5 MCG TABLET |
DIPHENHYDRAMINE 12.5 MG/5 ML CUP |
DIPHENHYDRAMINE 25 MG/10 ML CUP |
E.E.S. 400 MG TABLET |
ELETRIPTAN HBR 20 MG TABLET |
ELETRIPTAN HBR 40 MG TABLET |
EMEND 125 MG POWDER PACKET |
EPCLUSA 150-37.5 MG PELLET PKT |
EPCLUSA 200 MG-50 MG TABLET |
EPCLUSA 200-50 MG PELLET PACK |
EPCLUSA 400 MG-100 MG TABLET |
FESOTERODINE ER 4 MG TABLET |
FESOTERODINE ER 8 MG TABLET |
FIRDAPSE 10 MG TABLET |
FLAVOXATE HCL 100 MG TABLET |
FLUAD TRIVALENT 2024-2025 SYR |
FLUARIX TRIVALENT 2024-25 SYRG |
FLUBLOK TRIVALENT 2024-25 SYRG |
FLUCELVAX TRIVAL 2024-2025 SYR |
FLUCELVAX TRIVAL 2024-2025 VL |
FLULAVAL TRIVALENT 2024-25 SYR |
FLUMIST TRIVALNT NASAL 2024-25 |
FLUOXETINE DR 90 MG CAPSULE |
FLUOXETINE HCL 10 MG TABLET |
FLUOXETINE HCL 20 MG TABLET |
FLUVOXAMINE ER 100 MG CAPSULE |
FLUVOXAMINE ER 150 MG CAPSULE |
FLUZONE HIGH-DOSE TRIV 2024-25 |
FLUZONE TRIVALENT 2024-25 SYRG |
FLUZONE TRIVALENT 2024-25 VIAL |
FOLOTYN 20 MG/ML VIAL |
FOLOTYN 40 MG/2 ML VIAL |
FOSAMAX PLUS D 70 MG-2800 UNIT |
FOSAMAX PLUS D 70 MG-5600 UNIT |
GLYCOPYRROLATE 1.5 MG TABLET |
GRALISE ER 300 MG TABLET |
GRALISE ER 450 MG TABLET |
GRALISE ER 600 MG TABLET |
GRALISE ER 750 MG TABLET |
GRALISE ER 900 MG TABLET |
HALAVEN 1 MG/2 ML VIAL |
HARVONI 33.75-150 MG PELLET PK |
HARVONI 45-200 MG PELLET PACKT |
HARVONI 45-200 MG TABLET |
HARVONI 90-400 MG TABLET |
HYDROCODONE-ACETAMIN 10-300 MG |
HYDROCODONE-ACETAMIN 5-300 MG |
HYDROCODONE-ACETAMIN 7.5-300 |
HYDROCODONE-IBUPROFEN 10-200 |
HYDROCODONE-IBUPROFEN 5-200 MG |
HYRIMOZ(CF) 10 MG/0.1 ML SYRNG |
HYRIMOZ(CF) 20 MG/0.2 ML SYRNG |
HYRIMOZ(CF) 40 MG/0.4 ML SYRNG |
HYRIMOZ(CF) PEDI CROHN 80 MG |
HYRIMOZ(CF) PEDI CROHN 80-40 MG |
HYRIMOZ(CF) PEN 40 MG/0.4 ML |
HYRIMOZ(CF) PEN 80 MG/0.8 ML |
HYRIMOZ(CF) PEN CROHN-UC 80 MG |
HYRIMOZ(CF) PEN PSORIA 80-40 MG |
IMIPRAMINE PAMOATE 100 MG CAP |
IMIPRAMINE PAMOATE 125 MG CAP |
IMIPRAMINE PAMOATE 150 MG CAP |
IMIPRAMINE PAMOATE 75 MG CAP |
INSULIN GLARGINE 100 UNIT/ML |
INSULIN GLARGINE SOLOSTAR U100 |
ISOTRETINOIN 25 MG CAPSULE |
ISOTRETINOIN 35 MG CAPSULE |
IVERMECTIN 1% CREAM |
JUXTAPID 10 MG CAPSULE |
JUXTAPID 20 MG CAPSULE |
JUXTAPID 30 MG CAPSULE |
JUXTAPID 5 MG CAPSULE |
KEPIVANCE 5.16 MG VIAL |
KEPIVANCE 6.25 MG VIAL |
KORLYM 300 MG TABLET |
LAGEVRIO 200 MG CAP (EUA) |
LAMOTRIGINE ODT KIT (BLUE) |
LAMOTRIGINE ODT KIT (GREEN) |
LAMOTRIGINE ODT KIT (ORANGE) |
LAMOTRIGINE TAB START KIT-BLUE |
LAMOTRIGINE TAB START KT-GREEN |
LAMOTRIGINE TAB START KT-ORANG |
LEUKINE 250 MCG VIAL |
LEVALBUTEROL 0.31 MG/3 ML SOL |
LEVALBUTEROL 0.63 MG/3 ML SOL |
LEVALBUTEROL 1.25 MG/3 ML SOL |
LEVALBUTEROL CONC 1.25 MG/0.5 |
LEVONO-E ESTRAD 0.15-0.03-0.01 |
LEVONOR-ETH ESTRA 0.09-0.02 MG |
MENEST 0.3 MG TABLET |
MENEST 0.625 MG TABLET |
MENEST 1.25 MG TABLET |
MENEST 2.5 MG TABLET |
METOPROLOL TARTRATE 37.5 MG TB |
METOPROLOL TARTRATE 75 MG TAB |
MODERNA COVID 24-25(6M-11Y)EUA |
MOVANTIK 12.5 MG TABLET |
MOVANTIK 25 MG TABLET |
MOZOBIL 24 MG/1.2 ML VIAL |
MYALEPT 11.3 MG (5 MG/ML) VIAL |
NAFTIFINE HCL 1% CREAM |
NAFTIFINE HCL 2% CREAM |
NISOLDIPINE ER 17 MG TABLET |
NISOLDIPINE ER 20 MG TABLET |
NISOLDIPINE ER 25.5 MG TABLET |
NISOLDIPINE ER 30 MG TABLET |
NISOLDIPINE ER 34 MG TABLET |
NISOLDIPINE ER 40 MG TABLET |
NISOLDIPINE ER 8.5 MG TABLET |
OLANZAPINE-FLUOXETINE 12-25 MG |
OLANZAPINE-FLUOXETINE 12-50 MG |
OLANZAPINE-FLUOXETINE 3-25 MG |
OLANZAPINE-FLUOXETINE 6-25 MG |
OLANZAPINE-FLUOXETINE 6-50 MG |
OMNIPOD CLASSIC PDM KIT (GEN 3) |
OMNIPOD CLASSIC PODS (GEN 3) 5-PK |
PEG3350 100-7.5-2.691-1.01-5.9 |
PENTASA 250 MG CAPSULE |
PERSERIS ER 120 MG SYRINGE KIT |
PERSERIS ER 90 MG SYRINGE KIT |
PFIZER COVID 2024-25(5-11Y) EUA |
PFIZER COVID 2024-25(6M-4Y) EUA |
PHOSPHOLINE IODIDE 0.125% DROP |
PLASMA-LYTE A PH 7.4 SOLUTION |
PREVIDENT 5000 1.1% DRY MOUTH |
PREVIDENT 5000 BOOSTER PLUS |
PROLENSA 0.07% EYE DROPS |
QTERN 10 MG-5 MG TABLET |
QTERN 5 MG-5 MG TABLET |
RECTIV 0.4% OINTMENT |
REVCOVI 2.4 MG/1.5 ML VIAL |
RISPERDAL CONSTA 12.5 MG VIAL |
RISPERDAL CONSTA 25 MG VIAL |
RISPERDAL CONSTA 37.5 MG VIAL |
RISPERDAL CONSTA 50 MG VIAL |
SEVELAMER CARBONATE 800 MG TAB |
SILODOSIN 4 MG CAPSULE |
SILODOSIN 8 MG CAPSULE |
SIMLANDI(CF) AI 40 MG/0.4 ML |
SOMATULINE DEPOT 120 MG/0.5 ML |
SPIKEVAX 2024-25 (12Y UP) SYRG |
SUBVENITE TAB START KIT (BLUE) |
SUBVENITE TAB START KIT (GREEN) |
SUBVENITE TAB START KT (ORANGE) |
TAFLUPROST 0.0015% EYE DROP |
TALTZ 20 MG/0.25 ML SYRINGE |
TALTZ 40 MG/0.5 ML SYRINGE |
TALTZ 80 MG/ML AUTOINJ (2-PK) |
TALTZ 80 MG/ML AUTOINJ (3-PK) |
TALTZ 80 MG/ML AUTOINJECTOR |
TALTZ 80 MG/ML SYRINGE |
TARINA 24 FE 1 MG-20 MCG TAB |
TESTOSTERONE 10 MG GEL PUMP |
THEO-24 ER 100 MG CAPSULE |
THEO-24 ER 200 MG CAPSULE |
THEO-24 ER 300 MG CAPSULE |
THEO-24 ER 400 MG CAPSULE |
VANCOMYCIN HCL 100 GM SMARTPAK |
VANDAZOLE VAGINAL 0.75% GEL |
VECAMYL 2.5 MG TABLET |
VEKLURY 100 MG VIAL |
VELPHORO 500 MG CHEWABLE TAB |
V-GO 20 DISPOSABLE DEVICE |
V-GO 30 DISPOSABLE DEVICE |
V-GO 40 DISPOSABLE DEVICE |
VIIBRYD 10-20 MG STARTER PACK |
VIOKACE 10,440-39,150 UNIT TAB |
VIOKACE 20,880-78,300 UNITS TB |
VOTRIENT 200 MG TABLET |
XATMEP 2.5 MG/ML ORAL SOLUTION |
ZARXIO 300 MCG/0.5 ML SYRINGE |
ZARXIO 480 MCG/0.8 ML SYRINGE |
ZEGALOGUE 0.6 MG/0.6 ML SYRING |
ZEGALOGUE 0.6 MG/0.6 ML AUTOINJ |
ZIEXTENZO 6 MG/0.6 ML SYRINGE |
ZOLMITRIPTAN 2.5 MG ODT |
ZOLMITRIPTAN 2.5 MG TABLET |
ZOLMITRIPTAN 5 MG ODT |
Medicare Advantage Plans Tier Changes For 2025 | ||
|---|---|---|
Drug | Change | 2025 Tier |
CAPTOPRIL 100 MG TABLET | Tier Decreased | 1 |
CAPTOPRIL 50 MG TABLET | Tier Decreased | 1 |
CROMOLYN 20 MG/2 ML NEB SOLN | Tier Decreased | 3 |
DEFERASIROX 125 MG TB FOR SUSP | Tier Decreased | 3 |
DEFERASIROX 180 MG TABLET | Tier Decreased | 3 |
DEFERASIROX 360 MG TABLET | Tier Decreased | 3 |
DEFERASIROX 90 MG TABLET | Tier Decreased | 3 |
DEPO-SUBQ PROVERA 104 SYRINGE | Tier Decreased | 3 |
ELURYNG VAGINAL RING | Tier Decreased | 3 |
ENALAPRIL-HCTZ 10-25 MG TABLET | Tier Increased | 1 |
ETONOGESTREL-EE VAGINAL RING | Tier Decreased | 3 |
EVEROLIMUS 0.25 MG TABLET | Tier Decreased | 3 |
FELBAMATE 600 MG/5 ML SUSP | Tier Decreased | 4 |
GAVILYTE-C SOLUTION | Tier Decreased | 1 |
GAVILYTE-G SOLUTION | Tier Decreased | 1 |
GAVILYTE-N SOLUTION | Tier Decreased | 1 |
GLEOSTINE 10 MG CAPSULE | Tier Decreased | 4 |
LEUPROLIDE 2WK 14 MG/2.8 ML KT | Tier Decreased | 4 |
LURASIDONE HCL 120 MG TABLET | Tier Decreased | 4 |
LURASIDONE HCL 20 MG TABLET | Tier Decreased | 4 |
LURASIDONE HCL 40 MG TABLET | Tier Decreased | 4 |
LURASIDONE HCL 60 MG TABLET | Tier Decreased | 4 |
LURASIDONE HCL 80 MG TABLET | Tier Decreased | 4 |
MEROPENEM IV 1 GM VIAL | Tier Decreased | 3 |
MEROPENEM IV 500 MG VIAL | Tier Decreased | 3 |
MESALAMINE ER 500 MG CAPSULE | Tier Decreased | 4 |
MICAFUNGIN 100 MG VIAL | Tier Decreased | 4 |
MICAFUNGIN 50 MG VIAL | Tier Decreased | 4 |
NAYZILAM 5 MG NASAL SPRAY | Tier Decreased | 3 |
NEXPLANON 68 MG IMPLANT | Tier Decreased | 3 |
PAXLOVID 150-100 MG DOSE PACK | Tier Increased | 2 |
PAXLOVID 300-100 MG DOSE PACK | Tier Increased | 2 |
PEG 3350-ELECTROLYTE SOLUTION | Tier Decreased | 1 |
PEG-3350 AND ELECTROLYTES SOLN | Tier Decreased | 1 |
STAMARIL VIAL | Tier Decreased | 1 |
TRIUMEQ PD 60-5-30 MG TAB SUSP | Tier Decreased | 4 |
VALTOCO 10 MG NASAL SPRAY | Tier Decreased | 3 |
VALTOCO 15 MG NASAL SPRAY | Tier Decreased | 3 |
VALTOCO 20 MG NASAL SPRAY | Tier Decreased | 3 |
VALTOCO 5 MG NASAL SPRAY | Tier Decreased | 3 |
VENCLEXTA 10 MG TAB (10 MG X 2) | Tier Decreased | 3 |
VENCLEXTA 10 MG TABLET | Tier Decreased | 3 |
XULANE 150-35 MCG/DAY PATCH | Tier Decreased | 3 |
ZAFEMY 150-35 MCG/DAY PATCH | Tier Decreased | 3 |
AMOXICILLIN 125 MG/5 ML SUSP | Tier Increased | 2 |
AMOXICILLIN 250 MG CAPSULE | Tier Increased | 2 |
AMOXICILLIN 400 MG/5 ML SUSP | Tier Increased | 2 |
AMOXICILLIN 500 MG CAPSULE | Tier Increased | 2 |
AMOXICILLIN 500 MG TABLET | Tier Increased | 2 |
AMOXICILLIN 875 MG TABLET | Tier Increased | 2 |
AZELASTINE HCL 0.05% DROPS | Tier Increased | 3 |
BETAMETHASONE DP 0.05% CRM | Tier Increased | 3 |
BETAMETHASONE DP 0.05% LOT | Tier Increased | 3 |
BETAMETHASONE DP 0.05% OINT | Tier Increased | 3 |
BETAMETHASONE DP AUG 0.05% GEL | Tier Increased | 3 |
BETAMETHASONE DP AUG 0.05% LOT | Tier Increased | 3 |
BETAMETHASONE DP AUG 0.05% OIN | Tier Increased | 3 |
BETAMETHASONE VA 0.1% CREAM | Tier Increased | 3 |
BETAMETHASONE VA 0.1% LOTION | Tier Increased | 3 |
BETAMETHASONE VALER 0.1% OINTM | Tier Increased | 3 |
CARBAMAZEPINE 100 MG TAB CHEW | Tier Increased | 2 |
CARBAMAZEPINE 200 MG TABLET | Tier Increased | 2 |
CARBIDOPA 25 MG TABLET | Tier Increased | 4 |
CINACALCET HCL 90 MG TABLET | Tier Increased | 5 |
CIPROFLOXACIN HCL 250 MG TAB | Tier Increased | 2 |
CIPROFLOXACIN HCL 500 MG TAB | Tier Increased | 2 |
COLISTIMETHATE 150 MG VIAL | Tier Increased | 5 |
DIAZOXIDE 50 MG/ML ORAL SUSP | Tier Increased | 5 |
DONEPEZIL HCL ODT 10 MG TABLET | Tier Increased | 2 |
DONEPEZIL HCL ODT 5 MG TABLET | Tier Increased | 2 |
EMTRICITABINE-TENOFV 100-150 MG | Tier Increased | 5 |
HYDROCORTISONE-ACETIC EAR DROP | Tier Increased | 4 |
LACOSAMIDE 50 MG TABLET | Tier Increased | 4 |
LANSOPRAZOLE DR 15 MG CAPSULE | Tier Increased | 3 |
LANSOPRAZOLE DR 30 MG CAPSULE | Tier Increased | 3 |
LITHIUM CARBONATE 150 MG CAP | Tier Increased | 2 |
LITHIUM CARBONATE 300 MG CAP | Tier Increased | 2 |
LITHIUM CARBONATE 300 MG TAB | Tier Increased | 2 |
LITHIUM CARBONATE 600 MG CAP | Tier Increased | 2 |
LITHIUM CARBONATE ER 300 MG TB | Tier Increased | 2 |
LITHIUM CARBONATE ER 450 MG TB | Tier Increased | 2 |
METHIMAZOLE 10 MG TABLET | Tier Increased | 2 |
METHIMAZOLE 5 MG TABLET | Tier Increased | 2 |
METHOTREXATE 2.5 MG TABLET | Tier Increased | 2 |
METOCLOPRAMIDE 10 MG TABLET | Tier Increased | 2 |
METOCLOPRAMIDE 5 MG TABLET | Tier Increased | 2 |
NEOMYCIN-POLY-HC EYE DROPS | Tier Increased | 4 |
OXCARBAZEPINE 150 MG TABLET | Tier Increased | 3 |
OXCARBAZEPINE 300 MG TABLET | Tier Increased | 3 |
OXCARBAZEPINE 300 MG/5 ML CUP | Tier Increased | 4 |
OXCARBAZEPINE 300 MG/5 ML SUSP | Tier Increased | 4 |
OXCARBAZEPINE 600 MG TABLET | Tier Increased | 3 |
PERIOGARD 0.12% ORAL RINSE | Tier Increased | 2 |
PREGABALIN 100 MG CAPSULE | Tier Increased | 3 |
PREGABALIN 150 MG CAPSULE | Tier Increased | 3 |
PREGABALIN 20 MG/ML SOLUTION | Tier Increased | 3 |
PREGABALIN 200 MG CAPSULE | Tier Increased | 3 |
PREGABALIN 225 MG CAPSULE | Tier Increased | 3 |
PREGABALIN 25 MG CAPSULE | Tier Increased | 3 |
PREGABALIN 300 MG CAPSULE | Tier Increased | 3 |
PREGABALIN 50 MG CAPSULE | Tier Increased | 3 |
PREGABALIN 75 MG CAPSULE | Tier Increased | 3 |
PROGESTERONE 100 MG CAPSULE | Tier Increased | 3 |
PROGESTERONE 200 MG CAPSULE | Tier Increased | 3 |
TESTOSTERONE 1% (25 MG/2.5 G) PK | Tier Increased | 4 |
TESTOSTERONE 1% (50 MG/5 G) PK | Tier Increased | 4 |
TESTOSTERONE 50 MG/5 GRAM GEL | Tier Increased | 4 |
TILIA FE 28 TABLET | Tier Increased | 4 |
TRI-LEGEST FE-28 DAY TABLET | Tier Increased | 4 |
ZYPREXA RELPREVV 210 MG VL KIT | Tier Increased | 4 |
Medicare - CNY PDP New Quantity Limits for 2025 | |
|---|---|
Drug | Amount/Frequency |
SOTYKTU 6 MG | 1/DAY |
PIQRAY 200 MG | 1/DAY |
PIQRAY 250 MG, 300 MG | 2/DAY |
LYTGOBI 12 MG | 3/DAY |
LYTGOBI 16 MG | 4/DAY |
LYTGOBI 20 MG | 5/DAY |
LUMAKRAS 120 MG | 8/DAY |
LUMAKRAS 320 MG | 3/DAY |
ISTURISA 5 MG | 12/DAY |
VTAMA | 60 GM/23 DAYS |
ZURZUVAE 20 MG, 25 MG | 28/365 DAYS |
ZURZUVAE 30 MG | 14/365 DAYS |
ZORYVE 0.3% CREAM | 60 GM/23 DAYS |
PAXLOVID 150-100 | 20 UNIT/90 DAYS |
ORAL PAXLOVID 300-100 MG/150 (2) | 30/90 DAYS |
City of NY PPO Removed From Formulary in 2025 | |
|---|---|
Drug | Alternative(s) |
STEGLATRO | FARXIGA, JARDIANCE |
TRUDHESA | DIHYDROERGOTAMINE MESYLATE |
RELISTOR | LUBIPROSTONE |
VYZULTA | BIMATOPROST, LATANOPROST |
BASAGLAR TEMPO PEN U-100 | INSULIN GLARGINE-YFGN, SEMGLEE (YFGN) PEN, TOUJEO SOLOSTAR |
KARBINAL ER | CARBINOXAMINE MALEATE, CETIRIZINE HCL, CLEMASTINE FUMARATE |
LUMIGAN | BIMATOPROST |
HUMALOG | INSULIN LISPRO |
SEGLUROMET | SYNJARDY, SYNJARDY XR, XIGDUO XR |
DYMISTA | AZELASTINE-FLUTICASONE |
BASAGLAR KWIKPEN U-100 | INSULIN GLARGINE-YFGN, SEMGLEE (YFGN) PEN, TOUJEO SOLOSTAR |
WEGOVY, ZEPBOUND |
|
ALVESCO | ARNUITY ELLIPTA, ASMANEX HFA, ASMANEX TWISTHALER, QVAR REDIHALER |
FLOVENT DISKUS | ARNUITY ELLIPTA, ASMANEX HFA, ASMANEX TWISTHALER, QVAR REDIHALER |
FLOVENT HFA | ARNUITY ELLIPTA, ASMANEX HFA, ASMANEX TWISTHALER, QVAR REDIHALER |
XYREM | SODIUM OXYBATE, XYWAV |
GILENYA | FINGOLIMOD |
METHYLPHENIDATE ER | METHYLPHENIDATE ER CAPSULES/TABLETS (EXCEPT 45MG, 63MG OR 72MG.) OR ER TABLETS (EXCEPT 45MG, DYANAVEL XR, MYDAYVIS, QUILLICHEW ER, QUILLIVANT XR, VYVANSE MYDAYIS, QUILLICHEW ER, VYVANSE |
ADVAIR DISKUS | FLUTICASONE PROPIONATE - SALMETEROL XINAFOATE |
FANAPT | ARIPIPRAZOLE, ASENAPINE, LURASIDONE, OLANZAPINE, QUETIAPINE |
City of NY HMO Drugs Removed from Formulary In 2025 | |
|---|---|
Drug | Alternative(s) |
EUFLEXXA | MONOVISC, ORTHOVISC |
STEGLATRO | FARXIGA, JARDIANCE |
FORTEO | TERIPARATIDE |
RELISTOR | LUBIPROSTONE, MOVANTIK, SYMPROIC |
VYZULTA | BIMATOPROST, LATANOPROST, TAFLUPROST |
BASAGLAR TEMPO PEN U-100 | INSULIN GLARGINE-YFGN, SEMGLEE (YFGN) PEN, TOUJEO SOLOSTAR |
HUMIRA PEN | ADALIMUMAB-ADAZ (CF) PEN, ADALIMUMAB-ADBM(CF)PEN, ADALIMUMAB-RYVK (CF) AUTOINJECT |
HUMIRA | ADALIMUMAB-ADAZ (CF) PEN, ADALIMUMAB-ADBM(CF)PEN, ADALIMUMAB-RYVK (CF) AUTOINJECT |
HUMIRA (CF) | ADALIMUMAB-ADAZ (CF) PEN, ADALIMUMAB-ADBM(CF)PEN, ADALIMUMAB-RYVK (CF) AUTOINJECT |
LUMIGAN | BIMATOPROST, LATANOPROST, TAFLUPROST |
HUMALOG | INSULIN LISPRO |
HUMIRA (CF) PEN CROHN'S-UC-HS | ADALIMUMAB-ADAZ(CF) PEN , ADALIMUMAB-ADBM (CF) PEN, ADALIMUMAB-RYVK(CF) AUTOINJECT |
SEGLUROMET | SYNJARDY, SYNJARDY XR, XIGDUO XR |
BASAGLAR KWIKPEN U-100 | INSULIN GLARGINE-YFGN, SEMGLEE (YFGN) PEN, TOUJEO SOLOSTAR |
HUMIRA (CF) PEN | ADALIMUMAB-ADAZ (CF) PEN, ADALIMUMAB-ADBM (CF) PEN, ADALIMUMAB-RYVK (CF) AUTOINJECT |
WEGOVY, ZEPBOUND |
|
ADVAIR DISKUS | FLUTICASONE-SALMETEROL, |
ALVESCO | ARNUITY ELLIPTA, ASMANEX HFA, ASMANEX TWISTHALER, |
APLENZIN | BUPROPION XL |
AUBAGIO |
|
BOTOX | DYSPORT, MYOBLOC, MIGRAINE - AIMOVIG, AJOVY, EMGALITY, QULIPTA |
CHORIONIC GONADOTROPIN | NOVAREL, OVIDREL |
CITRANATAL ASSURE |
|
COPAXONE | GENERIC EQUIVALENT AVAILABLE, GLATIRAMER ACETATE |
DYANAVEL XR | DEXTROAMPHETAMINE ER, DEXTROAMPHETAMINE/AMPHETAMINE |
FLOVENT DISKUS | ARNUITY ELLIPTA, ASMANEX HFA, ASMANEX TWISTHALER |
FLOVENT HFA | ARNUITY ELLIPTA, ASMANEX HFA, ASMANEX TWISTHALER |
IBRANCE | KISQALI, VERZENIO |
LATUDA | LURASIDONE HCL |
LEVEMIR FLEXPEN | SEMGLEE (YFGN) PEN, TOUJEO SOLOSTAR, TRESIBA FLEXTOUCH U-100 |
LEVEMIR FLEXTOUCH | SEMGLEE (YFGN) PEN, TOUJEO SOLOSTAR, TRESIBA FLEXTOUCH U-100 |
NORDITROPIN FLEXPRO | GENOTROPIN, OMNITROPE |
QUILLIVANT XR | DEXMETHYLPHENIDATE ER, DEXTROAMPHETAMINE/AMPHETAMINE |
SEREVENT DISKUS | STRIVERDI RESPIMAT |
SYMBICORT | BREYNA, BUDESONIDE-FORMOTEROL FUMARATE |
ZARXIO | NIVESTYM |
Small Group/Essential/Individual Plans Removed From Formulary in 2025 | |
|---|---|
Drug | Alternative(s) |
EUFLEXXA | MONOVISC, ORTHOVISC |
STEGLATRO | FARXIGA, JARDIANCE |
FANAPT | ARIPIPRAZOLE, ASENAPINE MALEATE, LURASIDONE HCL |
FORTEO | TERIPARATIDE |
RELISTOR | LUBIPROSTONE, MOVANTIK, SYMPROIC |
VYZULTA | BIMATOPROST, LATANOPROST, TAFLUPROST |
HUMIRA PEN | ADALIMUMAB-ADAZ (CF) PEN, ADALIMUMAB-ADBM(CF)PEN, ADALIMUMAB-RYVK (CF) AUTOINJECT |
HUMIRA (CF) | ADALIMUMAB-ADAZ(CF) PEN, ADALIMUMAB-ADBM (CF) PEN, ADALIMUMAB-RYVK (CF) AUTOINJECT |
LUMIGAN | BIMATOPROST, LATANOPROST, TAFLUPROST |
HUMALOG | INSULIN LISPRO |
HUMIRA (CF) PEN CROHN'S-UC-HS | ADALIMUMAB-ADAZ (CF) PEN, ADALIMUMAB-ADBM (CF) PEN, ADALIMUMAB-RYVK (CF) AUTOINJECT |
SEGLUROMET | SYNJARDY, SYNJARDY XR, XIGDUO XR |
BASAGLAR KWIKPEN U-100 | INSULIN GLARGINE-YFGN, SEMGLEE (YFGN) PEN, TOUJEO SOLOSTAR |
HUMIRA (CF) PEN | ADALIMUMAB-ADAZ (CF) PEN, ADALIMUMAB-ADBM (CF) PEN, ADALIMUMAB-RYVK (CF) AUTOINJECT |
SAXENDA | WEGOVY, ZEPBOUND |
ALVESCO | ARNUITY ELLIPTA, ASMANEX HFA, ASMANEX TWISTHALER, QVAR REDIHALER |
FLOVENT DISKUS | ARNUITY ELLIPTA, ASMANEX HFA, ASMANEX TWISTHALER, QVAR REDIHALER |
FLOVENT HFA | ARNUITY ELLIPTA, ASMANEX HFA, ASMANEX TWISTHALER, QVAR REDIHALER |
XYREM | SODIUM OXYBATE, XYWAV |
ADVAIR DISKUS | FLUTICASONE PROPIONATE - SALMETEROL XINAFOATE |
COPAXONE | GLATIRAMER ACETATE |
ENDOMETRIN | CRINONE 8% |
Commercial Large Group Drugs Removed from Formulary In 2025 | |
|---|---|
Drug | Alternative(s) |
EUFLEXXA | MONOVISC, ORTHOVISC |
STEGLATRO | FARXIGA, JARDIANCE |
FORTEO | TERIPARATIDE |
RELISTOR | LUBIPROSTONE, MOVANTIK. SYMPROIC |
VYZULTA | BIMATOPROST, LATANOPROST, TAFLUPROST |
BASAGLAR TEMPO PEN U-100 | INSULIN GLARGINE-YFGN, SEMGLEE (YFGN) PEN, TOUJEO SOLOSTAR |
HUMIRA PEN | ADALIMUMAB-ADAZ (CF) PEN, ADALIMUMAB-ADBM (CF) PEN, ADALIMUMAB-RYVK (CF) AUTOINJECT |
HUMIRA | ADALIMUMAB-ADAZ (CF) PEN, ADALIMUMAB-ADBM (CF) PEN, ADALIMUMAB-RYVK (CF) AUTOINJECT |
HUMIRA(CF) | ADALIMUMAB-ADAZ (CF) PEN, ADALIMUMAB-ADBM (CF) PEN, ADALIMUMAB-RYVK (CF) AUTOINJECT |
LUMIGAN | BIMATOPROST, LATANOPROST, TAFLUPROST |
HUMALOG | INSULIN LISPRO |
HUMIRA (CF) PEN CROHN'S-UC-HS | ADALIMUMAB-ADAZ (CF) PEN, ADALIMUMAB-ADBM (CF) PEN, ADALIMUMAB-RYVK (CF) AUTOINJECT |
SEGLUROMET | SYNJARDY, SYNJARDY XR, XIGDUO XR |
BASAGLAR KWIKPEN U-100 | INSULIN GLARGINE-YFGN, SEMGLEE (YFGN) PEN, TOUJEO SOLOSTAR |
HUMIRA (CF) PEN | ADALIMUMAB-ADAZ (CF) PEN, ADALIMUMAB-ADBM (CF) PEN, ADALIMUMAB-RYVK (CF) AUTOINJECT |
SAXENDA | WEGOVY, ZEPBOUND |
ADVAIR DISKUS | FLUTICASONE-SALMETEROL, |
ALVESCO | ARNUITY ELLIPTA, ASMANEX HFA, ASMANEX TWISTHALER, |
APLENZIN | BUPROPION XL |
AUBAGIO |
|
BOTOX | DYSPORT, MYOBLOC, MIGRAINE - AIMOVIG, AJOVY, EMGALITY, QULIPTA |
CHORIONIC GONADOTROPIN | NOVAREL, OVIDREL |
CITRANATAL ASSURE |
|
COPAXONE | GENERIC EQUIVALENT AVAILABLE, GLATIRAMER ACETATE |
DYANAVEL XR | DEXTROAMPHETAMINE ER, DEXTROAMPHETAMINE/AMPHETAMINE, |
FLOVENT DISKUS | ARNUITY ELLIPTA, ASMANEX HFA, ASMANEX TWISTHALER, |
FLOVENT HFA | ARNUITY ELLIPTA, ASMANEX HFA, ASMANEX TWISTHALER, |
IBRANCE | KISQALI, VERZENIO |
LATUDA | LURASIDONE HCL |
LEVEMIR FLEXPEN | SEMGLEE (YFGN) PEN, TOUJEO SOLOSTAR, TRESIBA FLEXTOUCH U-100 |
LEVEMIR FLEXTOUCH | SEMGLEE (YFGN) PEN, TOUJEO SOLOSTAR, TRESIBA FLEXTOUCH U-100 |
NORDITROPIN FLEXPRO | GENOTROPIN, OMNITROPE |
QUILLIVANT XR | DEXMETHYLPHENIDATE ER, DEXTROAMPHETAMINE/AMPHETAMINE |
SEREVENT DISKUS | STRIVERDI RESPIMAT |
SYMBICORT | BREYNA, BUDESONIDE-FORMOTEROL FUMARATE |
ZARXIO | NIVESTYM |
JP67293: 10/2024
