Medicaid |
Perforomist |
Brand Removal |
FORMOTEROL FUMARATE |
Medicaid |
Remodulin |
Brand Removal |
TREPROSTINIL |
Medicare Advantage Plans |
Incruse Ellipta |
Removed from Formulary |
SPIRIVA HANDIHALER & SPIRIVA RESPIMAT |
Medicare Advantage Plans |
Saphris |
Brand Removal |
ASENAPINE (generic) |
Medicare Advantage Plans |
Tecfidera |
Brand Removal |
DIMETHYL FUMARATE (generic) |
Medicare Advantage Plans |
Zytiga |
Brand Removal |
ABIRATERONE ACETATE (generic) |
Medicare Advantage Plans |
Lubiprosotone |
Needs Step Therapy |
LINZESS & MOVANTIK |
Medicare Advantage Plans |
Trulance |
Tier Increase to T4 |
LINZESS |
Medicare Advantage Plans |
Ciprodex |
Removed from Formulary |
CIPROFLOXACIN/DEXAMETHASONE (generic) |
Medicare Advantage Plans |
Pazeo |
Removed from Formulary |
AZELASTINE, OLOPATADINE & CROMOLYN SODIUM |
Medicare Advantage Plans |
Atripla |
Removed from Formulary |
EFAVIRENZ/EMTRICITABINE/TENOFOVIR DISOPROXIL FUMARATE (generic) |
Medicare Advantage Plans |
Truvada |
Removed from Formulary |
EMTRICITABINE/TENOFOVIR DISOPROXIL FUMARATE (generic) |
Medicare Advantage Plans |
Lopinavir/Ritonavir |
Tier Increase to T4 |
n/a |
Medicare - CNY PDP |
Anoro Ellipta |
Step Therapy Added or Updated |
STIOLTO RESPIMAT |
Medicare - CNY PDP |
Incruse Ellipta |
Step Therapy Added or Updated |
SPIRIVA HANDIHALER & SPIRIVA RESPIMAT |
Medicare - CNY PDP |
Budesonide-Formoterol |
Step Therapy Added or Updated |
SYMBICORT, DULERA, BREO |
Medicare - CNY PDP |
Invokana |
Step Therapy Added or Updated |
FARXIGA, JARDIANCE, STEGLATRO |
Medicare - CNY PDP |
NovoLog |
Step Therapy Added or Updated |
HUMALOG |
Medicare - CNY PDP |
Tradjenta |
Step Therapy Added or Updated |
JANUVIA, ONGLYZA, KOMBIGLYZE |
Medicare - CNY PDP |
Xiidra Ophthalmic |
Step Therapy Added or Updated |
RESTASIS |
Medicare - CNY PDP |
Cabometyx |
New Quantity Limit: 30/30 Days |
n/a |
Medicare - CNY PDP |
Sevelamer Carbonate |
New Quantity Limit: 9/Days |
n/a |
Medicare - CNY PDP |
Vimpat |
New Quantity Limit: 60/30 Days |
n/a |
Medicare - CNY PDP |
Invega Sustenna |
New Quantity Limit: 1/Fill |
n/a |
Medicare - CNY PDP |
Cinacalcet tablets |
Preauthorization Requirement Added or Updated |
n/a |
Medicare - CNY PDP |
Cimzia |
Preauthorization Requirement Added or Updated |
n/a |
Medicare - CNY PDP |
Octreotide |
Preauthorization Requirement Added or Updated |
n/a |
City of NY PPO |
Tradjenta |
Removed from Formulary |
JANUVIA |
City of NY PPO |
Ventolin HFA |
Removed from Formulary |
ALBUTEROL SULFATE HFA |
City of NY PPO |
Jentadueto/Jentadueto XR |
Removed from Formulary |
JANUMET, JANUMET XR |
City of NY PPO |
ProAir HFA/ProAir RespiClick |
Removed from Formulary |
ALBUTEROL SULFATE HFA |
City of NY PPO |
Invokana |
Removed from Formulary |
FARXIGA, JARDIANCE, STEGLATRO |
City of NY PPO |
Invokamet/Invokamet XR |
Removed from Formulary |
SEGLUROMET, SYNJARDY XR |
City of NY PPO |
Praluent pen |
Removed from Formulary |
REPATHA SURECLICK |
City of NY PPO |
Synthroid |
Removed from Formulary |
EUTHYROX, LEVO-T, LEVOTHYROXTINE SODIUM |
City of NY PPO |
NovoLog products |
Removed from Formulary |
HUMALOG PRODUCTS |
City of NY PPO |
Victoza |
Removed from Formulary |
BYDUREON, BYETTA, OZEMPIC |
City of NY PPO |
Synthroid |
Removed from Formulary |
EUTHYROX, LEVO-T, LEVOTHYROXINE SODIUM |
City of NY PPO |
Novolin products |
Removed from Formulary |
HUMULIN PRODUCTS |
City of NY PPO |
Lo Loestrin FE 1-10 |
Removed from Formulary |
BLISOVI FE, HAILEY FE |
City of NY PPO |
Invokana |
Removed from Formulary |
FARXIGA, JARDIANCE, STEGLATRO |
Small Group/Essential/Individual Plans |
Synthroid |
Preauthorization Requirement Added |
EUTHYROX, LEVOTHYROXINE SODIUM, LEVOXYL |
Small Group/Essential/Individual Plans |
Ventolin HFA |
Preauthorization Requirement Added |
ALBUTEROL SULFATE HFA |
Small Group/Essential/Individual Plans |
Lo Loestrin FE 1-10 |
Preauthorization Requirement Added |
BLISOVI 24 FE, HAILEY FE, JUNEL FE |
Small Group/Essential/Individual Plans |
NovoLog |
Preauthorization Requirement Added |
HUMALOG |
Small Group/Essential/Individual Plans |
Onglyza |
Preauthorization Requirement Added |
JANUVIA |
Small Group/Essential/Individual Plans |
Bystolic |
Preauthorization Requirement Added |
ATENOLOL, CARVEDILOL, METOPROLOL SUCCINATE |
Small Group/Essential/Individual Plans |
Invokana |
Preauthorization Requirement Added |
FARXIGA, JARDIANCE, STEGLATRO |
Small Group/Essential/Individual Plans |
Victoza |
Preauthorization Requirement Added |
BYDUREON, BYETTA, OZEMPIC, TRULICITY |
Small Group/Essential/Individual Plans |
Lumigan |
Preauthorization Requirement Added |
BIMATOPROST, LATANOPROST, TRAVOPROST |
Small Group/Essential/Individual Plans |
Praluent |
Preauthorization Requirement Added |
REPATHA |
Small Group/Essential/Individual Plans |
Advair |
New Quantity Limit: 1/Month |
n/a |
Small Group/Essential/Individual Plans |
Arnuity |
New Quantity Limit: 1/Month |
n/a |
Small Group/Essential/Individual Plans |
Incruse Ellipta |
New Quantity Limit: 1/Month |
n/a |
Small Group/Essential/Individual Plans |
Dulera |
New Quantity Limit: 1/Month |
n/a |
Small Group/Essential/Individual Plans |
Ajovy |
New Quantity Limit: 2/Month (3ML Total) |
n/a |
Small Group/Essential/Individual Plans |
Emgality |
New Quantity Limit: 1/Month |
n/a |
Small Group/Essential/Individual Plans |
Copaxone |
New Quantity Limit: 1/Month |
n/a |
Small Group/Essential/Individual Plans |
Duloxetine |
New Quantity Limit: 30/30 Days |
n/a |
Small Group/Essential/Individual Plans |
Buproprion XL |
New Quantity Limit: 30/30 Days |
n/a |
Small Group/Essential/Individual Plans |
Escitalopram |
New Quantity Limit: 30/30 Days |
n/a |
Small Group/Essential/Individual Plans |
Venlafaxine |
New Quantity Limit: 30/30 Days |
n/a |
Small Group/Essential/Individual Plans |
Desvenlafaxine |
New Quantity Limit: 30/30 Days |
n/a |
Small Group/Essential/Individual Plans |
Ozempic |
New Quantity Limit: 1/Month |
n/a |
Small Group/Essential/Individual Plans |
Trulicity |
New Quantity Limit: 1/Month |
n/a |
Small Group/Essential/Individual Plans |
Valacyclovir |
New Quantity Limit: 30/30 Days |
n/a |
Small Group/Essential/Individual Plans |
Zolpidem |
New Quantity Limit: 15/30 Days |
n/a |
Small Group/Essential/Individual Plans |
Eszopiclone |
New Quantity Limit: 15/30 Days |
n/a |
Small Group/Essential/Individual Plans |
Belsomra |
New Quantity Limit: 15/30 Days |
n/a |
Small Group/Essential/Individual Plans |
Ventolin HFA |
Moving to Non-Preferred Tier |
ALBUTEROL SULFATE HFA |
Small Group/Essential/Individual Plans |
Combigan |
Moving to Non-Preferred Tier |
BRIMONIDINE, TIMOLOL |
Small Group/Essential/Individual Plans |
Multaq |
Moving to Non-Preferred Tier |
AMIODARONE, DOFETILIDE, FLECAINIDE |
Small Group/Essential/Individual Plans |
Synthroid |
Moving to Non-Preferred Tier |
EUTHYROX, LEVOTHYROXINE, LEVOXYL |
Small Group/Essential/Individual Plans |
Bystolic |
Moving to Non-Preferred Tier |
ATENOLOL, CARVEDILOL, METOPROLOL |
Small Group/Essential/Individual Plans |
Invokana |
Moving to Non-Preferred Tier |
FARXIGA, JARDIANCE, STEGLATRO |
Small Group/Essential/Individual Plans |
Lumigan |
Moving to Non-Preferred Tier |
BIMATOPROST, LATANOPROST, TRAVOPROST |
Small Group/Essential/Individual Plans |
Alphagan P |
Moving to Non-Preferred Tier |
BRIMONIDINE TARTRATE |
Large Group |
Ventolin HFA |
Preauthorization Requirement Added |
ALBUTEROL SULFATE HFA |
Large Group |
Synthroid |
Preauthorization Requirement Added |
EUTHYROX, LEVOTHYROXINE, LEVOXYL |
Large Group |
Advair |
Preauthorization Requirement Added |
FLUTICASONE-SALMETEROL, WIXELA INHUB |
Large Group |
NovoLog |
Preauthorization Requirement Added |
HUMALOG |
Large Group |
Bystolic |
Preauthorization Requirement Added |
ATENOLOL, CARVEDILOL, METOPROLOL SUCCINATE |
Large Group |
Invokana |
Preauthorization Requirement Added |
FARXIGA, JARDIANCE, STEGLATRO |
Large Group |
Lo Loestrin FE 1-10 |
Preauthorization Requirement Added |
BLISOVI 24 FE, HAILEY FE, JUNEL FE |
Large Group |
Lumigan |
Preauthorization Requirement Added |
BIMATOPROST, LATANOPROST, TRAVOPROST |
Large Group |
Advair |
New Quantity Limit: 1/Month |
n/a |
Large Group |
Arnuity |
New Quantity Limit: 1/Month |
n/a |
Large Group |
Incruse Ellipta |
New Quantity Limit: 1/Month |
n/a |
Large Group |
Dulera |
New Quantity Limit: 1/Month |
n/a |
Large Group |
Ajovy |
New Quantity Limit: 2/Month (3ML Total) |
n/a |
Large Group |
Emgality |
New Quantity Limit: 1/Month |
n/a |
Large Group |
Copaxone |
New Quantity Limit: 1/Month |
n/a |
Large Group |
Duloxetine |
New Quantity Limit: 30/30 Days |
n/a |
Large Group |
Buproprion XL |
New Quantity Limit: 30/30 Days |
n/a |
Large Group |
Escitalopram |
New Quantity Limit: 30/30 Days |
n/a |
Large Group |
Venlafaxine |
New Quantity Limit: 30/30 Days |
n/a |
Large Group |
Desvenlafaxine |
New Quantity Limit: 30/30 Days |
n/a |
Large Group |
Invokana |
New Quantity Limit: 30/30 Days |
n/a |
Large Group |
Onglyza |
New Quantity Limit: 60/30 Days |
n/a |
Large Group |
Ozempic |
New Quantity Limit: 1/Month |
n/a |
Large Group |
Zolpidem |
New Quantity Limit: 15/30 Days |
n/a |
Large Group |
Eszopiclone |
New Quantity Limit: 15/30 Days |
n/a |
Large Group |
Temazepam |
New Quantity Limit: 15/30 Days |
n/a |
Large Group |
Ventolin HFA |
Moving to Non-Preferred Tier |
ALBUTEROL SULFATE HFA |
Large Group |
Adderall XR |
Moving to Non-Preferred Tier |
DEXTROAMPHETAMINE-AMPHETAMINE ER |
Large Group |
NovoLog |
Moving to Non-Preferred Tier |
HUMALOG |
Large Group |
Synthroid |
Moving to Non-Preferred Tier |
EUTHYROX, LEVOTHYROXINE, LEVOXYL |
Large Group |
Praluent |
Moving to Non-Preferred Tier |
REPATHA |
Large Group |
Combigan |
Moving to Non-Preferred Tier |
BRIMONIDINE TARTRATE, TIMOLOL MALEATE |
Large Group |
Victoza |
Moving to Non-Preferred Tier |
BYDUREON, BYETTA, OZEMPIC, TRULICITY |
Large Group |
Invokana |
Moving to Non-Preferred Tier |
FARXIGA, JARDIANCE, STEGLATRO |
Large Group |
Lumigan |
Moving to Non-Preferred Tier |
BIMATOPROST, LATANOPROST, TRAVOPROST |
Large Group |
Lo Loestrin FE 1-10 |
Moving to Non-Preferred Tier |
BLISOVI FE, HAILEY FE, JUNEL FE |
