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
|
