Essential Formulary Drug Alternatives Effective 01/01/2019

Essential Formulary Drug Alternatives

Effective 01/01/2019

Below are alternate choices for many common drugs not covered on the Essential drug list.

Category Anaphylaxis Treatment

Non-Covered Drug

ALLERGIC REACTIONS Auvi-Q, EpiPen, Epinephrine injection made by Impax

Covered Drug

Epinephrine injection (Authorized Generic of EpiPen made by Mylan)

Non-Steroidal AntiInflammatory Agents

ANALGESICS Cambia, Vivlodex, Zipsor

celecoxib, diclofenac, diflunisal, etodolac, fenoprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meloxicam, nabumetone, naproxen, oxaprozin, piroxicam, sulindac, tolmetin

Antiepilepsy

ANTICONVULSANTS Trokendi XR

topiramate ER

Interferon Beta Medications for Multiple Sclerosis

AUTONOMIC & CENTRAL NERVOUS SYSTEM

Extavia, Plegridy, Rebif

Avonex, Betaseron

Oral Long-Acting Opioid Analgesics

Arymo ER, Embeda, Hysingla ER, Nucynta ER, Opana ER, Xtampza ER, Zohydro ER

hydromorphone HCl ER, morphine sulfate ER, oxymorphone HCl ER, OxyContin

Oral Short-Acting Opioid Analgesics

Nucynta

codeine sulfate, hydromorphone HCl, morphine sulfate, oxycodone HCl, oxymorphone HCl

Transmucosal Fentanyl Analgesics Medication Assisted Treatment

Non-Steroidal Anti-Inflammatory Topical Acne Treatment

Abstral, Fentora, Lazanda, Subsys

Bunavail, Suboxone, Zubsolv

DERMATOLOGICAL AGENTS Pennsaid Acanya, Aktipak, Veltin

fentanyl citrate lozenge

buprenorphine/naloxone SL tabs

diclofenac solution adapalene, adapalene/benzoyl peroxide, clindamycin gel/lotion/solution, clindamycin/benzoyl peroxide, erythromycin/benzoyl peroxide, tretinoin cream

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Category

Blood Glucose Meters, Test Strips and Control Solutions

Non-Covered Drug

DIABETES Examples: Abbott (FreeStyle, Precision), Arkray(Glucocard), Bayer (Breeze, Contour), Nipro (TRUEtest, TRUEtrack)

Dipeptidyl Peptidase-4 (DPP4) Inhibitors & Combinations

Sodium-glucose co-transporter (SGLT2) Inhibitors & Combinations Glucagon-Like Peptide-1(GLP1) Agonists

Alogliptin(M), Alogliptin with metformin(M), Alogliptin with pioglitazone(M), Kazano, Kombiglyze XR, Nesina, Onglyza, Oseni Farxiga, Xigduo XR, Steglatro, Segluromet

Adlyxin, Tanzeum, Trulicity

Covered Drug

Lifescan (One Touch products), Roche (Accu-Chek)

Janumet, Janumet XR, Januvia, Jentadueto, Jentadueto XR, Tradjenta

Invokamet, Invokamet XR, Invokana, Jardiance, Synjardy, Synjardy XR Bydureon, Byetta, Ozempic, Victoza

Oral Combination Products Rapid-acting insulin Basal insulin

Growth Hormones

Topical Testosterone Gels

Anti-Diarrheal Agents AntiInflammatory, Anti-Ulcer Agents Inflammatory Bowel Disease Proton Pump Inhibitors

Steglujan Fiasp Basaglar

ENDOCRINE (OTHER) Genotropin, Humatrope, Nutropin, Omnitrope, Saizen, Zomacton Androgel, Fortesta, Testim, Testosterone 2% Gel (M), Volgelxo

GASTROINTESTINAL Motofen Duexis, Vimovo

Zorvolex

Asacol HD, Delzicol Dexilant, esomeprazole

Pancreatic Enzymes

Pancreaze, Pertzye, Viokace

HEMATOLOGICAL Erythropoiesis-Stimulating Agents Aranesp, Epogen

Muscle Relaxant

MUSCULOSKELETAL Amrix, tizanidine caps

Antiglaucoma Drugs

OPHTHALMIC Rescula, Zioptan

Glyxambi Novolog Lantus, Levemir, Toujeo, Tresiba

Norditropin

testosterone gel 1.62%

diphenoxylate/atropine famotidine PLUS ibuprofen, omeprazole PLUS naproxen ibuprofen, naproxen balsalazide, Apriso, mesalamine DR omeprazole, pantoprazole, lansoprazole, rabeprazole Creon, Zenpep

Procrit

Cyclobenzaprine, tizanidine tabs

latanoprost ophthalmic solution, Lumigan, Travatan Z

Essential Formulary Exclusions ?? 2019 | Page 2

1811 CR 009 11/2018

Category

Pulmonary AntiInflammatory Inhalers

Non-Covered Drug

RESPIRATORY Alvesco, Asmanex, QVAR, QVAR Redihaler

Pulmonary AntiInflammatory, Long-Acting Beta Agonist Combination Inhalers

Short-Acting Beta-2 Adrenergic Inhalers

Chronic Obstructive Pulmonary Disease (inhaled anticholinergics)

Chronic Obstructive Pulmonary Disease Long-Acting Beta Agonist & Anticholinergic

AirDuo, Dulera

Levalbuterol Inhaler (M), Proventil HFA, Xopenex HFA Tudorza Bevespi, Utibron

Covered Drug

Arnuity Ellipta, Flovent Diskus, Flovent HFA, Pulmicort Flexhaler Advair Diskus, Advair HFA, Breo Ellipta, Symbicort

ProAir HFA, Ventolin HFA

Incruse Ellipta, Spiriva

Anoro Ellipta, Stiolto Respimat

Cystic Fibrosis (inhaled antibiotics) Bethkis, Kitabis Pak, TOBI Podhaler

Tobramycin Neb (M)

UROLOGICAL Erectile Dysfunction Oral Agents Levitra, Staxyn, Stendra, Viagra, Cialis sildenafil, tadalafil

(M) Co-branded product

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