For ISHIP plans
Drug list changes for ISHIP plans are listed below. While changes are infrequent, please refer to your plan benefits for details.
M4 Formulary drug list changes
Effective July 1, 2025
| Drug name | Description of change | Cost-effective alternatives* |
|---|
| Drug name | Description of change | Generic or more cost-effective option |
|---|---|---|
| BETIMOL 0.5% EYE DROPS | No longer covered | timolol 0.5% eye drops |
| ELIGARD SYRINGE KITS | No longer covered | Covered under medical benefit only. |
| HUMIRA (ALL STRENGTHS & DOSAGE FORMS) | No longer covered | adalimumab-adaz, adalimumab-adbm, adalimumab-ryvk, Cyltezo, Simlandi |
| LEUPROLIDE DEPOT | No longer covered | Covered under medical benefit only. |
| LUPRON DEPOT/LUPRON DEPOT-PED | No longer covered | Covered under medical benefit only. |
| MESNEX TABLETS | No longer covered | mesna tablets |
| NYVEPRIA 6 MG/0.6 ML SYRINGES | No longer covered | Fulphila, Udenyca |
| PRADAXA PELLET PACKS | Moving to Tier 4 | dabigatran capsules |
| PRIMAQUINE 26.3 MG TABLETS (BRAND) | No longer covered | primaquine 26.3mg tablets (generic) |
| VICTOZA 2-PAK & 3-PAK PENS | No longer covered | liraglutide 2-pak & 3-pak pens |
Effective April 1, 2025
| Drug name | Description of change | Generic or more cost-effective option |
|---|---|---|
| isotretinoin capsules (select NDCs) | No longer covered | Accutane, Amnesteem, Claravis, Zenatane |
| MIPLYFFA CAPSULES | No longer covered | AQNEURSA PACKETS |
| PONVORY TABLETS | No longer covered | fingolimod capsules, dimethyl fumarate capsules |
| SPRYCEL TABLETS | No longer covered | dasatinib tablets |
Effective March 1, 2025
No changes
For GAIP plans
Drug list changes for GAIP plans are listed below. While changes are infrequent, please refer to your plan benefits for details.
B3 Formulary drug list changes
Effective July 1, 2025
No changes
| Drug name | Description of change | Cost-effective alternatives* |
|---|---|---|
| ANDROGEL 1.62% (1.25G) GEL PACKETS | Moving to Tier 3 | testosterone 1.62% (1.25 g) packets |
| BETIMOL 0.5% EYE DROPS | Moving to Tier 3 | timolol 0.5% eye drops |
| ELIGARD SYRINGE KITS | No longer covered | Covered under medical benefit only. |
| HUMIRA (ALL STRENGTHS & DOSAGE FORMS) | Moving to Tier 3 | adalimumab-adaz, adalimumab-adbm, adalimumab-ryvk, Cyltezo, Simlandi |
| HYCODAN 5 MG-1.5 MG/5 ML SOLUTION | Moving to Tier 3 | hydrocodone/homatropine solution, promethazine/codeine syrup, promethazine/DM syrup |
| LEUPROLIDE DEPOT | No longer covered | Covered under medical benefit only. |
| LUPRON DEPOT/LUPRON DEPOT-PED | No longer covered | Covered under medical benefit only. |
| NEXIUM 2.5 MG & 5 MG PACKETS | Moving to Tier 3 | omeprazole capsules, esomeprazole packets |
| NYVEPRIA 6 MG/0.6 ML SYRINGES | Moving to Tier 3 | Fulphila, Udenyca |
| PRIMAQUINE 26.3 MG TABLETS (BRAND) | Moving to Tier 3 | primaquine 26.3mg tablets (generic) |
| VICTOZA 2-PAK & 3-PAK PENS | Moving to Tier 3 | liraglutide 2-pak & 3-pak pens |
Effective April 1, 2025
| Drug name | Description of change | Generic or more cost-effective option |
|---|---|---|
| ANALPRAM-HC 2.5 %-1 % CREAM | Moving to Tier 3 | hydrocortisone-pramoxine 2.5%-1% cream |
| SPRYCEL TABLETS | Moving to Tier 3 | dasatinib tablets |
Effective March 1, 2025
No changes