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 drug list changes effective July 1, 2024
Drug Name
Description of Change
Cost-effective Alternative
Alrex 0.2% eye drops
No longer covered
loteprednol 0.2% eye drops
Emflaza tablets
No longer covered
deflazacort tablets
Forteo 600 mcg/2.4 mL pens
No longer covered
teriparatide 600 mcg/2.4 mL pens
Rectiv 0.4% ointment
No longer covered
nitroglycerin 0.4% ointment
Risperdal Consta vials
No longer covered
risperidone extended-release vials
M4 drug list effective October 1, 2024
| Drug name | Description of change | Cost-effective alternatives* |
|---|---|---|
| Akynzeo Capsules | No longer covered | granisetron tablets, ondansetron tablets |
| Apomorphine/Apokyn Cartridges | Covered under medical benefit | |
| Bacitracin Vials | Covered under medical benefit | |
| Benztropine Ampules/Vials | Covered under medical benefit | |
| Bumetanide Vials | Covered under medical benefit | bumetanide tablets |
| Buprenorphine Cartridges/Vials | Covered under medical benefit | |
| Carbaglu Tablets for Suspension | No longer covered | carglumic acid tablets |
| Cefaclor ER Tablets | No longer covered | cefaclor capsules |
| Clozapine ODT Tablets | Moving to Tier 3 | clozapine tablets |
| Consensi Tablets | No longer covered | amlodipine tablets and celecoxib capsules |
| Dexamethasone 1.5mg Dose Packs | No longer covered | dexamethasone tablets |
| Emend Packets | No longer covered | aprepitant capsules, granisetron tablets, ondansetron tablets |
| Fentanyl Ampules/Vials | Covered under medical benefit | |
| Fluphenazine Vials | Covered under medical benefit | |
| Glycopyrrolate 1.5mg Tablets | No longer covered | glycopyrrolate 1mg tablets |
| Fosamax Plus D Tablets | No longer covered | alendronate tablets and vitamin D tablets |
| Flurandrenolide Cream/Ointment | No longer covered | betamethasone, fluocinolone, triamcinolong topical products |
| Hetlioz Capsules/Suspension | No longer covered | ramelteon tablets |
| Hycodan Syrup | No longer covered | hydrocodone/homatropine syrup |
| Ibuprofen-Famotidine Tablets | No longer covered | ibuprofen tablets and famotidine tablets |
| Kalbitor Vials | Covered under medical benefit | |
| Kalydeco Packets/Tablets | No longer covered | Trikafta Packets/Tablets |
| Ketorolac Cartridges/Vials | Covered under medical benefit | ketorolac tablets |
| Korlym Tablets | No longer covered | mifepristone tablets |
| Lacrisert Eye Inserts | No longer covered | cyclosporine eye drops |
| Levorphanol Tablets | No longer covered | hydromorphone tablets, morphine tablets |
| Lupaneta Packs | No longer covered | leuprolide injections and norethindrone tablets |
| Luzu Cream | No longer covered | clotrimazole, econazole, ketoconazole, and nystatin creams |
| Mesalamine Kits | No longer covered | mesalamine enemas |
| Methadone Vials | Covered under medical benefit | |
| Metoclopramide ODT Tablets | No longer covered | metoclopramide tablets |
| Metyrosine Capsules | No longer covered | phenoxybenzamine capsules |
| Millipred Dose Packs | No longer covered | dexamethasone tablets |
| Molindone Tablets | Moving to Tier 3 | olanzapine, quetiapine, and risperidone tablets |
| Moxatag Tablets | No longer covered | amoxicillin capsules |
| Myrbetriq Tablets | No longer covered | mirabegron tablets |
| Naproxen-Esomeprazole Tablets | No longer covered | naproxen tablets and esomeprazole tablets |
| Nicardipine Capsules | Moving to Tier 3 | amlodipine and nifedipine tablets |
| Olanzapine Vials | No longer covered | risperidone ER vials |
| Omeprazole-Sodium Bicarbonate Packets | No longer covered | omeprazole capsules |
| Orphenadrine Vials | Covered under medical benefit | |
| Oxycodone 2.5-300mg tablets | No longer covered | oxycodone 2.5-325mg tablets |
| Prezista Tablets & Suspension | No longer covered | darunavir tablets |
| Prochlorperazine Vials | Covered under medical benefit | |
| Restasis Eye Drops | No longer covered | cyclosporine eye drops |
| Serostim Vials | No longer covered | Genotropin, Omnitrope |
| Skyrizi Vials | Covered under medical benefit | Skyrizi Pens/Syringes |
| Sympazan Films | No longer covered | clobazam tablets |
| Temazepam 22.5mg Capsules | No longer covered | temazepam 15mg or 30mg capsules |
| Trexall Tablets | No longer covered | methotrexate tablets |
| Urelle Tablets | No longer covered | methenamine tablets |
| Uro-SP | No longer covered | methenamine tablets |
| Versacloz Suspension | No longer covered | clozapine tablets |
| Xermelo Tablets | No longer covered | Somatuline Depot |
| Zimhi Syringes | No longer covered | naloxone syringes |
For GAIP plans
Drug list changes for GAIP plans are listed below. While changes are infrequent, please refer to your plan benefits for details.
Preferred B3 drug list changes effective October 1, 2024
Drug Name
Description of Change
Cost-effective Alternative
Restasis Eye Drops
Moving to Tier 3
cyclosporine eye drops