2019 Drug List Negative Changes
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1 2019 Drug List Negative Changes Updated 03/26/2019 If you are taking a drug that is removed from the formulary (also known as the Drug List), we will tell you. We will also tell you if we add any restrictions on a drug. We will tell you at least 60 days before we make these changes. This gives you time to talk to your doctor about what to do next. If the Food and Drug Administration (FDA) says a drug you are taking is not safe, we will take it off the formulary right away. We will also send you a letter telling you that. The table below shows changes made to our 2019 formulary. Your cost share depends on your coverage stage. Your formulary tells you the tier that applies to each covered drug. Date of Change Drug Name Type of Change Possible Alternative Drug(s) Comments 1/1/2019 GLEOSTINE CAPS 5 MG 1/1/2019 IPRIVASK SOLR 1/1/2019 ISTODAX SOLR This drug was removed from the market. 1/1/2019 PEG-INTRON REDIPEN PAK 4 KIT This drug was removed from the market. 1/1/2019 POTIGA TABS 300 MG 2/1/2019 FINACEA GEL This drug was removed from the formulary. 15% azelaic acid gel 15% 2/1/2019 MENOMUNE- A/C/Y/W-135 INJ 2/1/2019 TRELSTAR SUSR TRELSTAR MIXJECT 2/1/2019 ZYTIGA TAB This drug was removed from the formulary. 250MG abiraterone acetate tabs NORVIR NORVIR tabs Y0020_DrugLstNegChngWebNtc17_NM
2 Date of Change Drug Name Type of Change Possible Alternative Comments Drug(s) PEGASYS PROCLICK PEGASYS mometasone furoate Nasal triamcinolone acetonide Susp 50 MCG/ACT CLINIMIX 2.75%/DEXTROSE 5% CLINIMIX 4.25%/DEXTROSE 5% amifostine SOLR TETANUS/DIPHTHE RIA TOXOIDS- ADSORBED SUSP ketoprofen CAPS 50 MG triamterene & hydrochlorothiazide 4/1/2019 4/1/2019 This drug was removed from the market. This drug was removed from the market. TDVAX SUSP CAPS 50MG-25MG This drug was removed from the market. ADVAIR DISKU AER 100/50 ADVAIR DISKU AER 250/50 ADVAIR DISKU AER 500/50 ELIDEL CRE 1% INVIRASE CAPS 4/1/2019 MOEXIPRIL/HYDRO CHLOROTHIAZIDE TABS 4/1/2019 NUTRESTORE PACK 4/1/2019 PRALUENT SOSY 75 MG/ML This drug was removed from the formulary. This drug was removed from the formulary. This drug was removed from the formulary. Fluticasone-Salmeterol Aer Powder BA MCG/DOSE Fluticasone-Salmeterol Aer Powder BA MCG/DOSE Fluticasone-Salmeterol Aer Powder BA MCG/DOSE This drug was removed from the formulary. Pimecrolimus Cream 1% This drug was removed from the market. This drug was removed from the market.
3 Date of Change Drug Name Type of Change Possible Alternative Drug(s) Comments 4/1/2019 REMODULIN INJ This drug was removed from the formulary. Treprostinil Sodium Inj 10 10MG/ML MG/ML 4/1/2019 REMODULIN INJ This drug was removed from the formulary. Treprostinil Sodium Inj 1 1MG/ML MG/ML 4/1/2019 REMODULIN INJ This drug was removed from the formulary. Treprostinil Sodium Inj 2.5MG/ML 2.5 MG/ML 4/1/2019 REMODULIN INJ This drug was removed from the formulary. Treprostinil Sodium Inj 5 5MG/ML MG/ML If you or your doctor disagrees with the change to your drug, you may request an exception. To request an exception, call us at: State Phone Number NM , TTY: 711 PA , TTY: 711 SC , TTY: 711 From October 1 March 31, 7 days a week, 8 a.m. to 8 p.m. From April 1 - September 30, Monday through Friday, 8 a.m. to 8 p.m. A messaging system is used after hours, weekends, and on federal holidays. Your doctor must provide a statement to support your request. For details on asking for an exception, check your Evidence of Coverage.
4 If you don t agree with our decision, you may file a complaint with us. To file a complaint, call us at: State Phone Number NM , TTY: 711 PA , TTY: 711 SC , TTY: 711 From October 1 March 31, 7 days a week, 8 a.m. to 8 p.m. From April 1 - September 30, Monday through Friday, 8 a.m. to 8 p.m. A messaging system is used after hours, weekends, and on federal holidays. Your doctor must provide a statement to support your request. You may also send your complaint to us in writing at the following address. Allwell Attn: Medicare Appeals & Grievances 7700 Forsyth Boulevard St. Louis, MO The Formulary may change at any time. You will receive notice when necessary.
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2019 Drug List Negative Changes
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