LABEL NAME CHANGE EFFECTIVE DATE ARCALYST 220 MG INJECTION

Transcription

1 LABEL NAME CHANGE EFFECTIVE DATE ARCALYST 220 MG INJECTION Added Prior Authorization 7/1/17 CORLANOR 5 MG TABLET Added Prior Authorization 7/1/17 CORLANOR 7.5 MG TABLET Added Prior Authorization 7/1/17 ENTRESTO 24 MG- 26 MG TABLET Added Prior Authorization 7/1/17 ENTRESTO 49 MG- 51 MG TABLET Added Prior Authorization 7/1/17 ENTRESTO 97 MG- 103 MG TABLET Added Prior Authorization 7/1/17 ERIVEDGE 150 MG CAPSULE Added Prior Authorization 7/1/17 INLYTA 1 MG TABLET Added Prior Authorization 7/1/17 INLYTA 5 MG TABLET Added Prior Authorization 7/1/17 RIBAVIRIN 200 MG CAPSULE Added Prior Authorization 7/1/17 RIBAVIRIN 200 MG TABLET Added Prior Authorization 7/1/17 SUTENT 12.5 MG CAPSULE Added Prior Authorization 7/1/17 SUTENT 25 MG CAPSULE Added Prior Authorization 7/1/17 SUTENT 37.5 MG CAPSULE Added Prior Authorization 7/1/17 SUTENT 50 MG CAPSULE Added Prior Authorization 7/1/17 XYREM 500 MG/ML ORAL SOLUTION Added Prior Authorization 7/1/17 ATOMOXETINE HCL 10 MG CAPSULE Added to Formulary 7/1/17 ATOMOXETINE HCL 100 MG CAPSULE Added to Formulary 7/1/17 ATOMOXETINE HCL 18 MG CAPSULE Added to Formulary 7/1/17 ATOMOXETINE HCL 25 MG CAPSULE Added to Formulary 7/1/17 ATOMOXETINE HCL 40 MG CAPSULE Added to Formulary 7/1/17 ATOMOXETINE HCL 60 MG CAPSULE Added to Formulary 7/1/17 ATOMOXETINE HCL 80 MG CAPSULE Added to Formulary 7/1/17 EPINEPHRINE 0.15 MG AUTO- INJCT (MYLAN) Added to Formulary 7/1/17 EPINEPHRINE 0.3 MG AUTO- INJECT (MYLAN) Added to Formulary 7/1/17 KALETRA 80 MG- 20 MG/ML SOLN Added to Formulary 7/1/17 RYDAPT 25 MG CAPSULE Added to Formulary with Prior Authorization 7/1/17 ACETASOL HC EAR DROPS Removed from Formulary 7/1/17 ADAPALENE 0.1% CREAM Removed from Formulary 7/1/17 ADAPALENE 0.1% GEL Removed from Formulary 7/1/17 ADAPALENE 0.3% GEL Removed from Formulary 7/1/17 ADAPALENE 0.3% GEL PUMP Removed from Formulary 7/1/17 ALCLOMETASONE DIPR 0.05% OINT Removed from Formulary 7/1/17 ALCLOMETASONE DIPRO 0.05% CRM Removed from Formulary 7/1/17 ALMOTRIPTAN MALATE 12.5 MG TAB Removed from Formulary 7/1/17 ALMOTRIPTAN MALATE 6.25 MG TAB Removed from Formulary 7/1/17 ASPIRIN- DIPYRIDAM ER MG Removed from Formulary 7/1/17 AVAR CLEANSER Removed from Formulary 7/1/17 BALSALAZIDE DISODIUM 750 MG CP Removed from Formulary 7/1/17 BENZOYL PEROXIDE 9.8% FOAM Removed from Formulary 7/1/17 BETAMETHASONE DP AUG 0.05% GEL Removed from Formulary 7/1/17 BETAMETHASONE DP AUG 0.05% LOT Removed from Formulary 7/1/17 BETAMETHASONE VALER 0.12% FOAM Removed from Formulary 7/1/17 BP 10-1 WASH Removed from Formulary 7/1/17 BP 5.3% FOAM Removed from Formulary 7/1/17 BP 9.8% FOAM Removed from Formulary 7/1/17 BPO 3% FOAMING CLOTHS Removed from Formulary 7/1/17 BPO 4% GEL Removed from Formulary 7/1/17 BPO 6% FOAMING CLOTHS Removed from Formulary 7/1/17 BPO 8% GEL Removed from Formulary 7/1/17 BPO 9% FOAMING CLOTHS Removed from Formulary 7/1/17

2 BROMFENAC SODIUM 0.09% EYE DRP Removed from Formulary 7/1/17 BUDESONIDE 32 MCG NASAL SPRAY Removed from Formulary (Rx only) 7/1/17 CANDESARTAN CILEXETIL 16 MG TB Removed from Formulary 7/1/17 CANDESARTAN CILEXETIL 32 MG TB Removed from Formulary 7/1/17 CANDESARTAN CILEXETIL 4 MG TAB Removed from Formulary 7/1/17 CANDESARTAN CILEXETIL 8 MG TAB Removed from Formulary 7/1/17 CANDESARTAN- HCTZ MG TB Removed from Formulary 7/1/17 CANDESARTAN- HCTZ MG TB Removed from Formulary 7/1/17 CANDESARTAN- HCTZ MG TAB Removed from Formulary 7/1/17 CEFIXIME 100 MG/5 ML SUSP Removed from Formulary 7/1/17 CEFIXIME 200 MG/5 ML SUSP Removed from Formulary 7/1/17 CEFPODOXIME 100 MG TABLET Removed from Formulary 7/1/17 CEFPODOXIME 100 MG/5 ML SUSP Removed from Formulary 7/1/17 CEFPODOXIME 200 MG TABLET Removed from Formulary 7/1/17 CEFPODOXIME 50 MG/5 ML SUSP Removed from Formulary 7/1/17 CELACYN GEL Removed from Formulary 7/1/17 CHLORDIAZEPOXIDE- CLIDINIUM CAP Removed from Formulary 7/1/17 CICLOPIROX 8% TREATMENT KIT Removed from Formulary 7/1/17 CLIND PH- BENZOYL PEROX 1.2-5% Removed from Formulary 7/1/17 CLINDA- BENZOYL PEROX 1-5% PUMP Removed from Formulary 7/1/17 CLINDAMYCIN PHOSPHATE 1% FOAM Removed from Formulary 7/1/17 CLINDAMYCIN- BENZOYL PEROX 1-5% Removed from Formulary 7/1/17 CLINDA- TRETINOIN 1.2% % Removed from Formulary 7/1/17 CLOBETASOL 0.05% GEL Removed from Formulary 7/1/17 CLOBETASOL 0.05% OINTMENT Removed from Formulary 7/1/17 CLOBETASOL 0.05% SHAMPOO Removed from Formulary 7/1/17 CLOBETASOL 0.05% TOPICAL LOTN Removed from Formulary 7/1/17 CLOBETASOL EMOLLNT 0.05% FOAM Removed from Formulary 7/1/17 CLOBETASOL EMULSION 0.05% FOAM Removed from Formulary 7/1/17 CLOBETASOL PROP 0.05% FOAM Removed from Formulary 7/1/17 CLOBETASOL PROP 0.05% SPRAY Removed from Formulary 7/1/17 D- AMPHETAMINE ER 10 MG CAPSULE Removed from Formulary 7/1/17 D- AMPHETAMINE ER 15 MG CAPSULE Removed from Formulary 7/1/17 D- AMPHETAMINE ER 5 MG CAPSULE Removed from Formulary 7/1/17 DESONIDE 0.05% CREAM Removed from Formulary 7/1/17 DESONIDE 0.05% LOTION Removed from Formulary 7/1/17 DESONIDE 0.05% OINTMENT Removed from Formulary 7/1/17 DESOXIMETASONE 0.05% CREAM Removed from Formulary 7/1/17 DESOXIMETASONE 0.05% GEL Removed from Formulary 7/1/17 DESOXIMETASONE 0.05% OINTMENT Removed from Formulary 7/1/17 DESOXIMETASONE 0.25% OINTMENT Removed from Formulary 7/1/17 DEXTROAMPHETAMINE 10 MG TAB Removed from Formulary 7/1/17 DEXTROAMPHETAMINE 5 MG TAB Removed from Formulary 7/1/17 DIFLORASONE 0.05% CREAM Removed from Formulary 7/1/17 DIFLORASONE 0.05% OINTMENT Removed from Formulary 7/1/17 DIHYDROERGOTAMINE 4 MG/ML SPRY Removed from Formulary 7/1/17 DRONABINOL 10 MG CAPSULE Removed from Formulary 7/1/17 DRONABINOL 2.5 MG CAPSULE Removed from Formulary 7/1/17 DRONABINOL 5 MG CAPSULE Removed from Formulary 7/1/17 DROSP- EE- LEVOMEF Removed from Formulary 7/1/17 ELETONE CREAM Removed from Formulary 7/1/17 ELETONE CREAM TWIN PACK Removed from Formulary 7/1/17

3 EMULSION SB TOPICAL EMULSION Removed from Formulary 7/1/17 EMULSION SB TOPICAL TWIN PACK Removed from Formulary 7/1/17 EPIPEN 0.3 MG AUTO- INJECTOR Removed from Formulary 7/1/17 EPIPEN 2- PAK 0.3 MG AUTO- INJCT Removed from Formulary 7/1/17 EPIPEN JR 0.15 MG AUTO- INJECTR Removed from Formulary 7/1/17 EPIPEN JR 2- PAK 0.15 MG INJCTR Removed from Formulary 7/1/17 EPLERENONE 25 MG TABLET Removed from Formulary 7/1/17 EPLERENONE 50 MG TABLET Removed from Formulary 7/1/17 ERYGEL 2% GEL Removed from Formulary 7/1/17 ERYTHROMYCIN 2% GEL Removed from Formulary 7/1/17 ERYTHROMYCIN- BENZOYL GEL Removed from Formulary 7/1/17 ETODOLAC ER 400 MG TABLET Removed from Formulary 7/1/17 ETODOLAC ER 500 MG TABLET Removed from Formulary 7/1/17 ETODOLAC ER 600 MG TABLET Removed from Formulary 7/1/17 FLUOCINOLONE 0.01% BODY OIL Removed from Formulary 7/1/17 FLUOCINOLONE 0.01% CREAM Removed from Formulary 7/1/17 FLUOCINOLONE 0.01% SCALP OIL Removed from Formulary 7/1/17 FLUOCINOLONE 0.01% SOLUTION Removed from Formulary 7/1/17 FLUOCINONIDE 0.05% GEL Removed from Formulary 7/1/17 FLUOCINONIDE 0.05% OINTMENT Removed from Formulary 7/1/17 FLUOCINONIDE 0.1% CREAM Removed from Formulary 7/1/17 FLUOCINONIDE- E 0.05% CREAM Removed from Formulary 7/1/17 FLURANDRENOLIDE 0.05% CREAM Removed from Formulary 7/1/17 FLURANDRENOLIDE 0.05% LOTION Removed from Formulary 7/1/17 FLURANDRENOLIDE 0.05% OINTMENT Removed from Formulary 7/1/17 FLUTICASONE PROP 0.05% LOTION Removed from Formulary 7/1/17 FLUVASTATIN ER 80 MG TABLET Removed from Formulary 7/1/17 FLUVASTATIN SODIUM 20 MG CAP Removed from Formulary 7/1/17 FLUVASTATIN SODIUM 40 MG CAP Removed from Formulary 7/1/17 FROVATRIPTAN SUCC 2.5 MG TAB Removed from Formulary 7/1/17 GRISEOFULVIN MICRO 500 MG TAB Removed from Formulary 7/1/17 GRISEOFULVIN ULTRA 125 MG TAB Removed from Formulary 7/1/17 GRISEOFULVIN ULTRA 250 MG TAB Removed from Formulary 7/1/17 HALOBETASOL PROP 0.05% CREAM Removed from Formulary 7/1/17 HALOBETASOL PROP 0.05% OINTMNT Removed from Formulary 7/1/17 HPR PLUS CREAM Removed from Formulary 7/1/17 HPR PLUS EMOLLIENT FOAM Removed from Formulary 7/1/17 HYDROCORT BUTY 0.1% LIPID CRM Removed from Formulary 7/1/17 HYDROCORT BUTY 0.1% LIPO CREAM Removed from Formulary 7/1/17 HYDROCORT- IODOQUINOL- ALOE SACH Removed from Formulary 7/1/17 HYDROCORTISON- ACETIC ACID SOLN Removed from Formulary 7/1/17 HYDROCORTISONE 1% ABSORBASE Removed from Formulary 7/1/17 HYDROCORTISONE BUTY 0.1% CREAM Removed from Formulary 7/1/17 HYDROCORTISONE BUTYR 0.1% OINT Removed from Formulary 7/1/17 HYDROCORTISONE BUTYR 0.1% SOLN Removed from Formulary 7/1/17 HYDROCORTISONE VAL 0.2% CREAM Removed from Formulary 7/1/17 HYDROCORTISONE VAL 0.2% OINTMT Removed from Formulary 7/1/17 HYDROMORPHONE HCL ER 12 MG TAB Removed from Formulary 7/1/17 HYDROMORPHONE HCL ER 16 MG TAB Removed from Formulary 7/1/17 HYDROMORPHONE HCL ER 32 MG TAB Removed from Formulary 7/1/17 HYDROMORPHONE HCL ER 8 MG TAB Removed from Formulary 7/1/17 KETOCONAZOLE 2% FOAM Removed from Formulary 7/1/17

4 LAYOLIS FE CHEWABLE TABLET Removed from Formulary 7/1/17 LEVALBUTEROL 0.31 MG/3 ML SOL Removed from Formulary 7/1/17 LEVALBUTEROL 0.63 MG/3 ML SOL Removed from Formulary 7/1/17 LEVALBUTEROL 1.25 MG/3 ML SOL Removed from Formulary 7/1/17 LEVALBUTEROL CONC 1.25 MG/0.5 Removed from Formulary 7/1/17 LEVORPHANOL 2 MG TABLET Removed from Formulary 7/1/17 LIDOCAINE 5% OINTMENT Removed from Formulary 7/1/17 LIDOCAINE HCL 3% LOTION Removed from Formulary 7/1/17 LINDANE 1% SHAMPOO Removed from Formulary 7/1/17 LUXAMEND WOUND CREAM Removed from Formulary 7/1/17 MALATHION 0.5% LOTION Removed from Formulary 7/1/17 MEFENAMIC ACID 250 MG CAPSULE Removed from Formulary 7/1/17 METAXALONE 400 MG TABLET Removed from Formulary 7/1/17 METAXALONE 800 MG TABLET Removed from Formulary 7/1/17 METHAZOLAMIDE 25 MG TABLET Removed from Formulary 7/1/17 METHAZOLAMIDE 50 MG TABLET Removed from Formulary 7/1/17 MIBELAS 24 FE CHEWABLE TABLET Removed from Formulary 7/1/17 MOMETASONE FUROATE 50 MCG SPRY Removed from Formulary 7/1/17 MUPIROCIN 2% CREAM Removed from Formulary 7/1/17 NAFTIFINE HCL 1% CREAM Removed from Formulary 7/1/17 NAFTIFINE HCL 2% CREAM Removed from Formulary 7/1/17 NAPROXEN SOD CR 375 MG TABLET Removed from Formulary 7/1/17 NAPROXEN SOD CR 500 MG TABLET Removed from Formulary 7/1/17 NAPROXEN SOD ER 375 MG TABLET Removed from Formulary 7/1/17 NAPROXEN SOD ER 500 MG TABLET Removed from Formulary 7/1/17 NICARDIPINE 20 MG CAPSULE Removed from Formulary 7/1/17 NICARDIPINE 30 MG CAPSULE Removed from Formulary 7/1/17 NIMODIPINE 30 MG CAPSULE Removed from Formulary 7/1/17 NISOLDIPINE ER 17 MG TABLET Removed from Formulary 7/1/17 NISOLDIPINE ER 20 MG TABLET Removed from Formulary 7/1/17 NISOLDIPINE ER 25.5 MG TABLET Removed from Formulary 7/1/17 NISOLDIPINE ER 30 MG TABLET Removed from Formulary 7/1/17 NISOLDIPINE ER 34 MG TABLET Removed from Formulary 7/1/17 NISOLDIPINE ER 40 MG TABLET Removed from Formulary 7/1/17 NISOLDIPINE ER 8.5 MG TABLET Removed from Formulary 7/1/17 NITROFURANTOIN 25 MG/5 ML SUSP Removed from Formulary 7/1/17 NIVATOPIC PLUS CREAM Removed from Formulary 7/1/17 NORET- ESTR- FE (21)- 75 Removed from Formulary 7/1/17 NORETH- ESTRAD- FE (21)- 75 Removed from Formulary 7/1/17 NORETH- ESTRAD- FE (24)- 75 Removed from Formulary 7/1/17 NORETHIN- ESTRA- FE MG Removed from Formulary 7/1/17 NYSTATIN- TRIAMCINOLONE CREAM Removed from Formulary 7/1/17 NYSTATIN- TRIAMCINOLONE OINTM Removed from Formulary 7/1/17 OLMESARTAN MEDOXOMIL 20 MG TAB Removed from Formulary 7/1/17 OLMESARTAN MEDOXOMIL 40 MG TAB Removed from Formulary 7/1/17 OLMESARTAN MEDOXOMIL 5 MG TAB Removed from Formulary 7/1/17 OLMESARTAN- HCTZ MG TAB Removed from Formulary 7/1/17 OLMESARTAN- HCTZ MG TAB Removed from Formulary 7/1/17 OLMESARTAN- HCTZ MG TAB Removed from Formulary 7/1/17 OMEPRAZOLE- BICARB 20-1,100 CAP Removed from Formulary 7/1/17 OMEPRAZOLE- BICARB 20-1,680 PKT Removed from Formulary 7/1/17 OMEPRAZOLE- BICARB 40-1,100 CAP Removed from Formulary 7/1/17

5 OMEPRAZOLE- BICARB 40-1,680 PKT Removed from Formulary 7/1/17 OPIUM TINCTURE 10 MG/ML Removed from Formulary 7/1/17 OXAPROZIN 600 MG CAPLET Removed from Formulary 7/1/17 OXAPROZIN 600 MG TABLET Removed from Formulary 7/1/17 OXICONAZOLE NITRATE 1% CREAM Removed from Formulary 7/1/17 OXYMORPHONE HCL 10 MG TABLET Removed from Formulary 7/1/17 OXYMORPHONE HCL 5 MG TABLET Removed from Formulary 7/1/17 OXYMORPHONE HCL ER 10 MG TAB Removed from Formulary 7/1/17 OXYMORPHONE HCL ER 15 MG TAB Removed from Formulary 7/1/17 OXYMORPHONE HCL ER 20 MG TAB Removed from Formulary 7/1/17 OXYMORPHONE HCL ER 30 MG TAB Removed from Formulary 7/1/17 OXYMORPHONE HCL ER 40 MG TAB Removed from Formulary 7/1/17 OXYMORPHONE HCL ER 5 MG TABLET Removed from Formulary 7/1/17 OXYMORPHONE HCL ER 7.5 MG TAB Removed from Formulary 7/1/17 POTASSIUM CITRATE ER 10 MEQ TB Removed from Formulary 7/1/17 POTASSIUM CITRATE ER 15 MEQ TB Removed from Formulary 7/1/17 POTASSIUM CITRATE ER 5 MEQ TAB Removed from Formulary 7/1/17 PR BENZOYL PEROXIDE 7% WASH Removed from Formulary 7/1/17 PRO DNA COLLECTION KIT Removed from Formulary 7/1/17 PROVENZA 4%- 1% PATCH Removed from Formulary 7/1/17 PRUMYX CREAM Removed from Formulary 7/1/17 RAJANI 28 TABLET Removed from Formulary 7/1/17 REA LO 30 CREAM Removed from Formulary 7/1/17 REA LO 39 CREAM Removed from Formulary 7/1/17 REA LO 40 CREAM Removed from Formulary 7/1/17 RECEDO TOPICAL GEL Removed from Formulary 7/1/17 SALICYLIC ACID 26% LIQUID Removed from Formulary 7/1/17 SALICYLIC ACID 27.5% LIQUID Removed from Formulary 7/1/17 SALICYLIC ACID 6% CREAM KIT Removed from Formulary 7/1/17 SALICYLIC ACID 6% FOAM Removed from Formulary 7/1/17 SALICYLIC ACID 6% GEL Removed from Formulary 7/1/17 SALICYLIC ACID ER 28.5% SOLN Removed from Formulary 7/1/17 SALVAX 6% FOAM Removed from Formulary 7/1/17 SOD SULFACE- SULF % CLSR Removed from Formulary 7/1/17 SOD SULFACE- SULFUR 10-5% CLOTH Removed from Formulary 7/1/17 SOD SULFACE- SULFUR 9-4.5% WASH Removed from Formulary 7/1/17 SOD SULFACETAMIDE- SULFUR CREAM Removed from Formulary 7/1/17 SOD SULFACETAMIDE- SULFUR LOTN Removed from Formulary 7/1/17 SOD SULFACETAMIDE- SULFUR SUSP Removed from Formulary 7/1/17 SOD SULFACET- SULFUR 10-4% PAD Removed from Formulary 7/1/17 SOD SULFAC- SULFUR % CRM Removed from Formulary 7/1/17 SODIUM SULFACET- SULFUR WASH Removed from Formulary 7/1/17 SODIUM SULF- SULFUR CLEANSER Removed from Formulary 7/1/17 SPINOSAD 0.9% TOPICAL SUSP Removed from Formulary 7/1/17 SS 10-2 CLEANSER Removed from Formulary 7/1/17 SSS 10-5 CREAM Removed from Formulary 7/1/17 STRATTERA 10 MG CAPSULE Removed from Formulary 7/1/17 STRATTERA 100 MG CAPSULE Removed from Formulary 7/1/17 STRATTERA 18 MG CAPSULE Removed from Formulary 7/1/17 STRATTERA 25 MG CAPSULE Removed from Formulary 7/1/17 STRATTERA 40 MG CAPSULE Removed from Formulary 7/1/17 STRATTERA 60 MG CAPSULE Removed from Formulary 7/1/17

6 STRATTERA 80 MG CAPSULE Removed from Formulary 7/1/17 SULFACETAMIDE- SULFUR 10-2% CRM Removed from Formulary 7/1/17 SULFACETAMIDE- SULFUR 10-5% CRM Removed from Formulary 7/1/17 SULFACETAMIDE- SULFUR 8-4% SUSP Removed from Formulary 7/1/17 SULFACLEANSE 8-4 SUSPENSION Removed from Formulary 7/1/17 SUMATRIPTAN 20 MG NASAL SPRAY Removed from Formulary 7/1/17 SUMATRIPTAN 5 MG NASAL SPRAY Removed from Formulary 7/1/17 SYNVEXIA 4%- 1% PATCH Removed from Formulary 7/1/17 TELMISARTAN 20 MG TABLET Removed from Formulary 7/1/17 TELMISARTAN 40 MG TABLET Removed from Formulary 7/1/17 TELMISARTAN 80 MG TABLET Removed from Formulary 7/1/17 TELMISARTAN- HCTZ MG TB Removed from Formulary 7/1/17 TELMISARTAN- HCTZ MG TB Removed from Formulary 7/1/17 TELMISARTAN- HCTZ MG TAB Removed from Formulary 7/1/17 TIZANIDINE HCL 2 MG CAPSULE Removed from Formulary 7/1/17 TIZANIDINE HCL 4 MG CAPSULE Removed from Formulary 7/1/17 TIZANIDINE HCL 6 MG CAPSULE Removed from Formulary 7/1/17 TOLTERODINE TART ER 2 MG CAP Removed from Formulary 7/1/17 TOLTERODINE TART ER 4 MG CAP Removed from Formulary 7/1/17 TOLTERODINE TARTRATE 1 MG TAB Removed from Formulary 7/1/17 TOLTERODINE TARTRATE 2 MG TAB Removed from Formulary 7/1/17 TRETINOIN GEL MICRO 0.04% PUMP Removed from Formulary 7/1/17 TRETINOIN GEL MICRO 0.04% TUBE Removed from Formulary 7/1/17 TRETINOIN GEL MICRO 0.1% PUMP Removed from Formulary 7/1/17 TRETINOIN GEL MICRO 0.1% TUBE Removed from Formulary 7/1/17 TRIAMCINOLONE MG/G SPRAY Removed from Formulary 7/1/17 TRIANEX 0.05% OINTMENT Removed from Formulary 7/1/17 TROSPIUM CHLORIDE 20 MG TABLET Removed from Formulary 7/1/17 TROSPIUM CHLORIDE ER 60 MG CAP Removed from Formulary 7/1/17 UREA 39% CREAM Removed from Formulary 7/1/17 UREA 40% CREAM Removed from Formulary 7/1/17 UREA 40% GEL Removed from Formulary 7/1/17 UREA 45% CREAM Removed from Formulary 7/1/17 UREA 45% LOTION Removed from Formulary 7/1/17 UREA 45% NAIL GEL Removed from Formulary 7/1/17 UREA 47% CREAM Removed from Formulary 7/1/17 UREA 50% CREAM Removed from Formulary 7/1/17 VICTRELIS 200 MG CAPSULE Removed from Formulary 7/1/17 ZERUVIA 4%- 1% PATCH Removed from Formulary 7/1/17