Drug Class
|
Drug Name
|
Preferred Status
|
|
Antiplatelets
|
aspirin-dipyridamole ER
|
Non-Preferred
|
|
Aspirin and Extended Release Dipyridamole®
|
Removed
|
|
Attention Deficit/ Hyperactivity Disorder
|
Metadate ER™
|
Removed – see methylphenidate ER
|
|
Calcium Channel Blockers
|
Adalat®
|
Removed
|
|
Cartia XT®
|
Removed – see diltiazem ER
|
|
Taztia XT®
|
Removed – see diltiazem ER
|
|
Estrogens
|
Cenestin®
|
Removed
|
|
Estrasorb®
|
Removed
|
|
Femtrace®
|
Removed
|
|
Estrogen-Progestin Combinations
|
jinteli
|
Removed – see norethindrone acetate -ethinyl estradiol
|
|
mimvey
|
Removed -- see estradiol-norethindrone
|
|
Inhaled Corticosteroids – Long-Acting Beta-Agonist Combinations
(No changes to preferred drug status. Separating asthma/COPD subclasses for clarity of Therapeutic Interchange.)
|
Advair Diskus® /HFA®
|
Preferred
|
|
Breo Ellipta®
|
Preferred
|
|
Dulera®
|
Non-Preferred, EA required
|
|
Symbicort®
|
Non-Preferred
|
|
Long-Acting Beta-Agonist – Long Acting Muscarinic Agent Combinations
(LABA – LAMA)
(No changes to preferred drug status. Separating asthma/COPD subclasses for clarity of Therapeutic Interchange.)
|
Anoro Ellipta®
|
Preferred, EA required
|
|
Stioloto®
|
Non-Preferred, Not subject to TIP or DAW-1, and EA required
|
|
Utibron Neohaler®
|
Non-Preferred, Not subject to TIP or DAW-1, and EA required
|
|
Long-Acting Muscarinic Agents (LAMA)
(No changes to preferred drugs. Renaming drug class)
|
Incruse Ellipta®
|
Non-Preferred, Not subject to TIP or DAW-1, and EA required
|
|
Seebri Neohaler®
|
Non-Preferred, Not subject to TIP or DAW-1, and EA required
|
|
Spiriva Handihaler®
|
Preferred, EA required
|
|
Spiriva Respimat®
|
Preferred, EA required
|
|
Tudorza Pressair®
|
Non-Preferred, EA required
|
|
Nasal Corticosteroids
|
mometasone furoate
|
Non-Preferred
|
|
PCSK-9 Inhibitors
(Proprotein Convertase Subtilisin Kexin Type 9)
(new drug class)
|
Praluent®
|
Non-Preferred, PA required
|
|
Repatha®
|
Preferred, PA required
|
|
Repatha Sureclick®
|
Preferred, PA required
|
|
Statin-type Cholesterol Lowering Agents
(No changes to preferred drug status. Separating asthma/COPD subclasses for clarityof Therapeutic Interchange.)
|
atorvastatin
|
High Potency, Preferred
|
|
Crestor®
|
High Potency, Non-preferred, Not subject to DAW-1 override
|
|
Lipitor®
|
High Potency, Non-preferred
|
|
Targeted Immune Modulaters
|
Taltz®
|
Non-preferred, not subject to DAW-1 override
|
|
Triptans
|
Onzetra®
|
Non-Preferred, not subject to TIP/DAW-1 override
|
