PHARMACY BULLETIN

Dear Provider:

This notification is to inform you of formulary changes for all Medicare Part D plans processed by EnvisionRxOptions. Attached is a formulary change addendum (by plan) with the effective dates of the changes.

Should you need to view a complete Medicare formulary, they are available on the various Part D Plan websites. For your convenience, the plan websites are listed below. (Your pharmacies may not be participating in all plans listed.)

  • AgeWell New York
  • Boston Medical Center HealthNet Plan
  • Care N’ Care
  • EnvisionRxPlus
  • Health Choice Generations
  • HealthSun
  • Medical Card System
  • Memorial Hermann Health Solutions
  • Provider Partners Health Plan
  • Tribute Health Plans
  • Ultimate Health Plan
  • Virginia Premier Health Plan

EnvisionRxOptions is required to email or fax these notifications to be compliant with Medicare Part D.

If you have any questions, please contact EnvisionRxOptions Pharmacy Department at (800) 361-4542.

Sincerely,

EnvisionRxOptions

AgeWell New York
2016 Negative Formulary Changes
Effective Date / Drug / Change / Reason
03/01/2016 / ABILIFY DISC TAB 10MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / FOSCARNET INJ 24MG/ML / Deletion from Formulary / CMS Required Deletion
03/01/2016 / IPOL INJ INACTIVE / Deletion from Formulary / CMS Required Deletion
03/01/2016 / NEUMEGA INJ 5MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / PHENYTOIN EX CAP 200MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / PHENYTOIN EX CAP 300MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / TEVETEN HCT TAB 600-12.5 / Deletion from Formulary / CMS Required Deletion
03/01/2016 / TEVETEN HCT TAB 600-25MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / TICLOPIDINE TAB 250MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / VIIBRYD KIT / Deletion from Formulary / CMS Required Deletion
04/01/2016 / AVANDIA TAB 8MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / LOMUSTINE CAP 10MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / LOMUSTINE CAP 40MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / LOMUSTINE CAP 100MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / PRANDIMET TAB 1-500MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / PRANDIMET TAB 2-500MG / Deletion from Formulary / CMS Required Deletion
05/01/2016 / ARZERRA CON 1000/50 / Deletion from Formulary / CMS Required Deletion
05/01/2016 / AVODART CAP 0.5MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / FLUCONAZOLE/ INJ NACL 200 / Deletion from Formulary / CMS Required Deletion
05/01/2016 / INVEGA TAB 1.5MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / INVEGA TAB 3MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / INVEGA TAB 6MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / INVEGA TAB 9MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / JALYN CAP / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / LESCOL XL TAB 80MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / ORAP TAB 1MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / ORAP TAB 2MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / SURMONTIL CAP 100MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / SURMONTIL CAP 25MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / SURMONTIL CAP 50MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / VIRAMUNE XR TAB 100MG / Deletion from Formulary / Generic Drug Added to Formulary
06/01/2016 / AMNESTEEM CAP 10MG / Deletion from Formulary / CMS Required Deletion
06/01/2016 / AMNESTEEM CAP 20MG / Deletion from Formulary / CMS Required Deletion
06/01/2016 / AMNESTEEM CAP 40MG / Deletion from Formulary / CMS Required Deletion
06/01/2016 / AVANDAMET TAB 2-1000MG / Deletion from Formulary / CMS Required Deletion
06/01/2016 / CEFAZOLIN 330 MG/ML / Deletion from Formulary / CMS Required Deletion
06/01/2016 / COMVAX INJ / Deletion from Formulary / CMS Required Deletion
06/01/2016 / FULYZAQ TAB 125MG / Deletion from Formulary / CMS Required Deletion
AgeWell New York
2016 Negative Formulary Changes
Effective Date / Drug / Change / Reason
06/01/2016 / TREANDA INJ 45/0.5ML / Deletion from Formulary / CMS Required Deletion
07/01/2016 / DAUNOXOME INJ 2MG/ML / Deletion from Formulary / CMS Required Deletion
07/01/2016 / PROMACTA TAB 75MG / Deletion from Formulary / CMS Required Deletion
07/01/2016 / ZAZOLE CRE 0.4% / Deletion from Formulary / CMS Required Deletion
08/01/2016 / BRINTELLIX TAB 10MG / Deletion from Formulary / CMS Required Deletion
08/01/2016 / BRINTELLIX TAB 20MG / Deletion from Formulary / CMS Required Deletion
08/01/2016 / BRINTELLIX TAB 5MG / Deletion from Formulary / CMS Required Deletion
08/01/2016 / LINDANE LOT 1% / Deletion from Formulary / CMS Required Deletion
08/01/2016 / VOLTAREN GEL 1% / Deletion from Formulary / Generic Drug Added to Formulary
10/01/2016 / AMP-SULBACTA INJ 1.5GM / Deletion from Formulary / CMS Required Deletion
10/01/2016 / BUPROBAN TAB 150MG / Deletion from Formulary / CMS Required Deletion
10/01/2016 / CRESTOR TAB 10MG / Deletion from Formulary / Generic Drug Added to Formulary
10/01/2016 / CRESTOR TAB 20MG / Deletion from Formulary / Generic Drug Added to Formulary
10/01/2016 / CRESTOR TAB 40MG / Deletion from Formulary / Generic Drug Added to Formulary
10/01/2016 / CRESTOR TAB 5MG / Deletion from Formulary / Generic Drug Added to Formulary
Boston Medical Center HealthNet Plan
2016 Negative Formulary Changes
Effective Date / Drug / Change / Reason
03/01/2016 / ABILIFY DISC TAB 10MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / FOSCARNET INJ 24MG/ML / Deletion from Formulary / CMS Required Deletion
03/01/2016 / IPOL INJ INACTIVE / Deletion from Formulary / CMS Required Deletion
03/01/2016 / NEUMEGA INJ 5 MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / PHENYTOIN EX CAP 200 MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / PHENYTOIN EX CAP 300 MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / TEVETEN HCT TAB 600-12.5 / Deletion from Formulary / CMS Required Deletion
03/01/2016 / TEVETEN HCT TAB 600-25MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / TICLOPIDINE TAB 250 MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / VIIBRYD KIT / Deletion from Formulary / CMS Required Deletion
04/01/2016 / AVANDIA TAB 8MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / LOMUSTINE CAP 100MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / LOMUSTINE CAP 10MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / LOMUSTINE CAP 40MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / PRANDIMET TAB 1-500MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / PRANDIMET TAB 2-500MG / Deletion from Formulary / CMS Required Deletion
05/01/2016 / AGGRENOX CAP 25-200MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / ANDROID CAP 10MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / ARZERRA CON 1000/50 / Deletion from Formulary / CMS Required Deletion
Boston Medical Center HealthNet Plan
2016 Negative Formulary Changes
Effective Date / Drug / Change / Reason
05/01/2016 / AVODART CAP 0.5MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / FLUCONAZOLE/ INJ NACL 200 / Deletion from Formulary / CMS Required Deletion
05/01/2016 / INVEGA TAB 1.5MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / INVEGA TAB 3MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / INVEGA TAB 6MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / INVEGA TAB 9MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / JALYN CAP / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / LESCOL XL TAB 80MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / MEGACE ES SUS 625/5ML / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / ORAP TAB 1MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / ORAP TAB 2MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / PULMICORT SUS 1MG/2ML / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / SURMONTIL CAP 100MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / SURMONTIL CAP 25MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / SURMONTIL CAP 50MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / VIRAMUNE XR TAB 100MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / ZYVOX SUS 100MG/5M / Deletion from Formulary / Generic Drug Added to Formulary
06/01/2016 / AMNESTEEM CAP 10MG / Deletion from Formulary / CMS Required Deletion
06/01/2016 / AMNESTEEM CAP 20MG / Deletion from Formulary / CMS Required Deletion
06/01/2016 / AMNESTEEM CAP 40MG / Deletion from Formulary / CMS Required Deletion
06/01/2016 / AVANDAMET TAB 2-1000MG / Deletion from Formulary / CMS Required Deletion
06/01/2016 / CEFAZOLIN INJ 1GM / Deletion from Formulary / CMS Required Deletion
06/01/2016 / COMVAX INJ / Deletion from Formulary / CMS Required Deletion
06/01/2016 / FULYZAQ TAB 125MG / Deletion from Formulary / CMS Required Deletion
06/01/2016 / LINCOCIN INJ 300MG/ML / Deletion from Formulary / Generic Drug Added to Formulary
06/01/2016 / TREANDA INJ 45/0.5ML / Deletion from Formulary / CMS Required Deletion
06/01/2016 / XENAZINE TAB 12.5MG / Deletion from Formulary / Generic Drug Added to Formulary
06/01/2016 / XENAZINE TAB 25MG / Deletion from Formulary / Generic Drug Added to Formulary
07/01/2016 / DAUNOXOME INJ 2MG/ML / Deletion from Formulary / CMS Required Deletion
07/01/2016 / PROMACTA TAB 75MG / Deletion from Formulary / CMS Required Deletion
07/01/2016 / ZAZOLE CRE 0.4% / Deletion from Formulary / CMS Required Deletion
08/01/2016 / BRINTELLIX TAB 10MG / Deletion from Formulary / CMS Required Deletion
08/01/2016 / BRINTELLIX TAB 20MG / Deletion from Formulary / CMS Required Deletion
08/01/2016 / BRINTELLIX TAB 5MG / Deletion from Formulary / CMS Required Deletion
08/01/2016 / LINDANE LOT 1% / Deletion from Formulary / CMS Required Deletion
08/01/2016 / TEGRETOL-XR TAB 100MG / Deletion from Formulary / Generic Drug Added to Formulary
10/01/2016 / BUPROBAN TAB 150MG / Deletion from Formulary / CMS Required Deletion
10/01/2016 / CRESTOR TAB 10MG / Deletion from Formulary / Generic Drug Added to Formulary
10/01/2016 / CRESTOR TAB 20MG / Deletion from Formulary / Generic Drug Added to Formulary
Boston Medical Center HealthNet Plan
2016 Negative Formulary Changes
Effective Date / Drug / Change / Reason
10/01/2016 / CRESTOR TAB 40MG / Deletion from Formulary / Generic Drug Added to Formulary
10/01/2016 / CRESTOR TAB 5MG / Deletion from Formulary / Generic Drug Added to Formulary
10/01/2016 / NAPHAZOLINE SOL 0.1% OP / Deletion from Formulary / CMS Required Deletion
Care N' Care
2016 Negative Formulary Changes
Effective Date / Drug / Change / Reason
03/01/2016 / ABILIFY DISC TAB 10MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / ENJUVIA TAB 0.625MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / FOSCARNET INJ 24MG/ML / Deletion from Formulary / CMS Required Deletion
03/01/2016 / IPOL INJ INACTIVE / Deletion from Formulary / CMS Required Deletion
03/01/2016 / NEUMEGA INJ 5 MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / PHENYTOIN EX CAP 200 MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / PHENYTOIN EX CAP 300 MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / SUCLEAR KIT / Deletion from Formulary / CMS Required Deletion
03/01/2016 / TEVETEN HCT TAB 600-12.5 / Deletion from Formulary / CMS Required Deletion
03/01/2016 / TEVETEN HCT TAB 600-25MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / VIIBRYD KIT / Deletion from Formulary / CMS Required Deletion
04/01/2016 / FLAGYL ER TAB 750MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / LOMUSTINE CAP 100MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / LOMUSTINE CAP 10MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / LOMUSTINE CAP 40MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / PRANDIMET TAB 1-500MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / PRANDIMET TAB 2-500MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / SPRIX SPR 15.75MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / TOBRA/NACL INJ 80/0.9 / Deletion from Formulary / CMS Required Deletion
04/01/2016 / TRIAMCINOLON AER 55MCG/AC / Deletion from Formulary / CMS Required Deletion
05/01/2016 / ARZERRA CON 1000/50 / Deletion from Formulary / CMS Required Deletion
05/01/2016 / ATRALIN GEL 0.05% / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / AVODART CAP 0.5MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / EXELON DIS 13.3/24 / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / EXELON DIS 4.6MG/24 / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / EXELON DIS 9.5MG/24 / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / FLUCONAZOLE/ INJ NACL 200 / Deletion from Formulary / CMS Required Deletion
05/01/2016 / INVEGA TAB 1.5MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / INVEGA TAB 3MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / INVEGA TAB 6MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / INVEGA TAB 9MG / Deletion from Formulary / Generic Drug Added to Formulary
Care N' Care
2016 Negative Formulary Changes
Effective Date / Drug / Change / Reason
05/01/2016 / JALYN CAP / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / ORAP TAB 1MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / ORAP TAB 2MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / REPREXAIN TAB 2.5-200 / Deletion from Formulary / CMS Required Deletion
05/01/2016 / SURMONTIL CAP 100MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / SURMONTIL CAP 25MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / SURMONTIL CAP 50MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / VIRAMUNE XR TAB 100MG / Deletion from Formulary / Generic Drug Added to Formulary
06/01/2016 / AMNESTEEM CAP 10MG / Deletion from Formulary / CMS Required Deletion
06/01/2016 / AMNESTEEM CAP 20MG / Deletion from Formulary / CMS Required Deletion
06/01/2016 / AMNESTEEM CAP 40MG / Deletion from Formulary / CMS Required Deletion
06/01/2016 / CEFAZOLIN 330 MG/ML / Deletion from Formulary / CMS Required Deletion
06/01/2016 / COMVAX INJ / Deletion from Formulary / CMS Required Deletion
06/01/2016 / FULYZAQ TAB 125MG / Deletion from Formulary / CMS Required Deletion
06/01/2016 / SOMA TAB 250MG / Deletion from Formulary / Generic Drug Added to Formulary
06/01/2016 / TREANDA INJ 45/0.5ML / Deletion from Formulary / CMS Required Deletion
06/01/2016 / WELLBUTRIN TAB 75MG / Deletion from Formulary / CMS Required Deletion
07/01/2016 / CANTIL TAB 25MG / Deletion from Formulary / CMS Required Deletion
07/01/2016 / DAUNOXOME INJ 2MG/ML / Deletion from Formulary / CMS Required Deletion
07/01/2016 / GLEEVEC TAB 100MG / Deletion from Formulary / Generic Drug Added to Formulary
07/01/2016 / GLEEVEC TAB 400MG / Deletion from Formulary / Generic Drug Added to Formulary
07/01/2016 / NAFTIN CRE 2% / Deletion from Formulary / Generic Drug Added to Formulary
07/01/2016 / PRIMSOL SOL 50MG/5ML / Deletion from Formulary / CMS Required Deletion
07/01/2016 / PROMACTA TAB 75MG / Deletion from Formulary / CMS Required Deletion
07/01/2016 / ZAZOLE CRE 0.4% / Deletion from Formulary / CMS Required Deletion
08/01/2016 / BRINTELLIX TAB 10MG / Deletion from Formulary / CMS Required Deletion
08/01/2016 / BRINTELLIX TAB 20MG / Deletion from Formulary / CMS Required Deletion
08/01/2016 / BRINTELLIX TAB 5MG / Deletion from Formulary / CMS Required Deletion
08/01/2016 / FROVA TAB 2.5MG / Deletion from Formulary / Generic Drug Added to Formulary
08/01/2016 / MYOZYME INJ 50MG / Deletion from Formulary / CMS Required Deletion
08/01/2016 / NASONEX SPR 50MCG/AC / Deletion from Formulary / Generic Drug Added to Formulary
08/01/2016 / OXISTAT CRE 1% / Deletion from Formulary / Generic Drug Added to Formulary
08/01/2016 / VOLTAREN GEL 1% / Deletion from Formulary / Generic Drug Added to Formulary
09/01/2016 / ENJUVIA TAB 1.25MG / Deletion from Formulary / CMS Required Deletion
09/01/2016 / WELLBUTRIN TAB 100MG / Deletion from Formulary / CMS Required Deletion
10/01/2016 / ALTABAX OIN 1% / Deletion from Formulary / CMS Required Deletion
10/01/2016 / AMP-SULBACTA INJ 1.5GM / Deletion from Formulary / CMS Required Deletion
10/01/2016 / BUPROBAN TAB 150MG / Deletion from Formulary / CMS Required Deletion
10/01/2016 / CRESTOR TAB 10MG / Deletion from Formulary / Generic Drug Added to Formulary
Care N' Care
2016 Negative Formulary Changes
Effective Date / Drug / Change / Reason
10/01/2016 / CRESTOR TAB 20MG / Deletion from Formulary / Generic Drug Added to Formulary
10/01/2016 / CRESTOR TAB 40MG / Deletion from Formulary / Generic Drug Added to Formulary
10/01/2016 / CRESTOR TAB 5MG / Deletion from Formulary / Generic Drug Added to Formulary
10/01/2016 / ENJUVIA TAB 0.3MG / Deletion from Formulary / CMS Required Deletion
10/01/2016 / ENJUVIA TAB 0.45MG / Deletion from Formulary / CMS Required Deletion
10/01/2016 / ENJUVIA TAB 0.9MG / Deletion from Formulary / CMS Required Deletion
10/01/2016 / GLYSET TAB 100MG / Deletion from Formulary / Generic Drug Added to Formulary
10/01/2016 / GLYSET TAB 25MG / Deletion from Formulary / Generic Drug Added to Formulary
10/01/2016 / GLYSET TAB 50MG / Deletion from Formulary / Generic Drug Added to Formulary
10/01/2016 / MOBIC SUS 7.5/5ML / Deletion from Formulary / CMS Required Deletion
10/01/2016 / NAPHAZOLINE SOL 0.1% OP / Deletion from Formulary / CMS Required Deletion
EnvisionRxPlus Silver
2016 Negative Formulary Changes
Effective Date / Drug / Change / Reason
03/01/2016 / ABILIFY DISC TAB 10MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / FOSCARNET INJ 24MG/ML / Deletion from Formulary / CMS Required Deletion
03/01/2016 / IPOL INJ INACTIVE / Deletion from Formulary / CMS Required Deletion
03/01/2016 / NEUMEGA INJ 5MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / PHENYTOIN EX CAP 200MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / PHENYTOIN EX CAP 300MG / Deletion from Formulary / CMS Required Deletion
03/01/2016 / VIIBRYD KIT / Deletion from Formulary / CMS Required Deletion
04/01/2016 / ENDODAN TAB / Deletion from Formulary / CMS Required Deletion
04/01/2016 / LOMUSTINE CAP 100MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / LOMUSTINE CAP 10MG / Deletion from Formulary / CMS Required Deletion
04/01/2016 / LOMUSTINE CAP 40MG / Deletion from Formulary / CMS Required Deletion
05/01/2016 / ANDROGEL GEL PUMP 1% / Deletion from Formulary / CMS Required Deletion
05/01/2016 / ARZERRA CON 1000/50 / Deletion from Formulary / CMS Required Deletion
05/01/2016 / AVODART CAP 0.5MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / FLUCONAZOLE/ INJ NACL 200 / Deletion from Formulary / CMS Required Deletion
05/01/2016 / INVEGA TAB 1.5MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / INVEGA TAB 3MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / INVEGA TAB 6MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / INVEGA TAB 9MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / JALYN CAP / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / ORAP TAB 1MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / ORAP TAB 2MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / SURMONTIL CAP 100MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / SURMONTIL CAP 25MG / Deletion from Formulary / Generic Drug Added to Formulary
EnvisionRxPlus Silver
2016 Negative Formulary Changes
Effective Date / Drug / Change / Reason
05/01/2016 / SURMONTIL CAP 50MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / VIRAMUNE XR TAB 100MG / Deletion from Formulary / Generic Drug Added to Formulary
05/01/2016 / ZYVOX SUS 100MG/5M / Deletion from Formulary / Generic Drug Added to Formulary
06/01/2016 / CEFAZOLIN 330 MG/ML / Deletion from Formulary / CMS Required Deletion
06/01/2016 / COMVAX INJ / Deletion from Formulary / CMS Required Deletion
06/01/2016 / FULYZAQ TAB 125MG / Deletion from Formulary / CMS Required Deletion
06/01/2016 / TREANDA INJ 45/0.5ML / Deletion from Formulary / CMS Required Deletion
07/01/2016 / OTEZLA TAB 10/20/30 / Deletion from Formulary / CMS Required Deletion
07/01/2016 / PROMACTA TAB 75MG / Deletion from Formulary / CMS Required Deletion
07/01/2016 / UCERIS AER 2MG/ACT / Deletion from Formulary / CMS Required Deletion