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Medications we cover

Your plan has a list of medications we cover. This is called the preferred drug list (PDL). Medicaid and Florida Healthy Kids (FHK) each have their own PDL.

Questions?

Contact us. We’re here to help.

Your plan’s PDL

Medicaid

Medicaid plans use the Florida Medicaid PDL. You can check the PDL to see if we cover your medication. You can also check a list of recent updates to the PDL on their site. 

 

We also offer our Medicaid members a supplemental PDL. This is a list of additional drugs we cover. If you don’t see your medication on the Medicaid PDL, you may find it on our supplemental PDL (PDF). 

 

You can also check the updates section on this page. It lists recent changes to our supplemental PDL. 

Florida Healthy Kids

FHK has a searchable PDL you can check for your or your child’s medication. You can also check the updates section on this page. It lists the recent changes to the FHK PDL. 

 

There are many different things that you can do with your or your child’s PDL search tool. You can:

 

  • Search for your medicine by name or class

  • Find generic alternatives to your medicine

  • See if your medicine has quantity limits, has age limits, or needs prior authorization 

PDL changes and updates

You can find the latest changes to the Medicaid PDL on the Florida Agency for Health Care Administration (AHCA) website. Just look for the document called “Changes Summary Report.”

Other drug lists

 

You can also see the list of medications we cover for diabetes supplies.

 

Diabetes supplies (PDF)

 

Florida Healthy Kids PDL updates

June 2023

 

Additions:

 

  • N/A

 

Removals:

 

  • Firvanq 50 mg per ml solution

 

Other Updates:

 

  • N/A

 

May 2023

 

Additions:

 

  • Breztri aerosphere 160mcg/9 mcg/4.8 mcg inhalation (Step Therapy, Quantity Limit)
  • CVS pinworm 50 mg per ml suspension
  • Fexofenadine HCL 30 mg per ml suspension (Quantity Limit)
  • Gilenya 0.25 mg capsules (Prior Authorization, Quantity Limit)
  • GNP hydrocortisone max strength 1% ointment
  • Trikafta 100 mg/50 mg/75 mg/150 mg tablets (Prior Authorization)
  • Trikafta 50 mg/25 mg/37.5 mg/75 mg tablets (Prior Authorization)
  • Urea 20% cream

 

Removals:

 

  • Amphotericin b 50 mg reconstituted intravenous solution
  • Aztreonam 1 gm solution for injection
  • Aztreonam 2 gm solution for injection
  • Cholecalciferol 125 mcg per ml drops
  • Cholecalciferol 2000 unit chewable tablets
  • Cholecalciferol 3000 unit tablets
  • Cholecalciferol 400 unit capsules
  • Cholecalciferol 4000 unit capsules
  • Clindamycin phosphate 300 mg per 2 ml injection
  • Clindamycin phosphate 600 mg per 4 ml injection
  • Clindamycin phosphate 9 gm per 60 ml injection
  • Clindamycin phosphate 900 mg per 6 ml injection
  • Colestipol 5 gm granule packets
  • Colestipol 5 gm granules
  • Colistimethate sodium150 mg solution for injection
  • Creon delayed release 12000-38000 unit capsules
  • Creon delayed release 24000-76000 unit capsules
  • Creon delayed release 3000-9500 unit capsules
  • Creon delayed release 36000-114000 unit capsules
  • Creon delayed release 6000-19000 unit capsules
  • Dekas essential oral liquid
  • Diuril 250 mg per 5 ml oral suspension
  • Elmiron 100 mg capsules
  • Enfamil expecta 28 mg/0.8 mg/200 mg capsules
  • Ergocalciferol 2000 unit tablets
  • Ergocalciferol 400 unit tablets
  • Fluconazole 100 mg in sodium chloride 0.9% per 50 ml intervenous solution
  • Fluconazole 200 mg in sodium chloride 0.9% per 100 ml intervenous solution
  • Fluconazole 400 mg in sodium chloride 0.9% per 200 ml intervenous solution
  • Fluocinolone acetonide 0.01% cream
  • Fluocinolone acetonide 0.01% scalp oil
  • Ganciclovir sodium 500 mg per 10 ml intravenous solution
  • Ganciclovir sodium 500 mg reconstituted intravenous solution
  • Heparin sodium (porcine) 20000 units per ml injection
  • Heparin sodium (porcine) 5000 units per 0.5 ml injection
  • Hydroxychloroquine sulfate 100 mg tablets
  • Hydroxychloroquine sulfate 300 mg tablets
  • Hydroxychloroquine sulfate 400 mg tablets
  • Hydroxyprogesterone caproate bulk powder
  • Hydroxyprogesterone caproate oil 250 mg per ml injection
  • Hydroxyprogesterone caproate solution 275 mg per 1.1 ml auto-injector
  • Imipenem-cilastatin 250 mg intravenous solution
  • Imipenem-cilastatin 500 mg intravenous solution
  • Isosorbide dinitrate 40 mg tablets
  • Lidocaine 4% cream
  • Lidocaine HCL 4% solution
  • Lincomycin HCL 300 mg per ml injection
  • Magnesium 400 mg tablet
  • Makena 275 mg per 1.1 ml auto-injector
  • Meropenem 1 gm and sodium chloride 0.9% per 50 ml intravenous solution
  • Meropenem 1 gm intravenous solution
  • Meropenem 500 mg and sodium chloride 0.9% per 50 ml intravenous solution
  • Meropenem 500 mg intravenous solution
  • Metronidazole 500 mg per 100 ml intravenous solution
  • Mexiletine HCL 150 mg capsules
  • Mexiletine HCL 200 mg capsules
  • Mexiletine HCL 250 mg capsules
  • Niacin extended release 1000 mg tablets
  • Niacin extended release 500 mg tablets
  • Niacin extended release 750 mg tablets
  • Olmesartan hydrochlorothiazide 20 mg/12.5 mg tablets
  • Olmesartan hydrochlorothiazide 40 mg/12.5 mg tablets
  • Olmesartan hydrochlorothiazide 40 mg/25 mg tablets
  • Omega-3 fatty acids 435 mg capsules
  • Pediatric multiple vitamins with minerals chewable tablets
  • Polymyxin b sulfate 500,000 unit solution for injection
  • Posaconazole delayed release 100 mg tablets
  • Quinidine sulfate 200 mg tablets
  • Quinidine sulfate 300 mg tablets
  • Ranolazine extended release 1000 mg tablet
  • Ranolazine extended release 500 mg tablet
  • Ribavirin 6 gm reconstituted inhalation solution
  • Stiolto Respimat 2.5-2.5 mcg per actuation inhaler
  • Triamcinolone acetonide 0.05% ointment
  • Valganciclovir 50 mg per ml reconstituted oral solution
  • Vancomycin 1 gm and sodium chloride 0.9% per 200 ml intravenous solution
  • Vancomycin 500 mg and dextrose 5% per 100 ml intravenous solution
  • Vancomycin 500 mg and sodium chloride 0.9% per 100 ml intravenous solution
  • Vancomycin 750 mg and sodium chloride 0.9% per 150 ml intravenous solution

 

Other Updates:

 

  • Albendazole 200 mg tablets (Added Auto Prior Authorization, Removed Quantity Limit)
  • Betamethasone dipropionate 0.05% ointment (Changed Quantity Limit)
  • Emgality 120 mg per ml injection (Added Step Therapy, Added Quantity Limit, Removed Age Limit)
  • Emgality 120 mg per ml prefilled syringe (Added Step Therapy, Added Quantity Limit, Removed Age Limit)
  • Fluocinolone acetonide 0.025% cream (Changed Quantity Limit)
  • Fluocinolone acetonide 0.025% ointment (Changed Quantity Limit)
  • Fluticasone-Salmeterol 100 mcg/50 mcg inhaler (Removed Age Limit, Added Quantity Limit)
  • Fluticasone-Salmeterol 250 mcg/50 mcg inhaler (Removed Age Limit, Added Quantity Limit)
  • Fluticasone-Salmeterol 500 mcg/50 mcg inhaler (Removed Age Limit, Added Quantity Limit)
  • Lidocaine 5% ointment (Removed Prior Authorization)
  • Ozempic 2 mg per 1.5 ml pen injector (Added Step Therapy)
  • Ozempic 2 mg per 3 ml pen injector (Added Step Therapy)
  • Trulicity 0.75 mg per 0.5 ml pen injector (Added Step Therapy)
  • Trulicity 1.5 mg per 0.5 ml pen injector (Added Step Therapy)
  • Trulicity 3 mg per 0.5 ml pen injector (Added Step Therapy)
  • Trulicity 4.5 mg per 0.5 ml pen injector (Added Step Therapy)

 

April 2023

 

Additions:

 

  • N/A

 

Removals:

 

  • N/A

 

Other Updates:

 

  • N/A

 

March 2023

 

Additions:

 

  • Guaifenesin 100 mg/codeine 6.33 mg solution (Age Limit, Quantity Limit)

 

Removals:

 

  • Advair HFA 115 mcg/21 mcg inhalation
  • Advair HFA 230 mcg/21 mcg inhalation
  • Advair HFA 45 mcg/21 mcg inhalation
  • Ampicillin and sulbactam sodium 1.5 gm for injection
  • Ampicillin and sulbactam sodium 1.5 gm for intravenous solution
  • Ampicillin and sulbactam sodium 15 gm for intravenous solution
  • Ampicillin and sulbactam sodium 3 gm for injection
  • Ampicillin and sulbactam sodium 3 gm for intravenous solution
  • Ampicillin sodium 1 gm for injection
  • Ampicillin sodium 1 gm for intravenous solution
  • Ampicillin sodium 10 gm for intravenous solution
  • Ampicillin sodium 125 mg for injection
  • Ampicillin sodium 2 gm for injection
  • Ampicillin sodium 2 gm for intravenous solution
  • Ampicillin sodium 250 mg for injection
  • Ampicillin sodium 500 mg for injection
  • Anoro Ellipta 62.5 mcg/25 mcg inhalation
  • Asmanex 110 mcg 30 puff inhalation
  • Asmanex 220 mcg 120 puff inhalation
  • Azithromycin 500 mg intravenous for solution
  • Cefazolin sodium 1 gm for injection
  • Cefazolin sodium 1 gm for intravenous solution
  • Cefazolin sodium 10 gm for injection
  • Cefazolin sodium 2 gm for injection
  • Cefazolin sodium 500 mg for injection
  • Cefepime hydrochloric acid 1 gm for injection
  • Cefepime hydrochloric acid 2 gm for injection
  • Cefepime hydrochloric acid 2 gm for intravenous solution
  • Cefotaxime sodium 1 gm for injection
  • Cefotetan disodium 1 gm for injection
  • Cefotetan disodium 2 gm for injection
  • Cefoxitin sodium 1 gm and dextrose 4% per 50 mL
  • Cefoxitin sodium 1 gm for intravenous solution
  • Cefoxitin sodium 1 gm/dextrose 4% per 50 mL intravenous solution
  • Cefoxitin sodium 10 gm for intravenous solution
  • Cefoxitin sodium 2 gm and dextrose 2.2% per 50 mL
  • Cefoxitin sodium 2 gm for intravenous solution
  • Ceftriaxone sodium 1 gm and dextrose 3.74% in 50 mL intravenous solution
  • Ceftriaxone sodium 10 gm for injection
  • Ceftriaxone sodium 2 gm and dextrose 2.22% in 50 mL intravenous solution
  • Ceftriaxone sodium 20 mg per mL in dextrose injection
  • Ceftriaxone sodium 40 mg per mL in dextrose injection
  • Cefuroxime sodium 1 gm for intravenous solution
  • Cefuroxime sodium 1.5 gm for intravenous solution
  • Cefuroxime sodium 2 gm for intravenous solution
  • Cefuroxime sodium 750 mg for injection
  • Cephalexin 750 mg capsule
  • Ciprofloxacin 200 mg per 100 mL in dextrose water
  • Ciprofloxacin 250 mg per 5 mL for oral suspension
  • Ciprofloxacin 400 mg per 200 mL in dextrose water
  • Ciprofloxacin 500 mg per 5 mL for oral suspension
  • Doxycycline hyclate 150 mg tablet
  • Doxycycline hyclate 50 mg tablet
  • Doxycycline hyclate 75 mg tablet
  • Dulera 100 mcg/5 mcg inhalation
  • Dulera 200 mcg/5 mcg inhalation
  • Dulera 50 mcg/5 mcg inhalation
  • Erythromycin ethylsuccinate 200 mg per 5 ml for suspension
  • Heparin sodium (porcine) 100 unit per mL lock flush
  • Heparin sodium (porcine) 5000 unit per 0.5 mL prefilled syringe
  • Heparin sodium (porcine) 5000 unit per mL injection
  • Levofloxacin 250 mg per 50 mL in dextrose water intravenous solution
  • Levofloxacin 500 mg per 100 mL in dextrose water intravenous solution
  • Levofloxacin 750 mg per 150 mL in dextrose water intravenous solution
  • Penicillin g procaine 600,000 unit per mL intramuscular suspension
  • Penicillin g sodium 5,000,000 unit for injection
  • Piperacillin sodium and tazobactam sodium 13.5 gm for injection
  • Piperacillin sodium and tazobactam sodium 2.25 gm for injection
  • Piperacillin sodium and tazobactam sodium 3.375 gm for injection
  • Piperacillin sodium and tazobactam sodium 4.5 gm for injection
  • Piperacillin sodium and tazobactam sodium 40.5 gm for injection
  • Procaine 1,200,000 unit per 2 mL suspension
  • Procaine 900,000 unit/300,000 unit per 2 mL injection
  • Pulmicort Flexhaler 180 mcg inhalation
  • Pulmicort Flexhaler 90 mcg inhalation
  • Rivaroxaban 2.5 mg tablet
  • Rivaroxaban for suspension 1 mg per mL
  • Severent diskus 50 mcg inhalation
  • Terbutaline sulfate 1 mg per mL injection
  • Theo-24 extended release 100 mg capsule
  • Theo-24 extended release 200 mg capsule
  • Theo-24 extended release 300 mg capsule
  • Theo-24 extended release 400 mg capsule
  • Tobramycin 300 mg per 4 mL nebulizer solution

 

 

Other Updates:

 

  • N/A

 

February 2023

 

Additions:

 

  • Acid gone 160 mg/105 mg chewable tablet
  • Acid gone 95 mg/358 mg per 15 mL suspension
  • Afrin saline 0.65% nasal spray
  • Budesonide extended release 9 mg tablet
  • Carboxymethylcellulose sodium 1% ophthalmic gel
  • Carboxymethylcellulose sodium preservative free 1% ophthalmic gel
  • Cold and cough 2.5 mg/1 mg/5 mg per 5 mL liquid (Quantity Limit)
  • CVS disposable rectal enema 19 gm/7 gm per 118mL
  • CVS dry eye relief 0.2%/0.2%/1% ophthalmic solution
  • CVS eye allergy relief 0.027%/0.315% ophthalmic solution
  • CVS fiber 0.52 gm capsule
  • CVS lubricating/dry eye 0.5%/0.9% ophthalmic solution
  • Daily fiber 0.52 gm capsule
  • Deep sea 0.65% nasal spray
  • Dificid 200 mg tablet (Prior Authorization)
  • Dificid 40 mg per mL suspension (Prior Authorization)
  • Dimaphen dextromethorphan 2.5 mg/1 mg/5 mg per 5 mL liquid (Quantity Limit)
  • Dry eye relief drops 0.2%/0.2%/1% ophthalmic solution
  • Endacof dextromethorphan 2.5 mg/1 mg/5 mg per 5 mL liquid (Quantity Limit)
  • EQ multi symptom cold 2.5 mg/5 mg/100 mg per 5 mL liquid (Quantity Limit)
  • Esomeprazole magnesium delayed release 40 mg capsule (Quantity Limit)
  • Estradiol 0.01 mg/gm vaginal cream (Quantity Limit)
  • Ethacrynic acid 25 mg tablet
  • Fiber laxative 0.52 gm capsule
  • Fiber laxative 625 mg tablet
  • Fiber laxative plus calcium 625 mg tablet
  • GenTeal severe 0.3% ophthalmic gel
  • Glycerin childrens 1 gm rectal suppository 
  • GNP anorectal 5% cream (Quantity Limit)
  • GNP antacid extra strength 160 mg/105 mg chewable
  • GNP cold and cough 2.5 mg/1 mg/5 mg per 5 mL liquid (Quantity Limit)
  • GNP natural fiber 0.52 gm capsule
  • Gvoke kit 1 mg per 0.2 mL subcutaneous solution (Quantity Limit)
  • Headache relief 250 mg/250 mg/65 mg tablet
  • Hemorrhoidal relief 5% cream (Quantity Limit)
  • HM cold and cough 2.5 mg/1 mg/5 mg per 5 mL liquid (Quantity Limit)
  • HM saline 0.65% nasal spray
  • Imbruvica 140 mg tablet (Prior Authorization, Quantity Limit)
  • Imbruvica 280 mg tablet (Prior Authorization, Quantity Limit)
  • Imbruvica 420 mg tablet (Prior Authorization, Quantity Limit)
  • Imbruvica 560 mg tablet (Prior Authorization, Quantity Limit)
  • Invega Hafyera 1092 mg per 3.5 mL prefilled syringe (Prior Authorization, Quantity Limit)
  • Invega Hafyera 1560 mg per 5 mL prefilled syringe (Prior Authorization, Quantity Limit)
  • Lidocaine anorectal 5% cream (Quantity Limit)
  • Loratadine 5 mg per 5 mL syrup (Quantity Limit)
  • Lubricant eye drops 0.4%/0.3% ophthalmic solution
  • Magnesium citrate 1.745 gm per 30 mL solution
  • Miconazole nitrate vaginal suppository 1200 mg & 2% cream kit
  • Migraine relief 250 mg/250 mg/65 mg tablet
  • Mucinex free severe congestion and cough 10 mg/20 mg/400 mg per 20 mL liquid (Quantity Limit)
  • Mucus relief 2.5 mg/5 mg/100 mg per 5 mL liquid (Quantity Limit)
  • Naphcon-A 0.025%/0.3% ophthalmic solution
  • Ocean kids 0.65% nasal solution
  • Phenylephrine 10 mg tablet
  • Phenylephrine 10 mg/dextromethorphan 18 mg/guaifenesin 200 mg per 15 mL liquid (Quantity Limit)
  • Phenylephrine 2.5 mg/dextromethorphan 5 mg/guaifenesin 100 mg per 5 mL liquid (Quantity Limit)
  • Pramoxine 1% external foam (Quantity Limit)
  • Pseudoephedrine extended release 120 mg tablet
  • QC dibromm childrens cold and cough 2.5 mg/1 mg/5 mg per 5 mL liquid (Quantity Limit)
  • QC mucus relief severe congestion and cough 2.5 mg/5 ml/100 mg per 5 mL liquid (Quantity Limit)
  • Rectasmoothe 5% cream
  • Refresh Celluvisc 1% ophthalmic gel
  • Refresh Digital 0.5%/1%/0.5% ophthalmic solution
  • Refresh Liquigel 1% ophthalmic gel
  • Refresh Optive 1%/0.9% ophthalmic gel
  • Refresh Optive Advanced 0.5%/1%/0.5% ophthalmic solution
  • Refresh Optive preservative 0.5%/0.9% ophthalmic solution
  • Refresh Relieva preservative free 0.5%/0.9% ophthalmic solution
  • Refresh Relieva preservative free 0.5%/1% ophthalmic solution
  • Rynex dextromethorphan 2.5 mg/1 mg/5 mg per 5 mL liquid (Quantity Limit)
  • Saline mist 0.65% nasal spray
  • SM cold and cough dextromethorphan 2.5 mg/1 mg/5 mg per 5 mL liquid (Quantity Limit)
  • SM dry eye relief 0.2%/0.2%/1% ophthalmic solution
  • SM lubricant 0.4%/0.3% ophthalmic solution
  • SM severe congestion and cough 10 mg/20 mg/400 mg per 20 mL liquid (Quantity Limit)
  • Sudogest phenylephrine 10 mg tablet
  • Suphedrine extended release 120 mg tablet
  • Systane Ultra 0.4%/0.3% ophthalmic solution
  • Tramadol extended release 100 mg tablet (Auto Prior Authorization, Quantity Limit, Age Limit)
  • Tramadol extended release 200 mg tablet (Auto Prior Authorization, Quantity Limit, Age Limit)
  • Tramadol extended release 300 mg tablet (Auto Prior Authorization, Quantity Limit, Age Limit)
  • Vanacof 30 mg/1 mg/12.5 mg per 5 mL liquid (Quantity Limit)
  • Xifaxan 550 mg tablet (Prior Authorization)

 

Removals:

 

  • Acitretin 10 mg capsule
  • Acitretin 17.5 mg capsule
  • Acitretin 25 mg capsule
  • Acyclovir 5% cream
  • Adapaline 0.1%/benzocaine 2.5% gel
  • Aimovig auto-injector 140 mg per mL subcutaneous solution
  • Aimovig auto-injector 70 mg per mL subcutaneous solution
  • Alcohol sheets 70%
  • Alendronate 70 mg per 75 mL solution
  • Allantoin 0.5% cream, gel, and lotion
  • Aloe grande 10000 unit/1500 unti per 30mL lotion
  • Aloe grande 100000 unit/1500 unit per gm cream
  • Ammonium lactate 10% lotion
  • Ammonium lactate 5% lotion
  • Aquastat 0.9% intravenous solution
  • Aranesp (albumin free) 10 mcg per 0.4mL prefilled syringe injection solution
  • Aranesp (albumin free) 100 mcg per 0.5mL prefilled syringe injection solution
  • Aranesp (albumin free) 100 mcg per mL injection solution
  • Aranesp (albumin free) 150 mcg per 0.3mL prefilled syringe injection solution
  • Aranesp (albumin free) 200 mcg per 0.4mL prefilled syringe injection solution
  • Aranesp (albumin free) 200 mcg per mL injection solution
  • Aranesp (albumin free) 25 mcg per 0.42mL prefilled syringe injection solution
  • Aranesp (albumin free) 25 mcg per mL injection solution
  • Aranesp (albumin free) 300 mcg per 0.6mL prefilled syringe injection solution
  • Aranesp (albumin free) 40 mcg per 0.4mL prefilled syringe injection solution
  • Aranesp (albumin free) 40 mcg per mL injection solution
  • Aranesp (albumin free) 500 mcg per mL prefilled syringe injection solution
  • Aranesp (albumin free) 60 mcg per 0.3mL prefilled syringe injection solution
  • Aranesp (albumin free) 60 mcg per mL injection solution
  • Atopiclair cream
  • Auryxia 210 mg tablet
  • Aveeno calm & restore gel
  • Aveeno calm & restore serum liquid
  • Aveeno creamy moisturize oil
  • Aveeno daily moisturize oil
  • Azelaic acid 15% gel
  • Bacteriostatic sodium chloride 0.9% injection solution
  • BD Posiflush 0.9% intravenous solution
  • Benzocaine 20 mg/docusate sodium 283 mg rectal enema
  • Benzoyl peroxide 5%/erythromycin 3% gel
  • Betaseron 0.3 mg injection
  • Bisacodyl 10 mg per 30 mL enema
  • Brimonidine tartate 0.2%/timolol maleate 0.5% ophthalmic solution
  • Brinzolamide 1% ophthalmic solution
  • Butalbital 50 mg/acetaminophen 325 mg tablet
  • Butalbital 50 mg/acetaminophen 325 mg/caffeine 40 mg/codeine 30 mg capsule
  • Butalbital 50 mg/aspirin 325 mg/caffeine 40 mg capsule
  • Byetta 10 mcg pen-injector solution
  • Byetta 5 mcg pen-injector solution
  • Carbinoxamine maleate 4 mg per 5 mL solution
  • Cavilon emollient cream
  • Cavilon foot & dry skin cream
  • Cavilon foot and dry skin cream
  • Celotin 300 mg capsule
  • Cequa 0.09% ophthalmic solution
  • Cetaphil Pro eczema soothing 1% Lotion
  • Clean & clear watermelon moist gel
  • Clindamycin phosphate 1.5%/benzoyl peroxide 5% gel
  • Clorazepate dipotassium 15 mg tablet
  • Clorazepate dipotassium 3.75 mg tablet
  • Clorazepate dipotassium 7.5 mg tablet
  • Colchicine 0.6 mg capsule
  • CVS beauty 360 pure vitamin-e 28000 unit per 29mL oil
  • CVS beauty 360 soothing bath packet
  • CVS eczema care 1% cream
  • CVS eczema relief 1% cream
  • CVS scar gel
  • CVS vitamin-E moisturizing cream
  • CVS vitamin-E moisturizing oil
  • Dalfampridine extended release 12-hour 10 mg tablet
  • Denavir 1% cream
  • DermaZinc cream
  • Dexeryl cream
  • Diazoxide 50 mg per mL suspension
  • Diclofenac 3% gel
  • Diltiazem extended release 12-hour 120 mg capsule
  • Diltiazem extended release 12-hour 60 mg capsule
  • Diltiazem extended release 12-hour 90 mg capsule
  • Diltiazem extended release 24-hour 360 mg coated beads capsule
  • Diphenhydramine injection 50 mg per mL solution
  • Diphenoxylate 2.5 mg/atropine 0.025 mg per 5 mL liquid
  • Dofetilide 125 mcg capsule
  • Dofetilide 250 mcg capsule
  • Dofetilide 500 mcg capsule
  • Doxepin 5% cream
  • Econazole nitrate 1% cream
  • Eczema moisturizing 1% lotion
  • Eletone cream
  • Esbriet 267 mg capsule
  • Estring ring 2 mg vaginal
  • Eucerin baby eczema relief 1% cream
  • Eucerin eczema relief 1% cream
  • Eucerin eczema relief 2% cream
  • Eucrisa 2% ointment
  • Farxiga 10 mg tablet
  • Farxiga 5 mg tablet
  • Fexofenadine 180 mg/pseudoephedrin 240 mg extended release 24-hour tablet
  • Gel lined heel sleeves
  • Gel lined moisturizing booties
  • Gel lined moisturizing gloves
  • Glyxambi 10 mg/5 mg tablet
  • Glyxambi 25 mg/5 mg tablet
  • Gordons-Vite-A 100000 unit lotion
  • Gordons-Vite-A 100000 unit per gm cream
  • Hylaguard cream
  • Hylatopic plus cream
  • Hylatopic plus lotion
  • Ibrance 100 mg tablet
  • Ibrance 125 mg tablet
  • Ibrance 75 mg tablet
  • Ingrezza 40 mg capsule
  • Ingrezza 60 mg capsule
  • Ingrezza 80 mg capsule
  • Invokamet 150 mg/1000 mg tablet
  • Invokamet 150 mg/500 mg tablet
  • Invokamet 50 mg/1000 mg tablet
  • Invokamet 50 mg/500 mg tablet
  • Invokana 100 mg tablet
  • Invokana 300 mg tablet
  • Isotretinoin 25 mg capsule
  • Isotretinoin 30 mg capsule
  • Jentadueto 2.5 mg/1000 mg tablet
  • Jentadueto 2.5 mg/500 mg tablet
  • Jentadueto 2.5 mg/850 mg tablet
  • Keri renewal serum liquid
  • Kombiglyze XR extended release 2.5 mg/1000 mg tablet
  • Kombiglyze XR extended release 5 mg/1000 mg tablet
  • Kombiglyze XR extended release 5 mg/500 mg tablet
  • Lactic acid 10%/vitamin e 3500 units per 30 gm cream
  • Lamisilk repair complex serum liquid
  • Leukine 250 mcg reconstitued injection solution
  • Levocetirizine dihydrochloride 2.5 mg per 5 mL solution
  • Levofloxacin 0.5% ophthalmic solution
  • Lidocaine 3% cream
  • Lidocaine 4% ointment
  • Lidocaine 4% solution
  • Magnexium hydroxide 2400 mg per 10 mL suspension
  • Mederma advanced scar gel
  • Methylphenidate LA extended release 20 mg capsule
  • Methylphenidate LA extended release 30 mg capsule
  • Methylphenidate LA extended release 40 mg capsule
  • Methylphenidate LA extended release 60 mg capsule
  • Naproxen enteric coated delayed release 500 mg tablet
  • Natural vitamin-e moisturizing gel
  • Neuac 1.2%/5% gel
  • Neupogen 300 mcg injection solution
  • Neupogen 300 mcg per 0.5 mL prefilled syringe injection solution
  • Neupogen 480 mcg injection solution
  • Neupogen 480 mcg per 0.8 mL prefilled syringe injection solution
  • Nimodipine 30 mg capsule
  • Nivestym 300 mcg per 0.5 mL prefilled syringe injection solution
  • Nivestym 480 mcg per 0.8 mL prefilled syringe injection solution
  • Normal saline flush 0.9% intravenous solution
  • Nurtec 75 mg oral disintegrating tablet
  • Nutraseb cream
  • Nystatin 100000 units/triamcinolone 0.1% per gram cream
  • Nystatin 100000 units/triamcinolone 0.1% per gram ointment
  • Nyvepria 6 mg per 0.6 mL prefilled syringe injection solution
  • Onglyza 2.5 mg tablet
  • Onglyza 5 mg tablet
  • Oxymorphone extended release 12-hour 10 mg tablet
  • Oxymorphone extended release 12-hour 15 mg tablet
  • Oxymorphone extended release 12-hour 20 mg tablet
  • Oxymorphone extended release 12-hour 30 mg tablet
  • Oxymorphone extended release 12-hour 40 mg tablet
  • Oxymorphone extended release 12-hour 5 mg tablet
  • Oxymorphone extended release 12-hour 7.5 mg tablet
  • Pancreaze delayed release 10500 unit capsule
  • Pancreaze delayed release 16800 unit capsule
  • Pancreaze delayed release 21000 unit capsule
  • Pancreaze delayed release 2600 unit capsule
  • Pancreaze delayed release 37000 unit capsule
  • Pancreaze delayed release 4200 unit capsule
  • Pertyze delayed release 1600 unit capsule
  • Pertyze delayed release 2400 unit capsule
  • Pertyze delayed release 4000 unit capsule
  • Pertyze delayed release 8000 unit capsule
  • Pimecrolimus 1% cream
  • Potassium 550 mg/sodium citrate 500 mg/citric acid 334 mg per 5 mL solution
  • Prevacare total skin care solution
  • Promethazine 25 mg per mL injection solution
  • Promethazine 50 mg per mL injection solution
  • Promiseb cream
  • Qulipta 10 mg tablet
  • Qulipta 30 mg tablet
  • Qulipta 60 mg tablet
  • Salimez 6% cream
  • Saline 0.4%/phenol 0.9% injection solution
  • Santyl 250 units per gm ointment
  • Sardoettes pads
  • Sildenafil 10 mg per mL suspension
  • Silver nitrate 0.5% solution
  • Sulfacetamide sodium 10% ophthalmic ointment
  • Super E hand/body lotion
  • Super E ointment
  • Symlinpen 120 pen-injector 2400 mcg per 2.7 mL solution
  • Symlinpen 60 pen-injector 1500 mcg per 1.5 mL solution
  • Synjardy 12.5 mg/1000 mg tablet
  • Synjardy 12.5 mg/500 mg tablet
  • Synjardy 5 mg/1000 mg tablet
  • Synjardy 5 mg/500 mg tablet
  • Tetrix cream
  • Tradjenta 5 mg tablet
  • Ubrelvy 100 mg tablet
  • Ubrelvy 50 mg tablet
  • Urea 40% cream
  • Ventavis 10 mcg per mL inhalation solution
  • Ventavis 20 mcg per mL inhalation solution
  • Victoza pen-injector 18 mg per 3 mL solution
  • Vitamin E & C beauty lotion
  • Vitamin-A wrinkle treatment gel
  • Vitamin-E & vitamin-K beautiful skin oil
  • Vitamin-E 1000 unit/vitamin-A 14000 unit per 52mL beauty oil
  • Vitamin-E 24000 unit liquid
  • Vitamin-E 24000 unit per 52mL beauty oil
  • Vitamin-E 400 unit/vitamin-D 14000 unit per 52mL beauty oil
  • Vitamin-E complex cream
  • Vitamin-E Skin 4000 unit cream
  • Vitamin-E skin oil
  • Vitamin-E with vitamin A & D cream
  • Vita-Ray cream
  • Vosevi 400 mg/100 mg/100 mg tablet
  • WaxWel paraffin bath kit
  • Xeljanz 1 mg per mL solution
  • Xeljanz 10 mg tablet
  • Xeljanz 5 mg tablet
  • Xigduo XR extended release 24-hour 10 mg-1000 mg tablet
  • Xigduo XR extended release 24-hour 10 mg-500 mg tablet
  • Xigduo XR extended release 24-hour 2.5 mg-1000 mg tablet
  • Xigduo XR extended release 24-hour 5 mg-1000 mg tablet
  • Xigduo XR extended release 24-hour 5 mg-500 mg tablet
  • Zegalogue auto-injector 0.6 mg per 0.6mL solution
  • Ztlido 1.8% patch

 

 

Other Updates:

 

  • Acamprosate calcium delayed release 333 mg tablet (Added Prior Authorization)
  • Actimmune 2000000 unit per 0.5 mL injection (Added Prior Authorization)
  • Aftera 1.5 mg tablet (Added Quantity Limit)
  • All proton pump inhibitors (Added Quantity Limit of 180 tablets per 365 days)
  • Bacitracin 500 unit/polymyxin b 10000 unit per gm opthalmic ointment (Added Quantity Limit)
  • Bacitracin 500 units per gm ophthalmic ointment (Added Quantity Limit)
  • Bacitracin/polymyxin/neomycin/hydrocortisone 1% ophthalmic ointment (Added Quantity Limit)
  • Benzonatate 100 mg capsule (Added Quantity Limit)
  • Benzonatate 200 mg capsule (Added Quantity Limit)
  • Budesonide delayed release 3 mg capsule (Removed Step Therapy)
  • Calcipotriene 0.005% cream (Removed Auto PA)
  • Calcipotriene 0.005% ointment (Removed Auto PA)
  • Climara pro weekly 0.045 mg/0.015 mg per day patch (Added Quantity Limit)
  • Dorzolamide 22.3 mg/timolol maleate 6.8 mg per mL ophthalmic solution (Removed Step Therapy)
  • EContra EZ 1.5 mg tablet (Added Quantity Limit)
  • EContra One-Step 1.5 mg tablet (Added Quantity Limit)
  • Erythromycin 5 mg per gm ophthalmic Ointment (Added Quantity Limit)
  • Fluocinolone acetonide 0.01% otic oil (Added Quantity Limit)
  • Gentak 0.3% ophthalmic ointment (Added Quantity Limit)
  • Hydrocodone 5 mg/homatropine 1.5 mg per 5 mL solution (Added Quantity Limit)
  • Hydrocodone 5 mg/homatropine 1.5 mg tablet (Added Quantity Limit)
  • Hydromet 5mg/1.5 mg per 5 mL solution (Added Quantity Limit)
  • Intron-A injection 10000000 unit reconstituted solution (Added Prior Authorization)
  • Intron-A injection 50000000 unit reconstituted solution (Added Prior Authorization)
  • Jardiance 10 mg tablet (Added Prior Authorization)
  • Jardiance 25 mg tablet (Added Prior Authorization)
  • Levonorgestrel 1.5 mg tablet (Added Quantity Limit)
  • Movantik 12.5 mg tablet (Removed Auto PA)
  • Movantik 25 mg tablet (Removed Auto PA)
  • My Choice 1.5 mg tablet (Added Quantity Limit)
  • My Way 1.5 mg tablet (Added Quantity Limit)
  • New Day 1.5 mg tablet (Added Quantity Limit)
  • Nuedexta 20 mg/10 mg capsule (Added Prior Authorization)
  • OneTouch Ultra strip (Added Quantity Limit)
  • OneTouch Verio strip (Added Quantity Limit)
  • Opcicon One-Step 1.5 mg tablet (Added Quantity Limit)
  • Option 2 1.5 mg tablet (Added Quantity Limit)
  • Ranolazine extended release 1000 mg tablet (Added Prior Authorization)
  • Ranolazine extended release 500 mg tablet (Added Prior Authorization)
  • React 1.5 mg tablet (Added Quantity Limit)
  • Rivastigmine 13.3 mg 24-hour patch (Added Prior Authorization)
  • Rivastigmine 4.6 mg 24-hour patch (Added Prior Authorization)
  • Rivastigmine 9.5 mg 24-hour patch (Added Prior Authorization)
  • Take Action 1.5 mg tablet (Added Quantity Limit)
  • Tolterodine tartrate 1 mg tablet (Removed Step Therapy)
  • Tolterodine tartrate 2 mg tablet (Removed Step Therapy)
  • Tolterodine tartrate extended release 2 mg capsule (Removed Step Therapy)
  • Tolterodine tartrate extended release 4 mg capsule (Removed Step Therapy)
  • Trospium chloride 20 mg tablet (Removed Step Therapy)
  • Vancomycin 125 mg capsule (Added Quantity Limit)
  • Vancomycin 250 mg capsule (Added Quantity Limit)

 

January 2023

 

Additions:

 

  • OneTouch Delica Lancets 30G
  • OneTouch Delica Lancets 33G
  • OneTouch Delica Lancing Device
  • OneTouch Delica Plus Lancets 30G
  • OneTouch Delica Plus Lancets 33G
  • OneTouch Delica Plus Lancing Device

 

Removals:

 

  • Accu-Chek FastClix Lancet Device Kit
  • Accu-Chek FastClix Lancet Kit
  • Accu-Chek FastClix Lancets
  • Accu-Chek Safe-T Pro Lancets
  • Accu-Chek Softclix Lancets
  • Advanced Mobile Lancet
  • BD Lancet Ultrafine 30G
  • BD Lancet Ultrafine 33G
  • BD Microtainer Lancets
  • Clever Chek Lancets
  • Clever Choice Lancets 21G
  • Clever Choice Lancets 23G
  • Clever Choice Lancets 28G
  • CoaguChek Lancets
  • Comfort Assured Lancets 28G
  • Comfort Assured Lancets 33G
  • CVS Lancets 21G
  • CVS Lancets Micro Thin 33G
  • CVS Lancets Original
  • CVS Lancets Thin 26G
  • CVS Lancets Ultra Thin 30G
  • CVS Lancets Ultra-Thin 30G
  • CVS Lancing Device
  • CVS Ultra Thin Lancets
  • Drug Mart Lancets Thin 26G
  • Drug Mart Lancing Device
  • Easy Comfort Lancets Twist Top
  • EQL Color Lancets 21G
  • EQL Color Lancets Micro 33G
  • EQL Super Thin Lancets 30G
  • EQL Thin Lancets 26G
  • E-Z Ject Lancet Micro-Thin 33G
  • E-Z Ject Lancet Super Thin 30G
  • E-Z Ject Lancets 21G
  • E-Z Ject Lancets Thin 26G
  • Fine 30
  • Fingerstix Lancets
  • FreeStyle Lancets
  • FreeStyle Unistick II Lancets
  • Gilenya Cap 0.5mg
  • Global Inject Ease Lancets 28G
  • Global Inject Ease Lancets 30G
  • Global Lancing Device
  • GNP Lancets 21G
  • GNP Lancets Thin 26G
  • GoodSense Lancets 26G Univ
  • GoodSense Lancets 30G
  • GoodSense Lancets 33G
  • GoodSense Lancets 33G Univ
  • GoodSense Lancing Device
  • Kroger Lancets 21G
  • Kroger Lancets Micro Thin 33G
  • Kroger Lancets Thin 26G
  • Kroger Lancets UltraThin 30G
  • Kroger Lancing Device
  • Lancets 30G
  • Lancets 33G
  • Lancets Micro Thin 33G
  • Lancets Super Thin 28G
  • Lancets Thin
  • Lancets Ultra Thin
  • Lancets Ultra Thin 30G
  • Lancing Device
  • LifeScan Unistik 2
  • LifeScan Unistik II Lancets
  • Longs Lancets Standard
  • Longs Lancets Thin
  • Longs Lancets Ultra Thin
  • Medlance Extra 21G
  • Medlance Lite 25G
  • Medlance Plus Lancets
  • Medlance Universal 21G
  • Meijer Lancets
  • Meijer Lancets Thin
  • Meijer Lancets Universal 33G
  • Meijer Super Thin Lancets
  • Microlet Lancets
  • Microlet Next Lancing Device
  • OneTouch Club Lancets Fine Pt
  • OneTouch Delica Safety Lancing
  • OneTouch FinePoint Lancets
  • OneTouch SureSoft Lancing Device
  • OneTouch UltraSoft Lancets
  • Penlet 2 Blood Sampler Kit
  • Penlet 2 Lancing Replacement Cap
  • Pharmacist Choice Lancets
  • Pharmacy Counter Lancets
  • Preferred Plus Lancets Colored
  • Preferred Plus Lancets Thin
  • Pro Comfort Lancets 30G
  • Pro Comfort Lancets 31G
  • RA E-Zject Lancets 28G
  • RA E-Zject Lancets Thin 26G
  • RA E-Zject Lancets Thin 28G
  • RA E-Zject Lancets Ultra Thin
  • ReliOn Lancet Devices 30G
  • ReliOn Lancets Thin 26G
  • ReliOn Lancets Ultra-Thin 30G
  • ReliOn Lancing Device
  • ReliOn Ultra Thin Lancets 30G
  • ReliOn Ultra Thin Plus Lancets
  • Rexall Lancets Ultra Thin 30G
  • Safety Lancet 30G/Pressure Act
  • SAPS health Twist Top Lancets
  • SAPS Twist Top Lancets
  • Simple Diagnostics Lancing Dev
  • Single-Let
  • SM Lancets 33G
  • Smart Sense Color Lancets 33G
  • Smart Sense Standard Lancets
  • Smart Sense Super Thin Lancets
  • Smart Sense Thin Lancets 26G
  • Super Thin Lancets
  • Sure Comfort Lancets 18G
  • Sure Comfort Lancets 21G
  • Sure Comfort Lancets 23G
  • Sure Comfort Lancets 28G
  • Sure Comfort Lancets 30G
  • Sure Comfort Lancing Pen
  • TGT Lancet Micro Thin 33G
  • TGT Lancet Thin 26G
  • TGT Lancet Ultra Thin 30G
  • TopCare Lancets Micro-Thin 33G
  • Travel Lancets Advanced 28G
  • TRUEdraw Lancing Device
  • TRUEplus Lancets 26G
  • TRUEplus Lancets 28G
  • TRUEplus Lancets 30G
  • TRUEplus Lancets 33G
  • TRUEplus Safety Lancets 28G
  • Ultra Thin Lancets 31G
  • Ultra-Care Lancets 30G
  • Universal 1 Lancets Thin 26G
  • Universal 1 Lancets Ultra Thin
  • Value Plus Lancet Standard 21G
  • Value Plus Lancets Super Thin
  • Value Plus Lancets Thin 26G
  • Value Plus Lancing Device
  • Walgreens Lancets
  • Walgreens Lancets Micro Thin
  • Walgreens Lancets Super Thin
  • Walgreens Thin Lancets
  • Walgreens Ultra Thin Lancets
  • ZevRx Twist Top Lancets 30G

 

Other Updates:

 

  • N/A

Also of interest: