Recent Formulary Changes

Changes to the uniform formulary may affect your copayments for certain generic and brand-name medications. Learn more about recent changes and how they may affect you below.

• Zolpidem sublingual low dose (Intermezzo)/Diclofenac 1.5% solution (Pennsaid)/Diclofenac 1.3% patch (Flector) (PDF file)
• Interferon-alphacon-1 (Infergen)/Ribavirin (Ribapak)/Oxycodone IR (Oxecta) (PDF file)
• Fesoterodine (Toviaz)/Darifenacin (Enablex)/Oxybutynin (Oxytrol patch)/Oxybutynin (Gelnique 10%) (PDF file)
• AndroGel/Axiron (PDF file)
• Duexis/Sprix/Orencia/Zioptan (PDF file)
• Horizant/Gralise (PDF file)
• Onglyza/Kombiglyze/Nuvigil (PDF file)
• Atelvia/Oleptro/Viibryd/Levitra/Staxyn (PDF file)
• Singulair (PDF file)
• Fanapt/Latuda/Saphris (PDF file)
• Livalo/Fibricor/Natazia/Fortamet/Avandia/Avandamet/Avandaryl (PDF file)
• Tekamlo/Tribenzor/Aricept-23/Zuplenz/Diabetic Test Strips (PDF file)
• Lovaza (PDF file)
• Fenoglide (PDF file)
• Cardura XL/Rapaflo/Sumavel DosePro (PDF file)
• Qualaquin (PDF file)
• Basal Insulins/Sedative Hypnotics/Renin-Angiotensin Antihypertensive Agents (PDF file)
• Multiple Sclerosis Drugs/Antidepressant/Pulmonary Hypertension/Overactive Bladder/Narcotic Analgesics (PDF file)
• Simponi/Cimzia/Rapaflo/Viagra/Cialis (PDF file)

PDF files require Adobe Acrobat Reader.