Formulary Changes Update
The following changes to the MPC Approved Drug List (ADL) were approved by the Maryland Physicians Care Pharmacy & Therapeutics Committee. Please carefully review these changes. Key UPPER CASE = Brand Name Drugs Lower case italics = Generic Drugs QL = Quantity Limit
PA = Prior Authorization ST = Step Therapy AL = Age Limit ADL = Approved Drug List YOA = Years of Age DD = Discontinued Drug
April 2020
Drug Name Therapeutic Class Change Effective Date ADL Alternative (if applicable)
TUDORZA Inhaled Long Acting Muscarinic Removed from (aclidinium bromide) Antagonist formulary April 2020 INCRUSE, SPIRIVA SPIRIVA Inhaled Long Acting Muscarinic Added; No PA (tiotropium bromide) Antagonist April 2020 N/A
TOUJEO Removed from Insulin Basal (insulin glargine) formulary April 2020 BASAGLAR
HUMALOG Removed from Rapid-Acting Insulin formulary April 2020 ADMELOG, LISPRO AG LISPRO AG Added; No PA Rapid-Acting Insulin April 2020 N/A
SYMBICORT Pulmonary anti- Removed from inflammatory/Beta Agonist April 2020 Fluticasone-Salmeterol (budesonide & formoterol fumarate formulary dihydrate) Combos PROAIR AG Short-Acting Inhaled Removed from (albuterol sulfate) April 2020 VENTOLIN Bronchodilators formulary
May 2020
No Changes
June 2020
No Changes
July 2020
No Changes
August 2020
No Changes
September 2020
NoNo ChangesChanges
October 2020
Drug Name Therapeutic Class Change Effective Date ADL Alternative (if applicable)
CIPRODEX ciprofloxacin, Combination quinolone antibiotic Removed from (ciprofloxacin and dexamethasone) October 2020 erythromycin, & anti-inflammatory corticosteroid formulary gentamicin, tobramycin
AIMOVIG Calcitonin Gene-Related Peptide Added; with PA October 2020 N/A (erenumab) (CGRP) Inhibitors
EMGALITY Calcitonin Gene-Related Peptide Added; with PA October 2020 N/A (galcanezumab) (CGRP) Inhibitors
VUMERITY Removed from AUBAGIO, GILENYA, & October 2020 (diroximel fumarate) Rapid-Acting Insulin formulary TECFIDERA
SYMBICORT Pulmonary anti- (budesonide-formoterol) inflammatory/Beta Agonist Added: ST October 2020 Fluticasone-salmeterol Combos RYBELSUS Glucagon – Like Peptide – 1 (semaglutide) Added; with PA October 2020 TRULICITY & OZEMPIC Agonist
PREMARIN Removed from Generics Estrogen Only Estrogen & Estrogen Modifiers October 2020 (conjugated estrogens) formulary
November 2020
SeptemberNo Changes 2020
DecemberSeptember 2020 2020
SeptemberNoNo ChangesChanges 2020
SeptemberNo Changes 2020
No Changes January 2021
No Changes