Bluelink Accord Formulary Updates July 2019

BlueLink Accord Formulary Updates July 2019

Brand/Generic TRADE NAME Product Effective Date Description of Change AIMOVIG (erenumab-aooe subcutaneous soln auto-injector 140 mg/ml) Brand 4/1/19 Addition ALBENZA (albendazole tab 200 mg) Brand 7/1/19 Removal, generics available ambrisentan tab 10 mg Generic 4/14/19 Addition, generic for LETAIRIS ambrisentan tab 5 mg Generic 4/14/19 Addition, generic for LETAIRIS ANDROGEL (testosterone td gel 20.25 mg/1.25gm (1.62%)) Brand 7/1/19 Removal, generics available ANDROGEL (testosterone td gel 40.5 mg/2.5gm (1.62%)) Brand 7/1/19 Removal, generics available ANDROGEL PUMP (testosterone td gel 20.25 mg/act (1.62%)) Brand 7/1/19 Removal, generics available BICNU (carmustine for inj 100 mg) Brand 7/1/19 Removal, generics available bromocriptine mesylate cap 5 mg (base equivalent) Generic 7/1/19 Removal bromocriptine mesylate tab 2.5 mg (base equivalent) Generic 7/1/19 Removal buprenorphine hcl-naloxone hcl sl film 12-3 mg (base equiv) Generic 2/10/19 Addition, generic for SUBOXONE buprenorphine hcl-naloxone hcl sl film 2-0.5 mg (base equiv) Generic 2/10/19 Addition, generic for SUBOXONE buprenorphine hcl-naloxone hcl sl film 4-1 mg (base equiv) Generic 2/10/19 Addition, generic for SUBOXONE buprenorphine hcl-naloxone hcl sl film 8-2 mg (base equiv) Generic 2/10/19 Addition, generic for SUBOXONE butalbital-acetaminophen-caffeine cap 50-325-40 mg Generic 7/1/19 Removal CIALIS (tadalafil tab 10 mg) Brand 7/1/19 Removal, generics available CIALIS (tadalafil tab 2.5 mg) Brand 7/1/19 Removal, generics available CIALIS (tadalafil tab 20 mg) Brand 7/1/19 Removal, generics available CIALIS (tadalafil tab 5 mg) Brand 7/1/19 Removal, generics available cinacalcet hcl tab 30 mg (base equiv) Generic 3/10/19 Addition, generic for SENSIPAR cinacalcet hcl tab 60 mg (base equiv) Generic 3/10/19 Addition, generic for SENSIPAR cinacalcet hcl tab 90 mg (base equiv) Generic 3/10/19 Addition, generic for SENSIPAR COLCRYS (colchicine tab 0.6 mg) Brand 7/1/19 Removal fluticasone-salmeterol aer powder ba 100-50 mcg/dose Generic 2/17/19 Addition, generic for ADVAIR DISKUS fluticasone-salmeterol aer powder ba 250-50 mcg/dose Generic 2/17/19 Addition, generic for ADVAIR DISKUS fluticasone-salmeterol aer powder ba 500-50 mcg/dose Generic 2/17/19 Addition, generic for ADVAIR DISKUS ganirelix acetate inj 250 mcg/0.5ml Generic 4/1/19 Addition, generic for GANIRELIX ACETATE metaxalone tab 800 mg Generic 7/1/19 Removal MITIGARE (colchicine cap 0.6 mg) Brand 7/1/19 Addition NIVESTYM (filgrastim-aafi inj 300 mcg/ml) Brand 4/1/19 Addition NIVESTYM (filgrastim-aafi inj 480 mcg/1.6ml (300 mcg/ml)) Brand 4/1/19 Addition primaquine phosphate tab 26.3 mg (15 mg base) Generic 2/17/19 Addition, generic for PRIMAQUINE PHOSPHATE REVCOVI (elapegademase-lvlr im soln 2.4 mg/1.5ml (1.6 mg/ml)) Brand 7/1/19 Addition sirolimus oral soln 1 mg/ml Generic 2/3/19 Addition, generic for RAPAMUNE SPORANOX (itraconazole oral soln 10 mg/ml) Brand 7/1/19 Removal, generics available toremifene citrate tab 60 mg (base equivalent) Generic 1/27/19 Addition, generic for FARESTON TRESIBA (insulin degludec inj 100 unit/ml) Brand 2/3/19 Addition

Continued

July 2019 | BlueLink Accord Formulary Updates Brand/Generic TRADE NAME Product Effective Date Description of Change UDENYCA (pegfilgrastim-cbqv soln prefilled syringe 6 mg/0.6ml) Brand 7/1/19 Addition VENCLEXTA (venetoclax tab 10 mg) Brand 7/1/19 Addition VENCLEXTA (venetoclax tab 100 mg) Brand 7/1/19 Addition VENCLEXTA (venetoclax tab 50 mg) Brand 7/1/19 Addition VENCLEXTA STARTING PACK (venetoclax tab therapy starter pack Brand 7/1/19 Addition 10 & 50 & 100 mg)