2021 YAMHILL COMMUNITY CARE Updates October, 2020 Effective Date Brand Name Generic Name Type of Change Previous Value New Value 10/23/2020 ULTOMIRIS ravulizumab-cwvz REMOVE FROM Non-Formulary FORMULARY 10/23/2020 EPCLUSA sofosbuvir/velpatasvir REMOVE FROM Non-Formulary FORMULARY 10/23/2020 ULTOMIRIS ravulizumab-cwvz REMOVE FROM Non-Formulary FORMULARY 10/30/2020 CLINIMIX E amino acid 8 % comb REMOVE FROM Non-Formulary no.3/d10w/parenteral FORMULARY electrolytes no.37 10/30/2020 CLINIMIX E amino acid 8 % comb REMOVE FROM Non-Formulary no.3/d10w/parenteral FORMULARY electrolytes no.37 10/30/2020 CLINIMIX amino acids 8 % in dextrose REMOVE FROM Non-Formulary 14% water FORMULARY 10/30/2020 CLINIMIX amino acids 8 % in dextrose REMOVE FROM Non-Formulary 14% water FORMULARY 10/30/2020 CLINIMIX E amino acid 8 % comb REMOVE FROM Non-Formulary no.3/d14w/parenteral FORMULARY electrolytes no.37 10/30/2020 CLINIMIX E amino acid 8 % comb REMOVE FROM Non-Formulary no.3/d14w/parenteral FORMULARY electrolytes no.37 10/30/2020 CLINIMIX amino acid 6 % in dextrose REMOVE FROM Non-Formulary 5 % water FORMULARY 10/30/2020 CLINIMIX amino acids 8 % in dextrose REMOVE FROM Non-Formulary 10% water FORMULARY 10/30/2020 CLINIMIX amino acids 8 % in dextrose REMOVE FROM Non-Formulary 10% water FORMULARY BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 1 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates Effective Date Brand Name Generic Name Type of Change Previous Value New Value 10/30/2020 LIDOMARK 1-5 lidocaine hcl/preservative REMOVE FROM Non-Formulary free/adhesive bandage FORMULARY 10/30/2020 sofia2 flu-sars covid-19, influenza a, REMOVE FROM Non-Formulary antigen fia influenza b antigen FORMULARY immunoassay test BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 2 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates November, 2020 Effective Date Brand Name Generic Name Type of Change Previous Value New Value 11/06/2020 IBUPAK ibuprofen/glycerin REMOVE FROM Non-Formulary FORMULARY 11/06/2020 rufinamide rufinamide ADD TO FORMULARY Covered 11/06/2020 icosapent ethyl icosapent ethyl ADD TO FORMULARY Covered 11/13/2020 timolol maleate timolol maleate/pf REMOVE FROM Non-Formulary FORMULARY 11/13/2020 gemmily norethindrone acetate- REMOVE FROM Non-Formulary ethinyl estradiol/ferrous FORMULARY fumarate 11/13/2020 gemmily norethindrone acetate- REMOVE FROM Non-Formulary ethinyl estradiol/ferrous FORMULARY fumarate 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 3 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates Effective Date Brand Name Generic Name Type of Change Previous Value New Value 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 levothyroxine levothyroxine sodium REMOVE FROM Non-Formulary FORMULARY 11/20/2020 lyllana estradiol ADD TO FORMULARY Covered 11/20/2020 lyllana estradiol ADD TO FORMULARY Covered 11/20/2020 lyllana estradiol ADD TO FORMULARY Covered 11/20/2020 lyllana estradiol ADD TO FORMULARY Covered 11/20/2020 lyllana estradiol ADD TO FORMULARY Covered 11/20/2020 zovia 1-35 ethynodiol diacetate-ethinyl ADD TO FORMULARY Covered estradiol 11/27/2020 RETACRIT epoetin alfa-epbx ADD TO FORMULARY Covered 11/27/2020 RETACRIT epoetin alfa-epbx ADD TO FORMULARY Covered 11/27/2020 RETACRIT epoetin alfa-epbx ADD TO FORMULARY Covered BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 4 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates December, 2020 Effective Date Brand Name Generic Name Type of Change Previous Value New Value 12/04/2020 RETACRIT epoetin alfa-epbx ADD TO FORMULARY Covered 12/04/2020 RETACRIT epoetin alfa-epbx ADD TO FORMULARY Covered 12/04/2020 RETACRIT epoetin alfa-epbx ADD TO FORMULARY Covered 12/04/2020 alvimopan alvimopan REMOVE FROM Non-Formulary FORMULARY 12/04/2020 ivermectin ivermectin REMOVE FROM Non-Formulary FORMULARY 12/04/2020 XARACOLL bupivacaine hcl REMOVE FROM Non-Formulary FORMULARY 12/04/2020 XARACOLL bupivacaine hcl REMOVE FROM Non-Formulary FORMULARY 12/04/2020 NYVEPRIA pegfilgrastim-apgf ADD TO FORMULARY Covered 12/11/2020 rufinamide rufinamide ADD TO FORMULARY Covered 12/11/2020 alcohol swabs alcohol antiseptic pads REMOVE FROM Non-Formulary FORMULARY 12/11/2020 nymyo norgestimate-ethinyl ADD TO FORMULARY Covered estradiol 12/11/2020 CERIANNA fluoroestradiol f-18 REMOVE FROM Non-Formulary FORMULARY 12/11/2020 nitazoxanide nitazoxanide REMOVE FROM Non-Formulary FORMULARY 12/11/2020 nitazoxanide nitazoxanide REMOVE FROM Non-Formulary FORMULARY 12/11/2020 VAXELIS diphtheria,pertus(acell),tetan REMOVE FROM Non-Formulary us/hepb/polio/hib conj- FORMULARY meng/pf BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 5 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates Effective Date Brand Name Generic Name Type of Change Previous Value New Value 12/11/2020 VAXELIS diphtheria,pertus(acell),tetan REMOVE FROM Non-Formulary us/hepb/polio/hib conj- FORMULARY meng/pf 12/11/2020 VAXELIS diphtheria,pertus(acell),tetan REMOVE FROM Non-Formulary us/hepb/polio/hib conj- FORMULARY meng/pf 12/11/2020 VAXELIS diphtheria,pertus(acell),tetan REMOVE FROM Non-Formulary us/hepb/polio/hib conj- FORMULARY meng/pf 12/18/2020 ACZONE dapsone REMOVE FROM Non-Formulary FORMULARY 12/18/2020 ACZONE dapsone REMOVE FROM Non-Formulary FORMULARY 12/18/2020 bimatoprost bimatoprost REMOVE FROM Non-Formulary FORMULARY 12/18/2020 bimatoprost bimatoprost REMOVE FROM Non-Formulary FORMULARY 12/18/2020 docetaxel docetaxel REMOVE FROM Non-Formulary FORMULARY 12/18/2020 docetaxel docetaxel REMOVE FROM Non-Formulary FORMULARY 12/18/2020 acetaminophen acetaminophen REMOVE FROM Non-Formulary FORMULARY 12/18/2020 finasteride finasteride REMOVE FROM Non-Formulary FORMULARY 12/18/2020 finasteride finasteride REMOVE FROM Non-Formulary FORMULARY 12/18/2020 finasteride finasteride REMOVE FROM Non-Formulary FORMULARY 12/18/2020 sorbitan sorbitan monooleate REMOVE FROM Non-Formulary monooleate FORMULARY BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 6 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates Effective Date Brand Name Generic Name Type of Change Previous Value New Value 12/18/2020 norepinephrine norepinephrine bitartrate in REMOVE FROM Non-Formulary bitar-0.9% nacl 0.9 % sodium chloride FORMULARY 12/18/2020 docetaxel docetaxel REMOVE FROM Non-Formulary FORMULARY 12/18/2020 fluocinolone fluocinolone acetonide, REMOVE FROM Non-Formulary acetonide micro micronized FORMULARY 12/18/2020 fluocinolone fluocinolone acetonide, REMOVE FROM Non-Formulary acetonide micro micronized FORMULARY 12/18/2020 prednisolone- prednisolone REMOVE FROM Non-Formulary bromfenac acetate/bromfenac sodium FORMULARY 12/18/2020 t:slim x2 control- subcutaneous insulin pump REMOVE FROM Non-Formulary iq FORMULARY 12/18/2020 bremelanotide bremelanotide acetate REMOVE FROM Non-Formulary acetate FORMULARY 12/18/2020 oxytocin acetate oxytocin acetate REMOVE FROM Non-Formulary FORMULARY 12/18/2020 neuriva de-stress coffee REMOVE FROM Non-Formulary extract/theanine/superoxide FORMULARY dismutase 12/18/2020 perme8 gel base no.243 REMOVE FROM Non-Formulary anhydrous gel FORMULARY 12/18/2020 PRELIEF calcium glycerophosphate REMOVE FROM Non-Formulary FORMULARY 12/18/2020 MUCINEX guaifenesin/dextromethorph REMOVE FROM Non-Formulary JUNIOR an hbr/phenylephrine FORMULARY COUGH- CONGEST 12/18/2020 carboxymethylcel carboxymethylcellulose REMOVE FROM Non-Formulary lulose sodium sodium FORMULARY 12/18/2020 children's motrin ibuprofen REMOVE FROM Non-Formulary FORMULARY BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case italics. PAGE 7 UPDATED 10/2021 2021 YAMHILL COMMUNITY CARE Updates Effective Date Brand Name Generic Name Type of Change Previous Value New Value 12/18/2020 mycozyl ap miconazole nitrate REMOVE FROM Non-Formulary FORMULARY 12/18/2020 adult multivitamin multivitamin with REMOVE FROM Non-Formulary gummies minerals/folic acid FORMULARY 12/18/2020 pen needle pen needle, diabetic REMOVE FROM Non-Formulary FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY 12/18/2020 asenapine asenapine maleate REMOVE FROM Non-Formulary maleate FORMULARY