Formulary and Therapeutic Interchanges

3rd Quarter, 2023 (updated August 2, 2023)

Heritage Health - Nebraska Total Care 

Pharmacy Services – Suggested Interchanges
Class Non-Preferred Preferred Alternatives
ANTIDIABETICS Basaglar, Toujeo Max, Toujeo Solo, Admelog Solo, Rybelsus Insulin Glargine, Insulin Lisp, Insulin Lispro Kwik, Insulin
Aspart, Insulin Aspart Kwik, Ozempic*
ADHD/ANTI-NARCOLEPSY/ANTI-BESITY/ANOREXIANTS Focalin XR, Focalin,  Adhansia Xr, Aptensio XR, Jornay PM,
Quillivant, Amphet/dextr, Mydayis, Strattera, Intuniv
Dexmethylphenidate,
Dexmethylphenidate ER, Concerta, Methylin, Methylphenidate, Quillichew, Adderall,
Adderall XR, Atomoxetine, Guanfacine, Qelbree
ANTIASTHMATIC AND BRONCHODILATOR AGENTS Budes/formot, Proair Respi, Flutic/salme, Wixela Inhub,
Fluticas HFA, Budesonide
Symbicort, Ventolin HFA, Proventil HFA, Advair Diskus,
Advair HFA, Spiriva, Flovent HFA, Pulmicort
ANTIDEPRESSANTS Forfivo Xl, Trintellix, Desvenlafaxine,
Viibryd
Bupropion Hcl, Fluoxetine, Venlafaxine,
Escitalopram
GASTROINTESTINAL AGENTS - MISC. Delzicol, Canasa,
Pentasa, Cimzia, Lubiprostone, Sevelamer
Apriso, Lialda, Mesalamine,
Amitiza, Renvela

*This brand product has a generic equivalent recommended as an alternative.
*May require Prior Authorization
Abbreviations: ER = extended-release, XR = extended-release