Preferred Drug List Changes
The following changes have been made to the Nebraska PDL. Changes are effective July 16, 2020.
| Nebraska PDL Therapeutic Drug Class | Change effective July 16, 2020 |
|---|---|
| Acne Agents, Topical | Aklief moved to Non-Preferred Amzeq moved to Non-Preferred Benzoyl Peroxide Towelette OTC moved to Non-Preferred Clindamycin Phospahte Med Swab (topical) moved to Non-Preferred Retin-A Cream (topical) moved to Non-Preferred Retin-A Gel (topical) moved to Non-Preferred Tretinoin Cream (topical)- moved to Preferred Tretinoin Gel (AG) moved to Preferred Tretinoin Gel moved to Preferred |
| Analgesics, Opioids Long-Acting | Embeda moved to Non-Preferred |
| Androgenic Agents | Testosterone Gel (AG) (Vogelxo) transderm moved to Non-Preferred Testosterone Gel (Vogelxo) transderm moved to Non-Preferred Testosterone Gel Packet (AG) (Vogelxo) transderm moved to Non-Preferred Testosterone Gel Pump (AG) (Androgel) transderm moved to Preferred Testosterone Gel Pump (AG) (Vogelxo) transderm moved to Non-Preferred Testosterone Gel Pump (Androgel) transderm moved to Non-Preferred |
| Angiotensin Modulators | Fosinopril moved to Preferred Fosinopril/HCTZ moved to Preferred Quinapril/HCTZ moved to Preferred |
| Angiotensin Modulator Combinations | Amlodipine/Valsartan/HCTZ moved to Non-Preferred |
| Antibiotics, Vaginal | Metronidazole moved to Non-Preferred |
| Anticoagulants | Bevyxxa moved to Non-Preferred |
| Antimigraine Agents, Other | Ajovy moved to Preferred Emgality Syring 100mg moved to Non-Preferred Nurtec ODT moved to Preferred Reyvow moved to Non-Preferred Ubrelvy moved to Non-Preferred |
| Antimigraine Agents, Triptans | Relpax moved to Non-Preferred Tosymra moved to Non-Preferred |
| Antiparasitics, Topical | Sklice moved to Non-Preferred |
| Antivirals, Oral | Acyclovir Susp moved to Non-Preferred Tamiflu Capsule moved to Non-Preferred Tamiflu Susp moved to Non-Preferred |
| Bladder Relaxant Preparations | Solifenacin moved to Preferred Vesicare moved to Non-Preferred |
| Bone Resorption Suppression and Related Agents | Ibandronate moved to Preferred Teriparatide (Sub-Q) moved to Non-Preferred |
| Calcium Channel Blockers | Katerzia moved to Non-Preferred |
| Contraceptives, Oral | Afirmelle moved to Preferred Aurovela moved to Preferred Aurovela 24 Fe moved to Preferred Aurovela Fe moved to Preferred Ayuna moved to Preferred Cyred ED moved to Preferred Hailey moved to Preferred Jasmiel moved to Preferred Kalliga moved to Preferred Lo-Zumandimine moved to Preferred Simliya moved to Preferred Simpesse moved to Preferred Slynd moved to Preferred Tarina 24 Fe moved to Preferred Tri-Lo-Mili moved to Preferred Zumandimine moved to Preferred |
| Cystic Fibrosis | Trikafta moved to Non-Preferred |
| Glucagon Agents - *NEW* | Baqsimi moved to Preferred Diazoxide Susp moved to Non-Preferred Glucagon (injection) moved to Preferred Glucagon Emergency Kit (Fresenius) (Inj) moved to Non-Preferred Glucagon Emergency Kit (Lilly) (Inj) moved to Preferred Gvoke Pen & Syringe moved to Non-Preferred Proglycem Susp moved to Preferred |
| Growth Hormone | Nutropin AQ Pen (injection) moved to Non-Preferred |
| HAE Treatments - *NEW* | Berinert moved to Preferred Cinryze moved to Non-Preferred Firazyr moved to Preferred Haegarda moved to Preferred Icatibanr moved to Non-Preferred Kalbitor moved to Non-Preferred Ruconest moved to Non-Preferred Takhzyro moved to Non-Preferred |
| HIV/AIDS | Dovato moved to Non-Preferred Symtuza moved to Non-Preferred Temixys moved to Non-Preferred |
| Hypoglycemics, Incretin Mimetics / Enhancers | Rybelsus moved to Non-Preferred |
| Hypoglycemics, Insulin and Related Agents | Humalog Junior Kwikpen moved to Preferred Humulin 500 U/M Pen moved to Preferred Humulin 70/30 Pen OTC moved to Preferred Humulin Pen OTC moved to Preferred |
| Hypoglycemics, SGLT2 | Invokamet moved to Preferred Xigduo XR moved to Preferred |
| Lipotropics, Statins | Ezallor Sprinkle moved to Non-Preferred |
| Multiple Sclerosis Agents | Mavenclad moved to Non-Preferred Mayzent moved to Non-Preferred Rebif moved to Non-Preferred Rebif Rebidose Pen Injctr moved to Non-Preferred Vumerity moved to Non-Preferred |
| Nitrofuran Derivatives | Nitrofurantoin Susp moved to Non-Preferred |
| PAH - Pulmonary Arterial Hypertension Agents | Ambrisentan moved to Preferred Letairis moved to Non-Preferred |
| Phosphate Binders | Renagel moved to Non-Preferred Sevelamer Carbonate (AG) moved to Preferred Sevelamer Carbonate moved to Preferred |
| Prenatal Vitamins | PNV Combo #47/Iron/FA#1/DHA moved to Non-Preferred PNV NO.15/Iron Fum&PS CMP/FA moved to Non-Preferred PNV with CA, NO.74/Iron/FA OTC moved to Non-Preferred PNV#16/Iron FUM & PS/FA/OM-3 moved to Non-Preferred |
| Thyroid Hormones | Euthyrox moved to Non-Preferred |
| Ulcerative Colitis | Balsalazide moved to Non-Preferred Mesalamine (SFRowasa) (rectal) moved to Non-Preferred |