Preferred Drug List Changes
The following changes have been made to the Nebraska PDL. Changes are effective July 15, 2021.
| Nebraska PDL Therapeutic Drug Class | Change effective July 15, 2021 |
|---|---|
| ACNE AGENTS, TOPICAL | ACNE MEDICATION GEL OTC (TOPICAL) →NP AZELEX (TOPICAL) → NP CLINDAMYCIN PHOSPHATE MED. SWAB (TOPICAL) → PREFERRED ERYTHROMYCIN GEL (TOPICAL) → PREFERRED ERYTHROMYCIN GEL (AG) (TOPICAL) → PREFERRED ERYTHROMYCIN-BENZOYL PEROXIDE (TOPICAL) →PREFERRED RETIN-A GEL (TOPICAL) → PREFERRED RETIN-A CREAM (TOPICAL) → PREFERRED TRETINOIN CREAM (TOPICAL) → NP TRETINOIN GEL (AVITA, RETIN-A) (TOPICAL) → NP TRETINOIN GEL (AVITA, RETIN-A) (AG) (TOPICAL) → NP |
| ANALGESICS, NARCOTICS LONG | TRAMADOL ER (ULTRAM ER) (ORAL) → PREFERRED |
| ANALGESICS, NARCOTICS SHORT | OXYCODONE/ APAP TABLET (PROLATE) (ORAL) → NP TRAMADOL/ APAP (ORAL) → PREFERRED TRAMADOL 100MG (ORAL) → NP |
| ANDROGENIC AGENTS | ANDROGEL GEL PUMP (TRANDERM) → PREFERRED TESTOSTERONE GEL PUMP (ANDROGEL (TRANSDERM) → NP |
| ANGIOTENSIN MODULATOR COMBINATIONS | AMLODIPINE / OLMESARTAN (AG) (ORAL) → PREFERRED AMLODIPINE / OLMESARTAN (ORAL) → PREFERRED |
| ANGIOTENSIN MODULATORS | OLMESARTAN (AG) (ORAL) → PREFERRED OLMESARTAN (ORAL) → PREFERRED OLMESARTAN HCTZ (ORAL) → PREFERRED OLMESARTAN HCTZ (AG) (ORAL) → PREFERRED |
| ANTIBIOTICS, GI | NITAZOXANIDE TABLET (AG) (ORAL) → NP NITAZOXANIDE TABLET (ORAL) → NP TINIDAZOLE (ORAL) → PREFERRED |
| ANTIBIOTICS, INHALED | TOBRAMYCIN (BETHKIS) (AG) (INHALATION) → NP TOBRAMYCIN (BETHKIS) (INHALATION) → NP |
| ANTIEMETIC/ANTIVERTIGO AGENTS | EMEND CAPSULE (ORAL) → PREFERRED EMEND PACK (ORAL) → PREFERRED |
| ANTIFUNGALS, TOPICAL | NYSTATIN-TRIAMCINOLONE OINT (TOPICAL) → PREFERRED NYSTATIN- TRIAMCINOLONE CREAM (TOPICAL) → PREFERRED TAVABORALE (TOPICAL) → NP |
| ANTIMIGRAINE AGENTS, OTHER | NURTEC ODT (ORAL) → NP UBRELVY → PREFERRED |
| ANTIMIGRAINE AGENTS, TRIPTANS | IMITREX (NASAL) →PREFERRED SUMATRIPTAN (AG) (NASAL) → NP SUMATRIPTAN (NASAL) → NP ZOLMITRIPTAN SPRAY (AG) (NASAL) → NP |
| ANTIPARASITICS, TOPICAL | IVERMECTIN LOTION (TOPICAL) → NP |
| ANTIVIRALS, TOPICAL | ACYCLOVIR OINTMENT (TOPICAL) → PREFERRED |
| BLADDER RELAXANT PREPARATIONS | VESICARE LS (ORAL) → NP |
| BONE RESORPTION SUPPRESSION AND RELATED AGENTS | TERIPARATIDE (BRAND) (SUBCUTANEOUS) → PREFERRED |
| CONTRACEPTIVES, ORAL | LYLEQ (ORAL) → PREFERRED TRI-NYMYO (ORAL) → PREFERRED NYMYO (ORAL) → PREFERRED NYLIA (ORAL) → PREFERRED HAILEY FE (ORAL) → PREFERRED ICLEVIA (ORAL) → PREFERRED CHARLOTTA 24 FE (ORAL) → PREFERRED GEMMILY (ORAL) → PREFERRED MERZEE (ORAL) → PREFERRED |
| CYSTIC FIBROSIS, ORAL | BRONCHITOL (INHALATION) → NP |
| GI MOTILITY, CHRONIC | LUBIPROSTONE (AG) (ORAL) →NP |
| HAE TREATMENTS | ICATIBANT (SUBCUT) → PREFERRED FIRAZYR (SUB-Q) → NP ORLADEYO (ORAL) → NP |
| HEPATITIS B AGENTS | LAMIVUDINE HBV TABLET (ORAL) --> NP LAMIVUDINE HBV TABLET (AG) (ORAL) --> NP |
| HEPATITIS C AGENTS | HARVONI PELLET PACK (ORAL) (12 WEEKS) → NP SOVALDI PELLET PACK (ORAL) (12 WEEKLS) → NP |
| HIV / AIDS | ABACAVIR/LAMIVUDINE/ZIDOVUDINE (ORAL) → NP EDURANT (ORAL) → NP EFAVIRENZ CAPSULE (ORAL) → PREFERRED EFAVIRENZ TABLET (ORAL) → PREFERRED EFAVIRENZ/EMTRICITABINE/TENOFOVIR DISOPROXIL FUMARATE (ORAL) → NP EFAVIRENZ/LAMIVUDINE/TENOFOVIR DISOPROXIL FUMARATE (SYMFI LO) (ORAL) → NP EFAVIRENZ/LAMIVUDINE/TENOFOVIR DISOPROXIL FUMARATE (SYMFI) (ORAL) → NP EMTRICITABINE CAPSULE (ORAL) → NP EMTRICITABINE/ TENOFOVIR DISOPROXIL FUMARATE (ORAL)- NP KALETRA TABLET (ORAL) → NP LEXIVA TABLET (ORAL) → NP NORVIR TABLET (ORAL)→ NP PREZCOBIX (ORAL) → NP PREZISTA (ORAL) → NP PREZISTA ORAL SUSP → NP RITONAVIR TABLET (ORAL) → PREFERRED RUKOBIA (ORAL) →NP SUSTIVA TABLET (ORAL) →NP STATIVA CAPSULE (ORAL) →NP TIVICAY PD SUSPENSION (ORAL) →NP TYBOST (ORAL) →NP VIREAD POWDER (ORAL) →NP |
| HYPOGLYCEMICS, ALPHA-GLUCOSIDASE INHIBITORS | GLYSET (ORAL) → NP |
| HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS | TRULICITY (SUBCUTANEOUS) → PREFERRED |
| HYPOGLYCEMICS, INSULIN AND RELATED AGENTS | INSULIN ASPART CARTRIDGE (AG) (SUBCUTANEOUS) → PREFERRED INSULIN ASPART PEN (AG) (SUBCUTANEOUS) → PREFERRED INSULIN ASPART VIAL (AG) (SUBCUTANEOUS) → PREFERRED INSULIN ASPART/INSULIN ASPART PROTAMINE INSULIN PEN (AG) (SUBCUTANEOUS) → PREFERRED INSULIN ASPART/INSULIN ASPART PROTAMINE VIAL (AG) (SUBCUTANEOUS) → PREFERRED INSULIN LISPRO JUNIOR KWIKPEN (AG) (SUBCUTANEOUS) → PREFERRED INSULIN LISPRO PEN (AG) (SUBCUTANEOUS) → PREFERRED INSULIN LISPRO PROTAMINE MIX KWIKPEN (AG) (SUBCUTANEOUS) → PREFERRED INSULIN LISPRO VIAL (AG) (SUBCUTANEOUS) →PREFERRED LYUMJEV 100U/ML PEN (SUB-Q) → NP LYUMJEV 200U/ML PEN (SUB-Q) → NP LYUMJEV VIAL (SUB-Q) → NP SEMGLEE VIAL (SUB-Q) → NP |
| HYPOGLYCEMICS, SGLT2 | SYNJARDY (ORAL) → PREFERRED |
| IMMUNOSUPPRESSIVES, ORAL | RAPAMUNE TABLET (ORAL) → PREFERRED ZORTRESS (ORAL) → PREFERRED |
| LIPOTROPICS, OTHER | FENOFIBRATE CAPSULE (LOFIBRA) (ORAL) → PREFERRED FENOFIBRATE TABLET (LOFIBRA) (ORAL) → PREFERRED ICOSAPENT ETHYL (ORAL) → NP NEXLIZET (ORAL) → NP OEMGA-3 ACID ETHYL ESTERS (ORAL) → PREFERRED |
| MACROLIDES/KETOLIDES | ERYTHROMYCIN ETHYLSUCCINATE 200 SUSPENSION (AG) (ORAL) → PREFERRED |
| MULTIPLE SCLEROSIS AGENTS | BAFIERTAM CAPSULE DR (ORAL) → NP DIMETHYL FUMARATE DR (AG) (ORAL) → NP DIMETHYL FUMARATE DR (ORAL) → NP DIMETHYL FUMARATE DR STARTER PACK (ORAL) → NP GILENYA (ORAL) → NP KESIMPTA (SUB-Q) → PREFERRED ZEPOSIA CAPSULE (ORAL) → NP ZEPOSIA STARTER KIT (ORAL) → NP ZEPOSIA STARTER PACK (ORAL) → NP |
| OPIATE DEPENDENCE TREATMENTS | BUPRENORPHINE HCL (SUBLINGUAL) → PREFERRED BUPRENORPHINE/NALOXONE TAB (SUBLINGUAL) → PREFERRED |
| PAH AGENTS, ORAL AND INHALED | ADCIRCA (ORAL) → NP TADALAFIL (ADCIRCA) (ORAL) → PREFERRED |
| PHOSPHATE BINDERS | RENVELA TABLET (ORAL) → PREFERRED SEVELAMER CARBONATE TABLET (AG) (ORAL) → NP SEVELAMER CARBONATE TABLET (ORAL) → NP |
| PRENATAL VITAMINS | DERMACINRX PRENATRIX OTC (ORAL) → NP WESTGEL DHA (ORAL) → NP |
| PROTON PUMP INHIBITORS | PANTOPRAZOLE SUSPENSION (ORAL) → NP PROTONIX SUSPENSION (ORAL) → PREFERRED |
| THYROID HORMONES | LEVOTHYROXINE SODIUM CAPSULE (AG) (ORAL) → NP THYQUIDITY SOLUTION (ORAL) → NP |
| ULCERATIVE COLITIS AGENTS | LIALDA (ORAL) → PREFERRED ROWASA (RECTAL) → PREFERRED |
| UTERINE DISORDER TREATMENTS | ORIAHNN (ORAL) → PREFERRED |
| VASODILATORS, CORONARY | ISOSORBIDE DINITRATE (AG) (ORAL) → NP VERQUVO (ORAL) → NP |