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Preferred Drug List Changes

The following changes have been made to the Nebraska PDL. Changes are effective January 20, 2023.

Heritage Health - Nebraska Total Care 

 

PDL Changes effective 01/20/2023
Nebraska PDL Therapeutic Drug Class Brand Name (Route) PDL Status before 1/20/23 PDL status on and after 1/20/23
ALZHEIMER'S AGENTS RIVASTIGMINE (AG) (TRANSDERM.) NON PREFERRED PREFERRED
ALZHEIMER'S AGENTS RIVASTIGMINE (TRANSDERM.) NON PREFERRED PREFERRED
ALZHEIMER'S AGENTS EXELON (TRANSDERM.) PREFERRED NON PREFERRED
ANTIHYPERTENSIVES, SYMPATHOLYTICS CLONIDINE (TRANSDERM.) NON PREFERRED PREFERRED
BRONCHODILATORS, BETA AGONIST PROVENTIL HFA (INHALATION) NON PREFERRED PREFERRED
BRONCHODILATORS, BETA AGONIST VENTOLIN HFA (INHALATION) NON PREFERRED PREFERRED
BRONCHODILATORS, BETA AGONIST ALBUTEROL HFA (PROAIR) (AG) (INHALATION) PREFERRED NON PREFERRED
BRONCHODILATORS, BETA AGONIST ALBUTEROL HFA (PROAIR) (INHALATION) PREFERRED NON PREFERRED
COLONY STIMULATING FACTORS NYVEPRIA (SUBCUTANEOUS) NON PREFERRED PREFERRED
CYTOKINE AND CAM ANTAGONISTS COSENTYX PEN INJECTER (SUBCUTANE.) NON PREFERRED PREFERRED
CYTOKINE AND CAM ANTAGONISTS COSENTYX SYRINGE (SUBCUTANE.) NON PREFERRED PREFERRED
EPINEPHRINE, SELF-INJECTED EPIPEN (INTRAMUSC) NON PREFERRED PREFERRED
EPINEPHRINE, SELF-INJECTED EPIPEN JR (INTRAMUSC) NON PREFERRED PREFERRED
ERYTHROPOIESIS STIMULATING PROTEINS EPOGEN (INJECTION) NON PREFERRED PREFERRED
ERYTHROPOIESIS STIMULATING PROTEINS PROCRIT (INJECTION) PREFERRED NON PREFERRED
IMMUNOMODULATORS, ATOPIC DERMATITIS DUPIXENT PEN (SUBCUTANEOUS) NON PREFERRED PREFERRED
IMMUNOMODULATORS, ATOPIC DERMATITIS DUPIXENT SYRINGE (SUBCUTANEOUS) NON PREFERRED PREFERRED
IMMUNOMODULATORS, ATOPIC DERMATITIS PROTOPIC (TOPICAL) NON PREFERRED PREFERRED
INTRANASAL RHINITIS AGENTS FLUTICASONE OTC (NASAL) PREFERRED NON PREFERRED
NSAIDS DICLOFENAC (PENNSAID PUMP) (TOPICAL) NON PREFERRED PREFERRED
NSAIDS IBUPROFEN CAPSULE OTC (ORAL) NON PREFERRED PREFERRED
ONCOLOGY, ORAL - BREAST CAPECITABINE (ORAL) NON PREFERRED PREFERRED
ONCOLOGY, ORAL - BREAST IBRANCE CAPSULE (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - BREAST IBRANCE TABLET (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - BREAST XELODA (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - HEMATOLOGIC IMBRUVICA CAPSULE (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - HEMATOLOGIC IMBRUVICA TABLET (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - HEMATOLOGIC JAKAFI (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - HEMATOLOGIC SPRYCEL (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - HEMATOLOGIC VENCLEXTA (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - HEMATOLOGIC VENCLEXTA STARTING PACK (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - LUNG ALECENSA (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - LUNG TAGRISSO (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - OTHER CAPRELSA (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - OTHER LYNPARZA (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - OTHER ZEJULA (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - PROSTATE XTANDI CAPSULE (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - PROSTATE XTANDI TABLET (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - PROSTATE ZYTIGA (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - RENAL CELL INLYTA (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - RENAL CELL LENVIMA (ORAL) PREFERRED NON PREFERRED
ONCOLOGY, ORAL - RENAL CELL VOTRIENT (ORAL) PREFERRED NON PREFERRED
OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS OLOPATADINE DROPS (PATADAY) (OPHTHALMIC) PREFERRED NON PREFERRED
OPHTHALMICS FOR ALLERGIC CONJUNCTIVITIS OLOPATADINE OTC (PATADAY TWICE A DAY) (OPHTHALMIC) PREFERRED NON PREFERRED
OTIC ANTIBIOTICS CIPRO HC (OTIC) NON PREFERRED PREFERRED
PROGESTATIONAL AGENTS MAKENA AUTO INJECTOR (SUBCUTANEOUS) PREFERRED NON PREFERRED
SICKLE CELL ANEMIA TREATMENTS ENDARI (ORAL) NON PREFERRED PREFERRED
STEROIDS, TOPICAL LOW DERMA-SMOOTHE-FS (TOPICAL) NON PREFERRED PREFERRED
STEROIDS, TOPICAL VERY HIGH CLOBETASOL PROPIONATE GEL (TOPICAL) PREFERRED NON PREFERRED
STIMULANTS AND RELATED AGENTS DEXMETHYLPHENIDATE ER (AG) (ORAL) NON PREFERRED PREFERRED
STIMULANTS AND RELATED AGENTS DEXMETHYLPHENIDATE ER (ORAL) NON PREFERRED PREFERRED
STIMULANTS AND RELATED AGENTS QELBREE (ORAL) NON PREFERRED PREFERRED
STIMULANTS AND RELATED AGENTS FOCALIN XR (ORAL) PREFERRED NON PREFERRED