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Preferred Drug List Changes

The following changes have been made to the Nebraska Preferred Drug List Changes (PDL).

Heritage Health - Nebraska Total Care 

 

PDL changes effective 07/17/2026
Nebraska PDL Therapeutic Drug ClassBrand Name (Route)PDL Status before 07/17/2026PDL status on or after 07/17/2026
ANDROGENIC AGENTSTESTOSTERONE GEL PACKET (AG) (VOGELXO) (TRANSDERM)Non-PreferredPreferred
ANGIOTENSIN MODULATORSENTRESTO (ORAL)PreferredNon-Preferred
ANTIBIOTICS, GIVANCOMYCIN CAPSULE (AG) (ORAL)Non-PreferredPreferred
ANTIBIOTICS, GIVANCOMYCIN CAPSULE (ORAL)Non-PreferredPreferred
ANTIBIOTICS, VAGINALCLINDAMYCIN (VAGINAL)Non-PreferredPreferred
ANTIBIOTICS, VAGINALCLEOCIN CREAM (VAGINAL)PreferredNon-Preferred
ANTICOAGULANTSELIQUIS SPRINKLE (ORAL)Non-PreferredPreferred
ANTICOAGULANTSELIQUIS SUSPENSION (ORAL)Non-PreferredPreferred
ANTICOAGULANTSDABIGATRAN (ORAL)PreferredNon-Preferred
ANTIFUNGALS, TOPICALTOLNAFTATE POWDER OTC (TOPICAL)Non-PreferredPreferred
ANTIFUNGALS, TOPICALTOLNAFTATE SPRAY OTC (TOPICAL)Non-PreferredPreferred
ANTIMIGRAINE AGENTS, TRIPTANSNARATRIPTAN (ORAL)Non-PreferredPreferred
ANTIPARASITICS, TOPICALSPINOSAD (AG) (TOPICAL)Non-PreferredPreferred
CALCIUM CHANNEL BLOCKERSNORLIQVA (ORAL)Non-PreferredPreferred
GLUCAGON AGENTSGVOKE VIAL (SUBCUTANEOUS)Non-PreferredPreferred
GLUCAGON AGENTSGLUCAGON EMERGENCY KIT (MYLAN) (INJECTION)PreferredNon-Preferred
HIV / AIDSDARUNAVIR (ORAL)Non-PreferredPreferred
HIV / AIDSEMTRICITABINE CAPSULE (ORAL)Non-PreferredPreferred
HIV / AIDSMARAVIROC TABLET (ORAL)Non-PreferredPreferred
HIV / AIDSEMTRIVA CAPSULE (ORAL)PreferredNon-Preferred
HIV / AIDSNORVIR TABLET (ORAL)PreferredNon-Preferred
HIV / AIDSPREZISTA (ORAL)PreferredNon-Preferred
HIV / AIDSSELZENTRY TABLET (ORAL)PreferredNon-Preferred
HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERSJANUMET XR (ORAL)PreferredNon-Preferred
HYPOGLYCEMICS, INSULIN AND RELATED AGENTSHUMALOG CARTRIDGE (SUBCUTANE.)Non-PreferredPreferred
HYPOGLYCEMICS, INSULIN AND RELATED AGENTSHUMALOG JUNIOR KWIKPEN (SUBCUTANE.)Non-PreferredPreferred
HYPOGLYCEMICS, INSULIN AND RELATED AGENTSHUMALOG MIX PEN (SUBCUTANE.)Non-PreferredPreferred
HYPOGLYCEMICS, INSULIN AND RELATED AGENTSHUMALOG PEN (SUBCUTANE.)Non-PreferredPreferred
HYPOGLYCEMICS, INSULIN AND RELATED AGENTSHUMALOG VIAL (SUBCUTANE.)Non-PreferredPreferred
LIPOTROPICS, OTHERICOSAPENT ETHYL (ORAL)Non-PreferredPreferred
MACROLIDES/KETOLIDESERYTHROMYCIN ETHYLSUCCINATE 200 SUSPENSION (AG) (ORAL)Non-PreferredPreferred
MACROLIDES/KETOLIDESERYTHROMYCIN ETHYLSUCCINATE 200 SUSPENSION (ORAL)Non-PreferredPreferred
MACROLIDES/KETOLIDESAZITHROMYCIN PACKET (AG) (ORAL)PreferredNon-Preferred
MACROLIDES/KETOLIDESE.E.S. 200 SUSPENSION (ORAL)PreferredNon-Preferred
PHOSPHATE BINDERSCALCIUM ACETATE TABLET (ORAL)PreferredNon-Preferred
PLATELET AGGREGATION INHIBITORSBRILINTA (ORAL)PreferredNon-Preferred
SKELETAL MUSCLE RELAXANTSCHLORZOXAZONE (ORAL)PreferredNon-Preferred
VASODILATORS, CORONARYISOSORBIDE DINIT/HYDRALAZINE TABLET (AG) (ORAL)PreferredNon-Preferred

 

PDL changes effective 01/16/2026
Nebraska PDL Therapeutic Drug ClassDrug Name (Route)PDL Status before 1/16/26PDL status on or after 1/16/26
ANTIPARKINSON'S AGENTSENTACAPONE (ORAL)Non-PreferredPreferred
CYTOKINE AND CAM ANTAGONISTSHADLIMA KIT (INJECTION) (CF) 100 MG/MLNon-PreferredPreferred
CYTOKINE AND CAM ANTAGONISTSHADLIMA KIT (INJECTION) 50 MG/MLNon-PreferredPreferred
CYTOKINE AND CAM ANTAGONISTSHADLIMA PEN KIT (INJECTION) (CF) 100 MG/MLNon-PreferredPreferred
CYTOKINE AND CAM ANTAGONISTSHADLIMA PEN KIT (INJECTION) 50 MG/MLNon-PreferredPreferred
CYTOKINE AND CAM ANTAGONISTSSIMLANDI PEN KIT (INJECTION) (CF) 100 MG/MLNon-PreferredPreferred
CYTOKINE AND CAM ANTAGONISTSTALTZ AUTOINJECTOR (SUBCUTANE.)Non-PreferredPreferred
CYTOKINE AND CAM ANTAGONISTSTALTZ SYRINGE (SUBCUTANE.)Non-PreferredPreferred
CYTOKINE AND CAM ANTAGONISTSPYZCHIVA SYRINGE (SUBCUTANEOUS)Non-PreferredPreferred
CYTOKINE AND CAM ANTAGONISTSSTEQEYMA SYRINGE (SUBCUTANE.)Non-PreferredPreferred
IMMUNOMODULATORS, ATOPIC DERMATITISEBGLYSS PEN (SUBCUTANEOUS)Non-PreferredPreferred
IMMUNOMODULATORS, ATOPIC DERMATITISEBGLYSS SYRINGE (SUBCUTANEOUS)Non-PreferredPreferred
ANTIPARKINSON'S AGENTSCARBIDOPA/LEVODOPA/ENTACAPONE (ORAL)PreferredNon-Preferred
CYTOKINE AND CAM ANTAGONISTSCOSENTYX PEN (SUBCUTANE.)PreferredNon-Preferred
CYTOKINE AND CAM ANTAGONISTSCOSENTYX SYRINGE (SUBCUTANE.)PreferredNon-Preferred
CYTOKINE AND CAM ANTAGONISTSCYLTEZO KIT (INJECTION) (CF) 100 MG/MLPreferredNon-Preferred
CYTOKINE AND CAM ANTAGONISTSCYLTEZO KIT (INJECTION) (CF) 50 MG/MLPreferredNon-Preferred
CYTOKINE AND CAM ANTAGONISTSCYLTEZO PEN KIT (INJECTION) (CF) 100 MG/MLPreferredNon-Preferred
CYTOKINE AND CAM ANTAGONISTSCYLTEZO PEN KIT (INJECTION) (CF) 50 MG/MLPreferredNon-Preferred
CYTOKINE AND CAM ANTAGONISTSHUMIRA KIT (INJECTION) (CF) 100 MG/MLPreferredNon-Preferred
CYTOKINE AND CAM ANTAGONISTSHUMIRA KIT (INJECTION) 50 MG/MLPreferredNon-Preferred
CYTOKINE AND CAM ANTAGONISTSHUMIRA PEN KIT (INJECTION) (CF) 100 MG/MLPreferredNon-Preferred
CYTOKINE AND CAM ANTAGONISTSHUMIRA PEN KIT (INJECTION) 50 MG/MLPreferredNon-Preferred
STIMULANTS AND RELATED AGENTSADDERALL XR (ORAL)PreferredNon-Preferred