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Preferred Drug List Changes

The following changes have been made to the Nebraska PDL. Changes are effective July 22, 2022.

Heritage Health - Nebraska Total Care 

 

Nebraska PDL Therapeutic Drug Class Change effective July 22, 2022
ACNE AGENTS, TOPICAL  CLINDAMYCIN PHOSPHATE/BENZOYL PEROXIDE -> NON PREFERRED
ANGIOTENSIN MODULATORS FOSINOPRIL SODIUM -> NON PREFERRED
FOSINOPRIL SODIUM/HYDROCHLOROTHIAZIDE -> NON PREFERRED
ANTIBIOTICS, VAGINAL VANDAZOLE -> NON PREFERRED
METRONIDAZOLE VAGINAL -> PREFERRED
ANTIMIGRAINE AGENTS, OTHER NURTEC -> PREFERRED
BONE RESORPTION SUPRESSION AND RELATED DRUGS TERIPARATIDE -> NON PREFERRED
FORTEO -> PREFERRED
CONTRACEPTIVES, ORAL DOLISHALE -> PREFERRED
NEXTSTELLIS -> PREFERRED
GROWTH HORMONES NUTROPIN AQ -> PREFERRED
HIV/AIDS COMBINATION NRTI TRUVADA -> NON PREFERRED
EMTRICITABINE/TENOFOVIR DISOPROXIL -> PREFERRED
HIV/AIDS COMBINATION PRODUCTS MISC ATRIPLA -> NON PREFERRED
DOVATO -> PREFERRED
EFAVIRENZ/EMTRICITABINE/TENOFOVIR DISOPROXIL FUMARATE -> PREFERRED
HIV/AIDS PROTEASE INHIBITORS LEXIVA -> NON PREFERRED
HYPOGLYCEMICS, DIPEPTIDYL PEPTIDASE-4 (DPP-4) INHIBITOR GLYXAMBI -> NON PREFERRED
HYPOGLYCEMICS, GLUCAGON-LIKE PEPTIDE-1 RECEPTOR AGONIST (GLP-1 RA) BYETTA -> NON PREFERRED
OZEMPIC -> PREFERRED
HYPOGLYCEMICS, INSULIN AND RELATED DRUGS NOVOLOG MIX 70/30 -> NON PREFERRED
NOVOLIN N FLEXPEN -> PREFERRED
NOVOLIN R FLEXPEN -> PREFERRED
IMMUNOSUPPRESSIVES, ORAL ZORTRESS -> NON PREFERRED
EVEROLIMUS -> PREFERRED
MACROLIDES AND KETOLIDES, ORAL ERYTHROMYCIN ETHYLSUCCINATE -> NON PREFERRED
E.E.S. GRANULES -> PREFERRED
MULTIPLE SCLEROSIS DRUGS TECFIDERA -> NON PREFERRED
DIMETHYL FUMARATE -> PREFERRED
PAH (PULMNOARY ARTERIAL HYPERTENSION AGENTS), ORAL AND INHALED SILDENAFIL CITRATE -> NON PREFERRED
PANCREATIC ENZYMES PANCREAZE -> PREFERRED
PHOSPHATE BINDERS CALCIUM ACETATE -> NON PREFERRED
UTERINE DISORDER TREATMENT MYFEMBREE -> PREFERRED