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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