Preferred Drug List Changes

The following changes have been made to the Nebraska PDL. Changes are effective July 21, 2023.

Heritage Health - Nebraska Total Care 

 

PDL Changes effective 07/21/2023
Nebraska PDL Therapeutic Drug Class Brand Name (Route) PDL Status before 07/21/23 PDL status on and after 07/21/23
ACNE AGENTS, TOPICAL ADAPALENE CREAM (TOPICAL) NON PREFERRED PREFERRED
ACNE AGENTS, TOPICAL ADAPALENE GEL (AG) (TOPICAL) NON PREFERRED PREFERRED
ACNE AGENTS, TOPICAL ADAPALENE GEL (TOPICAL) NON PREFERRED PREFERRED
ACNE AGENTS, TOPICAL ADAPALENE GEL OTC (TOPICAL) NON PREFERRED PREFERRED
ACNE AGENTS, TOPICAL ADAPALENE GEL PUMP (AG) (TOPICAL) NON PREFERRED PREFERRED
ACNE AGENTS, TOPICAL ADAPALENE GEL PUMP (TOPICAL) NON PREFERRED PREFERRED
ANALGESICS, NARCOTICS LONG XTAMPZA ER (ORAL) NON PREFERRED PREFERRED
ANALGESICS, NARCOTICS SHORT TRAMADOL / APAP (ORAL) PREFERRED NON PREFERRED
ANGIOTENSIN MODULATOR COMBINATIONS AMLODIPINE / VALSARTAN / HCTZ (ORAL) NON PREFERRED PREFERRED
ANTIBIOTICS, INHALED TOBRAMYCIN (TOBI) (INHALATION) NON PREFERRED PREFERRED
ANTIEMETIC/ANTIVERTIGO AGENTS APREPITANT CAPSULE (ORAL) NON PREFERRED PREFERRED
ANTIEMETIC/ANTIVERTIGO AGENTS EMEND CAPSULE (ORAL) PREFERRED NON PREFERRED
ANTIEMETIC/ANTIVERTIGO AGENTS EMEND PACK (ORAL) PREFERRED NON PREFERRED
BETA-BLOCKERS BYSTOLIC (ORAL) NON PREFERRED PREFERRED
BLADDER RELAXANT PREPARATIONS MYRBETRIQ (ORAL) NON PREFERRED PREFERRED
BLADDER RELAXANT PREPARATIONS SOLIFENACIN (ORAL) PREFERRED NON PREFERRED
CONTRACEPTIVES, ORAL FINZALA FE (ORAL) NON PREFERRED PREFERRED
CONTRACEPTIVES, ORAL HER STYLE OTC (ORAL) NON PREFERRED PREFERRED
CONTRACEPTIVES, ORAL NORETHINDRONE/ETHINYL ESTRADIOL FE ESTROPHASIC (ESTROSTEP FE) (ORAL) NON PREFERRED PREFERRED
GI MOTILITY, CHRONIC RELISTOR SYRINGE (SUBCUTANE.) NON PREFERRED PREFERRED
GLUCAGON AGENTS ZEGALOGUE AUTOINJECTOR (SUBCUTANEOUS) NON PREFERRED PREFERRED
HIV / AIDS EDURANT (ORAL) NON PREFERRED PREFERRED
HIV / AIDS JULUCA (ORAL) NON PREFERRED PREFERRED
HIV / AIDS LOPINAVIR/RITONAVIR TABLET (ORAL) NON PREFERRED PREFERRED
HIV / AIDS NORVIR TABLET (ORAL) NON PREFERRED PREFERRED
HIV / AIDS RITONAVIR TABLET (ORAL) PREFERRED NON PREFERRED
HYPOGLYCEMICS, INSULIN AND RELATED AGENTS APIDRA SOLOSTAR PEN (SUBCUTANE.) NON PREFERRED PREFERRED
HYPOGLYCEMICS, INSULIN AND RELATED AGENTS APIDRA VIAL (SUBCUTANE.) NON PREFERRED PREFERRED
HYPOGLYCEMICS, INSULIN AND RELATED AGENTS INSULIN GLARGINE PEN (SUBCUTANE.) NON PREFERRED PREFERRED
HYPOGLYCEMICS, INSULIN AND RELATED AGENTS INSULIN GLARGINE VIAL (SUBCUTANE.) NON PREFERRED PREFERRED
HYPOGLYCEMICS, INSULIN AND RELATED AGENTS INSULIN LISPRO PROTAMINE MIX KWIKPEN (AG) (SUBCUTANEOUS) PREFERRED NON PREFERRED
LIPOTROPICS, OTHER PRALUENT PEN (SUBCUTANEOUS) NON PREFERRED PREFERRED
LIPOTROPICS, OTHER VASCEPA (ORAL) NON PREFERRED PREFERRED
MULTIPLE SCLEROSIS AGENTS FINGOLIMOD (ORAL) NON PREFERRED PREFERRED
MULTIPLE SCLEROSIS AGENTS TERIFLUNOMIDE TABLET (ORAL) NON PREFERRED PREFERRED
OPIATE DEPENDENCE TREATMENTS NALOXONE SPRAY (AG) (NASAL) NON PREFERRED PREFERRED
OPIATE DEPENDENCE TREATMENTS NALOXONE SPRAY (NASAL) NON PREFERRED PREFERRED
OPIATE DEPENDENCE TREATMENTS NARCAN SPRAY (NASAL) PREFERRED NON PREFERRED
PEDIATRIC VITAMIN PREPARATIONS POLY-VI-SOL DROPS OTC (ORAL) NON PREFERRED PREFERRED
PHOSPHATE BINDERS RENVELA POWDER PACK (ORAL) NON PREFERRED PREFERRED
PRENATAL VITAMINS PRENATAL VIT/FE FUMARATE/FA OTC (ORAL) NON PREFERRED PREFERRED
PRENATAL VITAMINS PNV WITH CA NO.68/IRON/FA NO.1/DHA (ORAL) PREFERRED NON PREFERRED
PROTON PUMP INHIBITORS DEXILANT (ORAL) NON PREFERRED PREFERRED
TETRACYCLINES MINOCYCLINE TABLETS (ORAL) PREFERRED NON PREFERRED
ULCERATIVE COLITIS AGENTS MESALAMINE (CANASA) (AG) (RECTAL) NON PREFERRED PREFERRED
ULCERATIVE COLITIS AGENTS MESALAMINE (CANASA) (RECTAL) NON PREFERRED PREFERRED
ULCERATIVE COLITIS AGENTS SFROWASA (RECTAL) NON PREFERRED PREFERRED
ULCERATIVE COLITIS AGENTS CANASA (RECTAL) PREFERRED NON PREFERRED
ULCERATIVE COLITIS AGENTS ROWASA (RECTAL) PREFERRED NON PREFERRED
VASODILATORS, CORONARY BIDIL (ORAL) NON PREFERRED PREFERRED