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Preferred Drug List Changes

The following changes have been made to the Nebraska PDL. Changes are effective July 16, 2020.

Nebraska PDL Therapeutic Drug Class Change effective July 16, 2020
Acne Agents, Topical Aklief moved to Non-Preferred
Amzeq moved to Non-Preferred
Benzoyl Peroxide Towelette OTC moved to Non-Preferred
Clindamycin Phospahte Med Swab (topical) moved to Non-Preferred
Retin-A Cream (topical) moved to Non-Preferred
Retin-A Gel (topical) moved to Non-Preferred
Tretinoin Cream (topical)- moved to Preferred
Tretinoin Gel (AG) moved to Preferred
Tretinoin Gel moved to Preferred
Analgesics, Opioids Long-Acting Embeda moved to Non-Preferred
Androgenic Agents Testosterone Gel (AG) (Vogelxo) transderm moved to Non-Preferred
Testosterone Gel (Vogelxo) transderm moved to Non-Preferred
Testosterone Gel Packet (AG) (Vogelxo) transderm moved to Non-Preferred
Testosterone Gel Pump (AG) (Androgel) transderm moved to Preferred
Testosterone Gel Pump (AG) (Vogelxo) transderm moved to Non-Preferred
Testosterone Gel Pump (Androgel) transderm moved to Non-Preferred
Angiotensin Modulators Fosinopril moved to Preferred
Fosinopril/HCTZ moved to Preferred
Quinapril/HCTZ moved to Preferred
Angiotensin Modulator Combinations Amlodipine/Valsartan/HCTZ moved to Non-Preferred
Antibiotics, Vaginal Metronidazole moved to Non-Preferred
Anticoagulants Bevyxxa moved to Non-Preferred
Antimigraine Agents, Other Ajovy moved to Preferred
Emgality Syring 100mg moved to Non-Preferred
Nurtec ODT moved to Preferred
Reyvow moved to Non-Preferred
Ubrelvy moved to Non-Preferred
Antimigraine Agents, Triptans Relpax moved to Non-Preferred
Tosymra moved to Non-Preferred
Antiparasitics, Topical Sklice moved to Non-Preferred
Antivirals, Oral Acyclovir Susp moved to Non-Preferred
Tamiflu Capsule moved to Non-Preferred
Tamiflu Susp moved to Non-Preferred
Bladder Relaxant Preparations Solifenacin moved to Preferred
Vesicare moved to Non-Preferred
Bone Resorption Suppression and Related Agents Ibandronate moved to Preferred
Teriparatide (Sub-Q) moved to Non-Preferred
Calcium Channel Blockers Katerzia moved to Non-Preferred
Contraceptives, Oral Afirmelle moved to Preferred
Aurovela moved to Preferred
Aurovela 24 Fe moved to Preferred
Aurovela Fe moved to Preferred
Ayuna moved to Preferred
Cyred ED moved to Preferred
Hailey moved to Preferred
Jasmiel moved to Preferred
Kalliga moved to Preferred
Lo-Zumandimine moved to Preferred
Simliya moved to Preferred
Simpesse moved to Preferred
Slynd moved to Preferred
Tarina 24 Fe moved to Preferred
Tri-Lo-Mili moved to Preferred
Zumandimine moved to Preferred
Cystic Fibrosis Trikafta moved to Non-Preferred
Glucagon Agents - *NEW* Baqsimi moved to Preferred
Diazoxide Susp moved to Non-Preferred
Glucagon (injection) moved to Preferred
Glucagon Emergency Kit (Fresenius) (Inj) moved to Non-Preferred
Glucagon Emergency Kit (Lilly) (Inj) moved to Preferred
Gvoke Pen & Syringe moved to Non-Preferred
Proglycem Susp moved to Preferred
Growth Hormone Nutropin AQ Pen (injection) moved to Non-Preferred
HAE Treatments - *NEW* Berinert moved to Preferred
Cinryze moved to Non-Preferred
Firazyr moved to Preferred
Haegarda moved to Preferred
Icatibanr moved to Non-Preferred
Kalbitor moved to Non-Preferred
Ruconest moved to Non-Preferred
Takhzyro moved to Non-Preferred
HIV/AIDS Dovato moved to Non-Preferred
Symtuza moved to Non-Preferred
Temixys moved to Non-Preferred
Hypoglycemics, Incretin Mimetics / Enhancers Rybelsus moved to Non-Preferred
Hypoglycemics, Insulin and Related Agents Humalog Junior Kwikpen moved to Preferred
Humulin 500 U/M Pen moved to Preferred
Humulin 70/30 Pen OTC moved to Preferred
Humulin Pen OTC moved to Preferred
Hypoglycemics, SGLT2 Invokamet moved to Preferred
Xigduo XR moved to Preferred
Lipotropics, Statins Ezallor Sprinkle moved to Non-Preferred
Multiple Sclerosis Agents Mavenclad moved to Non-Preferred
Mayzent moved to Non-Preferred
Rebif moved to Non-Preferred
Rebif Rebidose Pen Injctr moved to Non-Preferred
Vumerity moved to Non-Preferred
Nitrofuran Derivatives Nitrofurantoin Susp moved to Non-Preferred
PAH - Pulmonary Arterial Hypertension Agents Ambrisentan moved to Preferred
Letairis moved to Non-Preferred
Phosphate Binders Renagel moved to Non-Preferred
Sevelamer Carbonate (AG) moved to Preferred
Sevelamer Carbonate moved to Preferred
Prenatal Vitamins PNV Combo #47/Iron/FA#1/DHA moved to Non-Preferred
PNV NO.15/Iron Fum&PS CMP/FA moved to Non-Preferred
PNV with CA, NO.74/Iron/FA OTC moved to Non-Preferred
PNV#16/Iron FUM & PS/FA/OM-3 moved to Non-Preferred
Thyroid Hormones Euthyrox moved to Non-Preferred
Ulcerative Colitis Balsalazide moved to Non-Preferred
Mesalamine (SFRowasa) (rectal) moved to Non-Preferred