State & FederalMedicare AdvantageFebruary 29, 2020

Non-preferred products and corresponding preferred alternatives

Beginning January 1, 2020, we will be contacting members using non-preferred products with a high patient cost share about the availability of lower patient cost share preferred alternatives. If the member is interested in switching, we will call or fax their provider who can determine whether the preferred alternative is clinically appropriate. This is strictly informational and not a substitute for physician‑directed medical evaluations or treatments.

 

A list of the included non-preferred products and corresponding preferred alternatives is provided below. 

 

Nonpreferred products

Preferred alternative(s)

Aciphex DR

omeprazole

pantoprazole

Actos

pioglitazone HCL

Advair Diskus

fluticasone-salmeterol

Wixela Inhub

Aggrenox

aspirin-dipyridamole ER

Ampyra ER

dalfampridine ER

Breo Ellipta

fluticasone-salmeterol

Wixela Inhub

Cambia

diclofenac

sumatriptan

chlorzoxazone

cyclobenzaprine

Coumadin

warfarin

Crestor

rosuvastatin

Dexilant

omeprazole

pantoprazole

Dilantin

phenytoin

Diovan HCT

valsartan/hydrochlorothiazide

Duexis

ibuprofen & famotidine

Dymista

fluticasone & azelastine

Epzicom

abacavir-lamivudine

Evzio

naloxone HCL

Farxiga

Jardiance

Gleevec

imatinib

Glumetza

metformin ER (generic Glucophage XR)

Incruse Ellipta

Spiriva

Invega

paliperidone ER

Invokana

Jardiance

Jublia

ciclopirox

Kerydin

ciclopirox

Kombiglyze

Janumet XR

Lamictal

lamotrigine

Lanoxin

digoxin

Lipitor

atorvastatin

Livalo

atorvastatin

lovastatin

pravastatin

simvastatin

Lovaza

omega-3 acid ethyl esters

Mestinon

pyridostigmine

metformin ER (generic Glumetza)

metformin ER (generic Glucophage XR)

metformin ER OSM (generic Fortamet)

metformin ER (generic Glucophage XR)

Mirapex

pramipexole

Myrbetriq ER

oxybutynin

Nexium

omeprazole

pantoprazole

Nilandron

nilutamide

Novolin N

Humulin N

Novolog

Humalog

omeprazole-bicarbonate

omeprazole

pantoprazole

Onfi

clobazam

Onglyza

Januvia

Pennsaid

meloxicam

Protonix

omeprazole

pantoprazole

Renvela

sevelamer

Requip

ropinirole

Restasis

Xiidra

Soolantra

metronidazole

azelaic acid

Symbicort

fluticasone-salmeterol

Wixela Inhub

Synthroid

levothyroxine

Tresiba

Basaglar

Lantus

Toujeo

Trokendi XR

topiramate

Tudorza Pressair

Spiriva

Vasotec

enalapril

Vimovo

naproxen & omeprazole

Wellbutrin XL

bupropion XL

Xalatan

latanoprost

Xenazine

tetrabenazine

Zestoretic

lisinopril/hydrochlorothiazide

Zestril

lisinopril

Zileuton ER

montelukast

 

ABSCRNU-0123-20

PUBLICATIONS: March 2020 Anthem Connecticut Provider News