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Medicare Formulary Changes

Each month, the Centers for Medicare and Medicaid Services (CMS) changes the Medicare Part D prescription drug formulary. (Anthem Extra Covered Drug coverage does not change.) Updates by month are shown below.

See the 2021 Formulary List of Covered Drugs for more details about your Medicare and Anthem prescription drug coverage.

2021

June

Change Type Drug Name
Addition AURYXIA
Addition BRINZOLAMIDE
Addition CABENUVA 400 & 600 MG/2ML SUSP
Addition CABENUVA 600 & 900 MG/3ML SUSP
Addition DESMOPRESSIN ACETATE PF
Addition DESOGESTREL-ETHINYL ESTRADIOL
Addition DOLISHALE
Addition DUPIXENT 200 MG/1.14ML SOLN PRSYR
Addition DUPIXENT 300 MG/2ML SOLN PEN, 300 MG/2ML SOLN PRSYR
Addition LYUMJEV
Addition LYUMJEV KWIKPEN
Addition UKONIQ
Inactive Product AUGMENTIN 125-31.25 MG/5ML RECON SUSP
Inactive Product CETIRIZINE HCL ALLERGY CHILD
Inactive Product DIDANOSINE 200 MG CAP DR
Inactive Product DIDANOSINE 250 MG CAP DR, 400 MG CAP DR
Inactive Product NADOLOL-BENDROFLUMETHIAZIDE
Inactive Product PATANOL
QL Removed ELIGARD 22.5 MG KIT
QL Removed ELIGARD 7.5 MG KIT
QL Removed FIRMAGON
QL Removed FIRMAGON (240 MG DOSE)
QL Removed LUPRON DEPOT (4-MONTH)
QL Removed LUPRON DEPOT (6-MONTH)
QL Removed TRELSTAR MIXJECT 3.75 MG RECON SUSP
QL Removed XALKORI
QL Removed XOLAIR 150 MG RECON SOLN

May

Change Type Drug Name
Addition ALA-SCALP
Addition BREZTRI AEROSPHERE
Addition DROXIDOPA 100 MG CAP
Addition DROXIDOPA 200 MG CAP
Addition DROXIDOPA 300 MG CAP
Addition FASENRA
Addition FASENRA PEN
Addition GLYXAMBI
Addition ICLEVIA
Addition INVOKAMET
Addition INVOKAMET XR
Addition INVOKANA 100 MG TAB
Addition INVOKANA 300 MG TAB
Addition MENQUADFI
Addition TEPMETKO
Addition TRIJARDY XR 10-5-1000 MG TAB ER, 25-5-1000 MG TAB ER
Addition TRIJARDY XR 5-2.5-1000 MG TAB ER, 12.5-2.5-1000 MG TAB ER
Addition XTANDI 40 MG TAB
Addition XTANDI 80 MG TAB
Addition ZAFEMY
Drug moved to lower tier ADVAIR HFA
Drug moved to lower tier AZOPT
Drug moved to lower tier BREO ELLIPTA
Drug no longer available on the market PAREGORIC
PA removed ENTRESTO

April

Change Type Drug Name
Discontinued Product FLUCONAZOLE IN DEXTROSE
Discontinued Product GLUCOPHAGE XR 500 MG TAB ER 24H
Discontinued Product GLUCOPHAGE XR 750 MG TAB ER 24H
Discontinued Product PREMASOL 6 % SOLUTION
Discontinued Product K-EFFERVESCENT
Discontinued Product HUMAPEN LUXURA HD
Discontinued Product CALAN
Discontinued Product KLOR-CON SPRINKLE
Down Tier NITAZOXANIDE
Down Tier HEMADY
Down Tier NITAZOXANIDE
Down Tier HEMADY
MO Removed VIBATIV
MO Removed ROWEEPRA
New Product ORGOVYX
Not Part D Eligible POTASSIUM BICARBONATE
PA Removed GLYBURIDE 1.25 MG TAB
PA Removed GLYBURIDE 2.5 MG TAB
PA Removed GLYBURIDE 5 MG TAB
PA Removed GLYBURIDE MICRONIZED 1.5 MG TAB
PA Removed GLYBURIDE MICRONIZED 3 MG TAB
PA Removed GLYBURIDE MICRONIZED 6 MG TAB
PA Removed GLYBURIDE-METFORMIN 1.25-250 MG TAB
PA Removed GLYBURIDE-METFORMIN 2.5-500 MG TAB, 5-500 MG TAB
PA Removed EZETIMIBE-SIMVASTATIN
PA Removed MONTELUKAST SODIUM
STEP Removed ZENPEP 25000-79000 DR, 40000-126000 DR
STEP Removed ZENPEP 3000-14000 DR, 5000-24000 DR, 10000-32000 DR, 15000-47000 DR, 20000-63000 DR
STEP Removed ZENPEP 3000-14000 DR, 5000-24000 DR, 10000-32000 DR, 15000-47000 DR, 20000-63000 DR

March

Change Type Drug Name
Drug added ABIRATERONE ACETATE 500 MG TAB
Drug added ASENAPINE MALEATE 10 MG SL TAB
Drug added ASENAPINE MALEATE 2.5 MG SL TAB
Drug added ASENAPINE MALEATE 5 MG SL TAB
Drug added CYCLOPENTOLATE HCL 1 % SOLUTION
Drug added HYOSCYAMINE SULFATE 0.125 MG SL TAB, 0.125 MG TAB, 0.125 MG TAB DISP
Drug added LUBIPROSTONE
Drug added LYLEQ
Drug added NYLIA 7/7/7
Drug added ONCASPAR
Drug added TRI-NYMYO
Requirements added ASPARLAS
Requirements added DIFICID 40 MG/ML RECON SUSP
Requirements added AZACITIDINE
Requirements added ONUREG
Requirements added TYBLUME
Requirements added VIDAZA

February

Change Type Drug Name
Down tier, Remove S RYBELSUS 3 MG TAB
Down tier, Remove S RYBELSUS 7 MG TAB, 14 MG TAB
Drug added BLENREP
Drug added CYCLOPHOSPHAMIDE 1 GM/5ML, 500 MG/2.5ML
Drug added DEFERIPRONE
Drug added DIACOMIT 250 MG CAP, 250 MG PACKET
Drug added DIACOMIT 500 MG PACKET, 500 MG CAP
Drug added EFAVIRENZ-EMTRICITAB-TENOFOVIR
Drug added EMTRICITABINE-TENOFOVIR DF
Drug added FOSFOMYCIN TROMETHAMINE
Drug added GAVRETO
Drug added ICOSAPENT ETHYL
Drug added LAPATINIB DITOSYLATE
Drug added LEVOTHYROXINE SODIUM 13 MCG CAP, 50 MCG CAP, 75 MCG CAP, 88 MCG CAP, 100 MCG CAP, 112 MCG CAP, 125 MCG CAP, 137 MCG CAP, 150 MCG CAP, 175 MCG CAP, 200 MCG CAP
Drug added LEVOTHYROXINE SODIUM 25 MCG CAP
Drug added LILETTA (52 MG)
Drug added LOESTRIN 1.5/30 (21)
Drug added LOESTRIN 1/20 (21)
Drug added LOESTRIN FE 1.5/30
Drug added LOESTRIN FE 1/20
Drug added MICROGESTIN 24 FE
Drug added MONJUVI
Drug added NITAZOXANIDE
Drug added ONUREG
Drug added PARAPLATIN 1000 MG/100ML SOLUTION
Drug added PENTAMIDINE ISETHIONATE 300 MG RECON SOLN FOR NEBULIZATION
Drug added POTASSIUM CHLORIDE 10 % SOLUTION
Drug added RUFINAMIDE
Drug added SAPROPTERIN DIHYDROCHLORIDE 100 MG TAB SOL, 500 MG PACKET
Drug added TIMOLOL MALEATE PF
Drug added TRULICITY 3 MG/0.5ML SOLN, 4.5 MG/0.5ML SOLN
Drug added TYBLUME
Drug added ZEPZELCA
Drug added ZOVIA 1/35 (28)
Drug removed, not Part D ACTONEL 5 MG TAB
Drug removed, not Part D ADRUCIL
Drug removed, not Part D COLOCORT
Drug removed, not Part D GLUCOPHAGE 1000 MG TAB
Drug removed, not Part D GLUCOPHAGE 500 MG TAB
Drug removed, not Part D LARTRUVO
Drug removed, not Part D ORTHO TRI-CYCLEN LO
Drug removed, not Part D SECONAL
QLL change VALACYCLOVIR HCL 1 GM TAB

2020

December

Change Type Drug Name
Drug added CLINIMIX E/DEXTROSE (8/10)
Drug added CLINIMIX E/DEXTROSE (8/14)
Drug added CLINIMIX/DEXTROSE (6/5)
Drug added DEFERIPRONE
Drug added EMTRICITABINE-TENOFOVIR DF
Drug added FOSFOMYCIN TROMETHAMINE
Drug added GAVRETO
Drug added LAPATINIB DITOSYLATE
Drug added SAPROPTERIN DIHYDROCHLORIDE ORAL PACKET 500 MG
Drug added TRELEGY ELLIPTA INHALATION POWDER BREATH ACTIVATED 100-62.5-25 MCG/INH
Drug no longer available on the market ACTONEL ORAL TABLET 30MG, 5MG
Drug no longer available on the market LORCET
Drug no longer available on the market LORCET HD
Drug no longer available on the market MORPHINE SULFATE INTRAVENOUS SOLUTION 25 MG/ML