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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

October

Change Type Drug Name
Addition APO-VARENICLINE 0.5 MG TAB
Addition APO-VARENICLINE 1 MG TAB
Addition DAPTOMYCIN 500 MG RECON SOLN
Addition e.e.s. 400
Drug moved to lower tier formoterol fumarate
Inactive Product albuterol sulfate 4 mg tab er 12h
Inactive Product albuterol sulfate 8 mg tab er 12h
Inactive Product ALINIA 100 MG/5ML RECON SUSP
Inactive Product ALINIA 500 MG TAB
Inactive Product captopril-hydrochlorothiazide
Inactive Product GLUCOTROL 5 MG TAB
Inactive Product GLYSET
Inactive Product METHOTREXATE (ANTI-RHEUMATIC)
Inactive Product PATADAY
Inactive Product polyethylene glycol 3350
QL Updated budesonide-formoterol fumarate
QL Updated SYMBICORT

September

Change Type Drug Name
Addition AYVAKIT 25 MG TAB, 50 MG TAB
Addition formoterol fumarate
Addition HUMIRA PEN-PEDIATRIC UC START
Addition JEMPERLI
Addition LAZANDA
Addition LUMAKRAS
Addition RYBREVANT
Addition TRUSELTIQ (100MG DAILY DOSE)
Addition TRUSELTIQ (125MG DAILY DOSE)
Addition TRUSELTIQ (50MG DAILY DOSE)
Addition TRUSELTIQ (75MG DAILY DOSE)
Addition ZYNLONTA
PA Removed CELEBREX
PA Removed celecoxib
Inactive Product amethia lo
Inactive Product BONIVA 3 MG/3ML SOLUTION
Inactive Product cefotaxime sodium
Inactive Product diphenatol
Inactive Product e.e.s. 400
Inactive Product gavilyte-h
Inactive Product GLEOSTINE
Inactive Product ogestrel
Inactive Product vicodin
Inactive Product vicodin es
Inactive Product vicodin hp
Inactive Product VIDEX

August

Change Type Drug Name
Addition ARFORMOTEROL TARTRATE
Addition BEPOTASTINE BESILATE
Addition CALCITONIN (SALMON) 200 UNIT/ML SOLUTION
Addition COSENTYX 75 MG/0.5ML SOLN PRSYR
Addition ETRAVIRINE
Addition LOPINAVIR-RITONAVIR 100-25 MG TAB
Addition LOPINAVIR-RITONAVIR 200-50 MG TAB
Addition RUFINAMIDE 200 MG TAB
Addition RUFINAMIDE 400 MG TAB
Addition TIOPRONIN
Addition XPOVIO (100 MG ONCE WEEKLY) 50 MG TAB THPK
Addition XPOVIO (40 MG ONCE WEEKLY) 40 MG TAB THPK
Addition XPOVIO (40 MG TWICE WEEKLY) 40 MG TAB THPK
Addition XPOVIO (60 MG ONCE WEEKLY) 60 MG TAB THPK
Addition XPOVIO (80 MG ONCE WEEKLY) 40 MG TAB THPK
Inactive Product CLOCORTOLONE PIVALATE PUMP
Inactive Product VINCASAR PFS
PA Removed AMITRIPTYLINE HCL
PA Removed CARISOPRODOL
PA Removed HYDROXYZINE HCL 10 MG/5ML SYRUP
PA Removed HYDROXYZINE PAMOATE 25 MG CAP, 50 MG CAP
PA Removed METHOCARBAMOL 500 MG TAB, 750 MG TAB
PA Removed NORTRIPTYLINE HCL 10 MG CAP, 25 MG CAP
PA Removed NORTRIPTYLINE HCL 50 MG CAP, 75 MG CAP
PA Removed ORPHENADRINE CITRATE 100 MG TAB ER 12H
PA Removed PAMELOR
PA Removed ZOLPIDEM TARTRATE 12.5 MG TAB ER
PA Removed ZOLPIDEM TARTRATE 5 MG TAB, 10 MG TAB
PA Removed ZOLPIDEM TARTRATE 6.25 MG TAB ER
QL Added SKYRIZI

July

Change Type Drug Name
Addition PEPAXTO
Addition FOTIVDA
Addition RIABNI 100 MG/10ML, 500 MG/50ML
Addition RYTARY
Addition VELTASSA
Addition DEXTROSE-SODIUM CHLORIDE 5-0.3% SOLUTION
Addition SKYRIZI
QL Updated TIVICAY 10 MG TAB
QL Updated TIVICAY PD
Drug moved to lower tier LOKELMA
Inactive Product OXYCODONE-IBUPROFEN
Inactive Product SYMBYAX 6-50 MG CAP, 12-50 MG CAP
Inactive Product TAXOTERE
Inactive Product NEPHRAMINE
Inactive Product NORMOSOL-M IN D5W
Inactive Product ENABLEX
Inactive Product ANADROL-50
Inactive Product THEOPHYLLINE 200 MG TAB ER 12H

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