Lidocaine Viscous SOLUTION 2 % NF 2 Formulary Enhancement N/A Mouth/Throat MedroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 NF 2 Formulary Enhancement N/A MG/ML Intramuscular Roweepra XR Tablet Extended Release NF 2 Formulary Enhancement N/A 24 Hour 500 MG Oral Roweepra XR Tablet Extended Release NF 2 Formulary Enhancement N/A 24 Hour 750 MG Oral Selzentry SOLUTION 20 MG/ML Oral NF 4 Formulary Enhancement N/A Shingrix SUSPENSION RECONSTITUTED 50 MCG NF 4 Formulary Enhancement N/A Intramuscular Tacrolimus OINTMENT 0.03 % NF 2 Formulary Enhancement N/A EXTERNAL Tacrolimus OINTMENT 0.1 % NF 2 Formulary Enhancement N/A EXTERNAL Tenofovir Disoproxil Fumarate NF 5 Formulary Enhancement N/A TABLET 300 MG Oral Zenpep CAPSULE DELAYED RELEASE PARTICLES 20000 UNIT 3 NF CMS Required Deletion N/A Oral Zenpep CAPSULE DELAYED RELEASE PARTICLES NF 3 Formulary Enhancement N/A UNIT Oral EFFECTIVE 05/01/2018 Abacavir Sulfate SOLUTION 20 NF 4 Formulary Enhancement N/A MG/ML Oral Biktarvy TABLET 50-200-25 MG Oral NF 5 + QL 30 Formulary Enhancement N/A
Lidocaine Viscous SOLUTION 2 % Mouth/Throat NF 2 Formulary Enhancement N/A MedroxyPROGESTERone Acetate Suspension Prefilled Syringe 150 MG/ML Intramuscular NF 2 Formulary Enhancement N/A Roweepra XR Tablet Extended Release 24 Hour 500 MG Oral NF 2 Formulary Enhancement N/A Roweepra XR Tablet Extended Release 24 Hour 750 MG Oral NF 2 Formulary Enhancement N/A Selzentry SOLUTION 20 MG/ML Oral NF 4 Formulary Enhancement N/A Shingrix SUSPENSION RECONSTITUTED 50 MCG Intramuscular NF 4 Formulary Enhancement N/A Tacrolimus OINTMENT 0.03 % EXTERNAL NF 2 Formulary Enhancement N/A Tacrolimus OINTMENT 0.1 % EXTERNAL NF 2 Formulary Enhancement N/A Tenofovir Disoproxil Fumarate TABLET 300 MG Oral NF 5 Formulary Enhancement N/A Zenpep CAPSULE DELAYED RELEASE PARTICLES 20000 UNIT Oral 3 NF CMS Required Deletion N/A Zenpep CAPSULE DELAYED RELEASE PARTICLES UNIT Oral NF 3 Formulary Enhancement N/A EFFECTIVE 05/01/2018 Abacavir Sulfate SOLUTION 20 MG/ML Oral NF 4 Formulary Enhancement N/A Biktarvy TABLET 50-200-25 MG Oral NF 5 + QL 30 Formulary Enhancement N/A