moxifloxacin Vigamox SOLUTION 0.5 % Ophthalmic 3 NF Formulary Update 5 mg/ml, 3 Zenpep CAPSULE DELAYED RELEASE PARTICLES 25000-79000 NF 3 Formulary Enhancement N/A UNIT Oral Zenpep CAPSULE DELAYED RELEASE PARTICLES NF 3 Formulary Enhancement N/A UNIT Oral EFFECTIVE 06/01/2018 Abilify Maintena Suspension NF 4 Formulary Enhancement N/A Reconstituted ER 400 MG Intramuscular Alimta SOLUTION RECONSTITUTED NF 5 Formulary Enhancement N/A 100 MG Intravenous Daliresp Tablet 250 MCG Oral NF 3 Formulary Enhancement N/A estradiol 0.1 Estrace CREAM 0.1 MG/GM Vaginal 3 NF Formulary Update mg/ml, 3 Fabrazyme SOLUTION NF 5 + BD Formulary Enhancement N/A RECONSTITUTED 5 MG Intravenous Gengraf CAPSULE 50 MG ORAL 2 + BD NF CMS Required Deletion N/A Hydrocortisone Ace-Pramoxine NF 2 Formulary Enhancement N/A CREAM 1-1 % Rectal IBU TABLET 600 MG Oral NF 1 Formulary Enhancement N/A IBU TABLET 800 MG Oral NF 1 Formulary Enhancement N/A Ilaris (150mg Delivered) SOLUTION RECONSTITUTED 180 MG 5 NF CMS Required Deletion N/A Subcutaneous Imbruvica CAPSULE 70 MG Oral NF 5 + PA2 Formulary Enhancement N/A Imbruvica TABLET 140 MG Oral NF 5 + PA2 Formulary Enhancement N/A
Vigamox SOLUTION 0.5 % Ophthalmic 3 NF Formulary Update moxifloxacin 5 mg/ml, 3 Zenpep CAPSULE DELAYED RELEASE PARTICLES 25000-79000 UNIT Oral NF 3 Formulary Enhancement N/A Zenpep CAPSULE DELAYED RELEASE PARTICLES UNIT Oral NF 3 Formulary Enhancement N/A EFFECTIVE 06/01/2018 Abilify Maintena Suspension Reconstituted ER 400 MG Intramuscular NF 4 Formulary Enhancement N/A Alimta SOLUTION RECONSTITUTED 100 MG Intravenous NF 5 Formulary Enhancement N/A Daliresp Tablet 250 MCG Oral NF 3 Formulary Enhancement N/A Estrace CREAM 0.1 MG/GM Vaginal 3 NF Formulary Update estradiol 0.1 mg/ml, 3 Fabrazyme SOLUTION RECONSTITUTED 5 MG Intravenous NF 5 + BD Formulary Enhancement N/A Gengraf CAPSULE 50 MG ORAL 2 + BD NF CMS Required Deletion N/A Hydrocortisone Ace-Pramoxine CREAM 1-1 % Rectal NF 2 Formulary Enhancement N/A IBU TABLET 600 MG Oral NF 1 Formulary Enhancement N/A IBU TABLET 800 MG Oral NF 1 Formulary Enhancement N/A Ilaris (150mg Delivered) SOLUTION RECONSTITUTED 180 MG Subcutaneous 5 NF CMS Required Deletion N/A Imbruvica CAPSULE 70 MG Oral NF 5 + PA2 Formulary Enhancement N/A Imbruvica TABLET 140 MG Oral NF 5 + PA2 Formulary Enhancement N/A
AgeWell-5-Tier_2018_Addendum_Eff_07012018.docx