Tenofovir Disoproxil Fumarate NF 1 Formulary Enhancement N/A TABLET 300 MG Oral Zenpep CAPSULE DELAYED RELEASE PARTICLES 20000 UNIT 1 NF CMS Required Deletion N/A Oral Zenpep CAPSULE DELAYED RELEASE PARTICLES 40000-126000 NF 1 Formulary Enhancement N/A UNIT Oral EFFECTIVE 05/01/2018 Abacavir Sulfate SOLUTION 20 NF 1 Formulary Enhancement N/A MG/ML Oral Biktarvy TABLET 50-200-25 MG Oral NF 1 + QL 30 Formulary Enhancement N/A paroxetine Brisdelle CAPSULE 7.5 MG Oral 1 NF Formulary Update mesylate 7.5 mg, 1 caspofungin Cancidas SOLUTION 1 NF Formulary Update acetate 50 mg, RECONSTITUTED 50 MG Intravenous 1 caspofungin Cancidas SOLUTION 1 NF Formulary Update acetate 70 mg, RECONSTITUTED 70 MG Intravenous 1 glatiramer Copaxone Solution Prefilled Syringe 20 acetate 20 1 + PA1 NF Formulary Update MG/ML Subcutaneous mg/ml, 1 + PA1 glatiramer Copaxone Solution Prefilled Syringe 40 acetate 40 1 + PA1 NF Formulary Update MG/ML Subcutaneous mg/ml, 1 + PA1
Tenofovir Disoproxil Fumarate TABLET 300 MG Oral NF 1 Formulary Enhancement N/A Zenpep CAPSULE DELAYED RELEASE PARTICLES 20000 UNIT Oral 1 NF CMS Required Deletion N/A Zenpep CAPSULE DELAYED RELEASE PARTICLES 40000-126000 UNIT Oral NF 1 Formulary Enhancement N/A EFFECTIVE 05/01/2018 Abacavir Sulfate SOLUTION 20 MG/ML Oral NF 1 Formulary Enhancement N/A Biktarvy TABLET 50-200-25 MG Oral NF 1 + QL 30 Formulary Enhancement N/A Brisdelle CAPSULE 7.5 MG Oral 1 NF Formulary Update paroxetine mesylate 7.5 mg, 1 Cancidas SOLUTION RECONSTITUTED 50 MG Intravenous 1 NF Formulary Update caspofungin acetate 50 mg, 1 Cancidas SOLUTION RECONSTITUTED 70 MG Intravenous 1 NF Formulary Update caspofungin acetate 70 mg, 1 Copaxone Solution Prefilled Syringe 20 MG/ML Subcutaneous 1 + PA1 NF Formulary Update glatiramer acetate 20 mg/ml, 1 + PA1 Copaxone Solution Prefilled Syringe 40 MG/ML Subcutaneous 1 + PA1 NF Formulary Update glatiramer acetate 40 mg/ml, 1 + PA1
AgeWell_1-Tier_2018_Addendum_Eff_090120181.docx