Zenpep Capsule Delayed Release NF 1 Formulary Enhancement N/A Particles UNIT Oral abacavir 20 Ziagen SOLUTION 20 MG/ML Oral 1 NF Formulary Update mg/ml, 1 EFFECTIVE 08/01/2018 Auryxia TABLET 1 GM 210 MG(Fe) NF 1 Formulary Enhancement N/A ORAL Baclofen Tablet 5 MG Oral NF 1 Formulary Enhancement N/A Ciprofloxacin HCl SOLUTION 0.2 % NF 1 Formulary Enhancement N/A OTIC Ciprofloxacin SOLUTION 400 1 NF CMS Required Deletion N/A MG/40ML Intravenous Estarylla Tablet 0.25-35 MG-MCG Oral NF 1 Formulary Enhancement N/A Fiasp FlexTouch Solution Pen-injector NF 1 Formulary Enhancement N/A 100 UNIT/ML Subcutaneous Fiasp SOLUTION 100 UNIT/ML NF 1 Formulary Enhancement N/A Subcutaneous tiagabine Gabitril Tablet 12 MG Oral 1 NF Formulary Update hydrochloride 12 mg, 1 tiagabine Gabitril Tablet 16 MG Oral 1 NF Formulary Update hydrochloride 16 mg, 1 Humira Prefilled Syringe Kit 20 NF 1 Formulary Enhancement N/A MG/0.2ML Subcutaneous lamotrigine LaMICtal Starter KIT 25 (35) MG Oral 1 NF Formulary Update starter kit 25 mg, 1
Zenpep Capsule Delayed Release Particles UNIT Oral NF 1 Formulary Enhancement N/A Ziagen SOLUTION 20 MG/ML Oral 1 NF Formulary Update abacavir 20 mg/ml, 1 EFFECTIVE 08/01/2018 Auryxia TABLET 1 GM 210 MG(Fe) ORAL NF 1 Formulary Enhancement N/A Baclofen Tablet 5 MG Oral NF 1 Formulary Enhancement N/A Ciprofloxacin HCl SOLUTION 0.2 % OTIC NF 1 Formulary Enhancement N/A Ciprofloxacin SOLUTION 400 MG/40ML Intravenous 1 NF CMS Required Deletion N/A Estarylla Tablet 0.25-35 MG-MCG Oral NF 1 Formulary Enhancement N/A Fiasp FlexTouch Solution Pen-injector 100 UNIT/ML Subcutaneous NF 1 Formulary Enhancement N/A Fiasp SOLUTION 100 UNIT/ML Subcutaneous NF 1 Formulary Enhancement N/A Gabitril Tablet 12 MG Oral 1 NF Formulary Update tiagabine hydrochloride 12 mg, 1 Gabitril Tablet 16 MG Oral 1 NF Formulary Update tiagabine hydrochloride 16 mg, 1 Humira Prefilled Syringe Kit 20 MG/0.2ML Subcutaneous NF 1 Formulary Enhancement N/A LaMICtal Starter KIT 25 (35) MG Oral 1 NF Formulary Update lamotrigine starter kit 25 mg, 1
AgeWell-1-Tier_2018_Addendum_Eff_08012018.docx