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Formulary Change Notice

All Deletion Changes are posted at least 60 days before the effective date.

November 2010 (Deletions posted 9/01/2010)
No Changes.

October 2010 (Deletions posted 8/01/2010)
No Changes.

September 2010 (Deletions posted 7/01/2010)
 Drug Name   Type of Change   Effective
   Date		 
Aldara 5% Cream Brand deleted, generic added 9/1/2010 
Flomax 0.4 mg capsule Brand deleted, generic added 9/1/2010 

August 2010 (Deletions posted 6/01/2010)
No Changes.

July 2010 (Deletions posted 5/01/2010)
 Drug Name   Type of Change   Effective
   Date		 
Metaxalone 800 mg tablet  Add, tier 1 7/1/2010 
Soritane 17.5 and 22.5 mg capsules Add, tier 3 7/1/2010 
Amoxicillin-Clav ER 1000/62.5 Add, tier 1  7/1/2010 
Clindamycin Phosphate 1% Foam Add, tier 1 7/1/2010 
Diltiazem ER 24 hour tablet 180, 240, Add, tier 1 7/1/2010 
Fluoxetine DR 90 mg capsule Add, tier 1, with QLL #4  7/1/2010 
Losartan / HCTZ 50/12.5; 100/12.5 Add, tier 1, with Step Therapy 7/1/2010 
Losartan 25, 50 and 100 mg Add, tier 1, with Step Therapy 7/1/2010 
Creon All Strengths Add, tier 2 7/1/2010 
Ixiaro 6 mcg/0.5ml syringe  Add, tier 2 7/1/2010 
Surmontil 25, 50 and 100 mg caps Add, tier 2 7/1/2010 
Xifaxan 200 mg tablet Add, tier 2 7/1/2010 
Vpriv 400 units vial Add, tier 3 7/1/2010 
Mirapex 0.125, 0.25, 0.5, 1.0, & 1.5mg tablets Delete - Generic (Pramipexole) added 7/1/2010 
Risperdal M 1 mg ODT tablet Delete - Generic (Risperidone) 1 mg added 7/1/2010 
Creon - all "EC" strength FDA has removed from market 7/1/2010 
Lapase capsules FDA has removed from market 7/1/2010 
Lipram - all strengths FDA has removed from market 7/1/2010 
Pancrelipase - all strengths FDA has removed from market 7/1/2010 
Pancron 10 & 20 mg FDA has removed from market 7/1/2010 
Ultrase - all strengths FDA has removed from market 7/1/2010 
Viokase 8 & 16 tablets FDA has removed from market 7/1/2010 
Viokase Powder FDA has removed from market 7/1/2010 

June 2010 (Deletions posted 4/01/2010)
 Drug Name   Type of Change   Effective
   Date		 
Amantadine 50mg/5ml Syrup Add (Tier 1)  6/1/2010 
Imiquimod 5 % cream Add (Tier 1) 6/1/2010 
Minocycline ER 45, 90, & 135 mg tablets Add (Tier 1) 6/1/2010 
Tamsulosin 0.4 mg capsule Add (Tier 1) 6/1/2010 
Coartem tablet Add (Tier 2) 6/1/2010 
Ampyra ER 10 mg tablet  Add (Tier 3)  6/1/2010 
Revatio 10mg/12.5 ml vial injectable Add (Tier 3) 6/1/2010 
Zyprexa Relprevv 405 mg vial injectable Add (Tier 3) 6/1/2010 
Subutex 2 & 8 mg sublingual tablet Delete - Generic (Buprenorphine) added 6/1/2010 
Acular PF, Regular & LS, 0.4, 0.5 % Eye Drops Delete - Generic (Ketorolac) added 6/1/2010 
Trileptal 300mg/5ml Oral suspension Delete - Generic (Oxcarbazepine) added 6/1/2010 
Prograf 0.5, 1.0, & 5mg capsules Delete - Generic (Tacrolimus) added 6/1/2010 

May 2010 (Deletions posted 3/01/2010)
 Drug Name   Type of Change   Effective
   Date		 
Propoxyphene HCl 65 Delete 5/1/2010 
Propoxyphene HCl/APAP 65/ 650 Delete  5/1/2010 
Propoxyphene napsylate/APAP 50/325, 100/650 Delete 5/1/2010 

April 2010 (Deletions posted 2/01/2010)
No Changes.

March 2010 (Deletions posted 1/01/2010)
No Changes.

February 2010 (Deletions posted 12/01/2009)
No Changes.

January 2010 (Deletions posted 11/01/2009)
 Drug Name   Type of Change   Effective
   Date		 
Amoxicillin TR-K CLV 250/62.5/ 5ml susp  Add 1/1/2010 
Apraclonidine HCl 0.5% drops  Add 1/1/2010 
Benztropine 2mg/2ml vial  Add 1/1/2010 
Clindamycin-Benzoyl Peroxide Gel  Add 1/1/2010 
Codeine Sulfate 15, 30 & 60 mg tablets Add 1/1/2010 
Colcrys 0.6 mg tablet Add 1/1/2010 
Effient 5 & 10 mg tablets Add 1/1/2010 
Gavilyte-G Solution  Add 1/1/2010 
Malathion 0.5% Lotion Add 1/1/2010 
Next Choice 0.75 mg tablet Add 1/1/2010 
Onglyza 2.5 & 5 mg tablet Add, with QLL 30 1/1/2010 
Clonidine 0.1, 0.2, 0.3 mg/day patch  Add, with QLL 4 1/1/2010 
Adcirca 20 mg tablet  Add, with QLL 60  1/1/2010 
Saphris 5 & 10 mg sublingual tablets Add, with QLL 60 1/1/2010 
Galantamine 4 mg/ml oral solution Add, with Step Therapy 1/1/2010 
Hibtiter Vaccine vial Delete 1/1/2010 
Intal Inhaler Delete 1/1/2010 
Stomectol 6 mg tablet Delete 1/1/2010 
Colchicine 0.6 mg tablet Delete, alterrnative is Colcrys 0.6 mg tablet  1/1/2010 

December 2009 (Deletions posted 10/01/2009)
 Drug Name   Type of Change   Effective
   Date		 
Colchicine 0.6 mg  Delete 12/1/2009 

November 2009 (Deletions posted 9/01/2009)
 Drug Name   Type of Change   Effective
   Date		 
Clindamycin-Benzoyl Peroxide Gel Add 11/1/2009 
Malathion 0.5 % Lotion Add 11/1/2009 
Galantamine 4 mg/ml oral solution Add 1 11/1/2009 
Nateglinide 60 & 120 mg tablets Add 1 11/1/2009 
Saphris 5 & 10 mg sublingual tablets Add, QLL = #68 11/1/2009 
Clonidine 0., 0.2 & 0.3 mg/day patch Add, QLL = 5 11/1/2009 
Valturna Add, with Step Therapy 11/6/2009 

October 2009 (Deletions posted 8/01/2009)
 Drug Name   Type of Change   Effective
   Date		 
Apraclonidine 0.50% Add 10/1/2009 
Benztropine Mesylate 1 mg/ml  Add 10/1/2009 
Codiene Sulfate 15, 30 & 60 mg  Add 10/1/2009 
Colcrys 0.6 mg Add 10/1/2009 
E Potassium 62.5 & 250 mg/ml  Add 10/1/2009 
Errifent 5 & 10 mg Add 10/1/2009 
Hectoral 1 mcg Add 10/1/2009 
Lamictal XR 25, 50, 100 & 200 mg Add 10/1/2009 
Next Choice 0.75 mg Add 10/1/2009 
Nucynta 50, 75 & 100 mg Add 10/1/2009 
Onglyza 2.5 & 5 mg Add 10/1/2009 
Oxaliplatin 50 mg/10 ml & 100 mg/20 ml Add 10/1/2009 
Tacrolimus 0.5, 1 & 5 mg Add 10/1/2009 
Zipsor 25 mg  Add 10/1/2009