Transcription of 2019 CVS/Caremark Prescription Drug Formulary Changes
1 2019 CVS/Caremark Prescription Drug Formulary Changes Effective January 1, 2019 Formulary Exclusions: Below is a list of medicines that will no longer be covered as of January 1, 2019. ACANYA GEL ACTICLATE TABLET ALPROLIX INJECTION AVENOVA SOLUTION WITH NEUTROX BENZACLIN GEL CAMBIA ORAL POWDER CIMZIA KIT CONTRAVE TABLET ELOCTATE INJECTION FASENRA INJECTION INVOKAMET, INVOKAMET XR TABLET & INVOKANA JENTADUETO TABLET & XR TABLET TABLET LUPRON DEPOT INJECTION , , 30MG & ONETOUCH (ULTRA, MINI, FLEX, VERIO & ULTRALINK) KITS & 45MG STRIPS ONEXTON GEL SORILUX FOAM TARAGADOX TABLET TIROSINT CAPSULE TRADJENTA TABLET VANATOL (LQ, S) SOLUTION VELTIN GEL ZEMAIRA INJECTION ZIANA GEL ZUPLENZ FILM Members' physicians can request coverage for excluded medications by call 1 855 240 0536. CVS/Caremark will approve the request if the proper clinical criteria is met. Tier 2 to Tier 3: Below is a list of medicines that will move from the Tier 2 Copayment to the Tier 3 Copayment effective January 1, 2019.
2 FENTORA BUCCAL TABLET LUPRON DEPOT INJECTION & PYRIDIUM TABLET WELCHOL TABLET & PAK ZOLADEX IMPLANT For questions or concerns, please call toll free at 1 888 865 6590 to speak to a Customer Care representative 24 hours a day, seven days a week.
