rxdelta / Medicare Part D formulary diff

Coverage changes, 2026-05 to 2026-06

What changed in Part D drug coverage between two monthly CMS snapshots, and what each change is estimated to do to a member's out of pocket cost.

Generated 2026-05 to 2026-06 comparison Coverage phase priced: Initial coverage Normalized to 30 day supply

Scope of this comparison

Changes
1,030,491drug and plan pairs
Distinct changes
1,367groups
Drugs affected
591
Plans affected
5,517of 5,518
Drugs in 2026-05
6,115
Drugs in 2026-06
6,128

What these estimates do not account for

Read this before the findings, not after them. The figures below are ranges derived from published cost sharing tables. They are not predictions of what any individual member will pay, and each item here can move a real number by more than the change being reported.

Changes ranked by estimated member impact

50 of 1,367

Cost figures are ranges, not predictions. The range spans preferred, non preferred and mail order pharmacies and every supply length the plan publishes, scaled to 30 days. Each row leads with the modal case, a fill at a preferred retail pharmacy on a 30 day supply in the initial coverage phase, which is how a member most often actually fills a prescription. The modal figure does not replace the range. The range beneath it is the bound across every pharmacy type and supply length the plan publishes, and where that bound crosses zero the row is flagged, because the bound is then disagreeing with the headline about which way cost moves. A range marked 'or more' covers a drug joining or leaving the formulary. The price without formulary coverage is not in the CMS files, so only the covered side is priced.

Drug Change Tier before and after Plans Est. monthly changemodal case, then full range Severity
lansoprazole 15 MG Delayed Release Oral Capsule 70756-0806-30 RXCUI 596843 Drug removed
182 plans
  • H0544-056-000
  • H0544-064-000
  • H0544-065-000
  • H0544-095-000
  • H0629-001-000
  • H0629-002-000
  • H0629-003-000
  • H0629-004-000
  • H0907-001-000
  • H0907-003-000
  • H1212-001-000
  • H1212-002-000
  • H1212-003-000
  • H1607-012-000
  • H1607-015-000
  • H1894-002-000
  • H1894-011-000
  • H1947-001-000
  • H1947-003-000
  • H1947-004-000
  • H2441-001-000
  • H2593-029-000
  • H2593-031-000
  • H2593-032-000
  • H2593-043-000
  • H2593-044-000
  • H2593-045-000
  • H2593-046-000
  • H2593-047-000
  • H2593-048-000
  • H2593-051-000
  • H2593-053-000
  • H2628-001-000
  • H2628-003-000
  • H2628-004-000
  • H2628-005-000
  • H2687-001-000
  • H2836-006-000
  • H2836-007-000
  • H3204-001-000
  • and 142 more
 T4 Non-preferred drug to not covered 182 not published modal case not published range $93.67 to $100.00 or more 79.7 High
flavoxate hydrochloride 100 MG Oral Tablet 00574-0115-01 RXCUI 1095229 Drug removed
55 plans
  • H2630-001-000
  • H2630-002-000
  • H2942-001-000
  • H2942-002-000
  • H2942-003-000
  • H3335-015-000
  • H3335-018-000
  • H3335-038-000
  • H3335-053-000
  • H3335-055-000
  • H3335-060-000
  • H3335-061-000
  • H3335-062-000
  • H3351-002-000
  • H3351-006-000
  • H3351-012-000
  • H3351-017-000
  • H3351-019-000
  • H3351-020-000
  • H3351-022-000
  • H3351-023-000
  • H3388-002-000
  • H3388-014-000
  • H3388-020-000
  • H3660-028-000
  • H3660-029-000
  • H3660-044-000
  • H3660-050-000
  • H3660-053-001
  • H3660-053-002
  • H3660-057-000
  • H3907-059-001
  • H3907-059-002
  • H3907-059-003
  • H3907-059-004
  • H3907-059-005
  • H4279-001-000
  • H4279-004-000
  • H5163-001-000
  • H5163-002-000
  • and 15 more
 T4 Non-preferred drug to not covered 55 +$100.00 increase at modal case range $83.33 to $100.00 or more 79.1 High
acetaminophen 325 MG / hydrocodone bitartrate 7.5 MG Oral Tablet 65162-0115-50 RXCUI 857005 Drug removed
822 plans
  • H0029-007-000
  • H0029-008-000
  • H0029-009-000
  • H0029-010-000
  • H0029-011-000
  • H0062-011-000
  • H0062-012-000
  • H0074-001-000
  • H0074-004-000
  • H0107-003-000
  • H0107-004-000
  • H0111-001-000
  • H0111-004-000
  • H0174-004-000
  • H0174-006-000
  • H0174-009-000
  • H0174-010-000
  • H0174-014-000
  • H0174-015-000
  • H0174-016-000
  • H0174-017-000
  • H0174-018-000
  • H0174-019-000
  • H0174-020-000
  • H0174-021-000
  • H0174-022-000
  • H0174-023-000
  • H0174-024-000
  • H0174-025-000
  • H0174-026-000
  • H0270-001-000
  • H0351-038-000
  • H0351-053-000
  • H0351-054-000
  • H0351-057-000
  • H0351-063-000
  • H0351-064-000
  • H0351-065-000
  • H0351-066-000
  • H0351-067-000
  • and 782 more
 T4 Non-preferred drug to not covered 822 +$100.00 increase at modal case range $66.67 to $100.00 or more 78.2 High
acetaminophen 325 MG / oxycodone hydrochloride 7.5 MG Oral Tablet 42858-0103-01 RXCUI 1049225 Drug removed
811 plans
  • H0029-007-000
  • H0029-008-000
  • H0029-010-000
  • H0062-011-000
  • H0062-012-000
  • H0074-004-000
  • H0107-003-000
  • H0107-004-000
  • H0111-004-000
  • H0174-004-000
  • H0174-006-000
  • H0174-009-000
  • H0174-022-000
  • H0174-023-000
  • H0174-024-000
  • H0174-025-000
  • H0174-026-000
  • H0351-066-000
  • H0351-068-000
  • H0354-001-000
  • H0354-027-000
  • H0354-028-000
  • H0354-029-000
  • H0354-030-000
  • H0439-003-001
  • H0439-003-002
  • H0439-006-000
  • H0439-008-000
  • H0439-009-000
  • H0439-010-000
  • H0439-011-000
  • H0439-013-000
  • H0439-015-001
  • H0439-015-002
  • H0439-016-000
  • H0439-017-000
  • H0439-018-000
  • H0439-019-000
  • H0439-020-000
  • H0439-021-000
  • and 771 more
 T4 Non-preferred drug to not covered 811 +$100.00 increase at modal case range $66.67 to $100.00 or more 78.2 High
acetaminophen 325 MG / oxycodone hydrochloride 10 MG Oral Tablet 42858-0104-01 RXCUI 1049214 Drug removed
811 plans
  • H0029-007-000
  • H0029-008-000
  • H0029-010-000
  • H0062-011-000
  • H0062-012-000
  • H0074-004-000
  • H0107-003-000
  • H0107-004-000
  • H0111-004-000
  • H0174-004-000
  • H0174-006-000
  • H0174-009-000
  • H0174-022-000
  • H0174-023-000
  • H0174-024-000
  • H0174-025-000
  • H0174-026-000
  • H0351-066-000
  • H0351-068-000
  • H0354-001-000
  • H0354-027-000
  • H0354-028-000
  • H0354-029-000
  • H0354-030-000
  • H0439-003-001
  • H0439-003-002
  • H0439-006-000
  • H0439-008-000
  • H0439-009-000
  • H0439-010-000
  • H0439-011-000
  • H0439-013-000
  • H0439-015-001
  • H0439-015-002
  • H0439-016-000
  • H0439-017-000
  • H0439-018-000
  • H0439-019-000
  • H0439-020-000
  • H0439-021-000
  • and 771 more
 T4 Non-preferred drug to not covered 811 +$100.00 increase at modal case range $66.67 to $100.00 or more 78.2 High
acetaminophen 325 MG / oxycodone hydrochloride 5 MG Oral Tablet 42858-0102-50 RXCUI 1049221 Drug removed
637 plans
  • H0029-007-000
  • H0029-008-000
  • H0029-010-000
  • H0062-011-000
  • H0062-012-000
  • H0074-004-000
  • H0107-003-000
  • H0107-004-000
  • H0111-004-000
  • H0174-004-000
  • H0174-006-000
  • H0174-009-000
  • H0174-022-000
  • H0174-023-000
  • H0174-024-000
  • H0174-025-000
  • H0174-026-000
  • H0351-066-000
  • H0351-068-000
  • H0354-001-000
  • H0354-027-000
  • H0354-028-000
  • H0354-029-000
  • H0354-030-000
  • H0439-003-001
  • H0439-003-002
  • H0439-006-000
  • H0439-008-000
  • H0439-009-000
  • H0439-010-000
  • H0439-011-000
  • H0439-013-000
  • H0439-015-001
  • H0439-015-002
  • H0439-016-000
  • H0439-017-000
  • H0439-018-000
  • H0439-019-000
  • H0439-020-000
  • H0439-021-000
  • and 597 more
 T4 Non-preferred drug to not covered 637 +$100.00 increase at modal case range $66.67 to $100.00 or more 78.2 High
olanzapine 10 MG Oral Tablet 33342-0070-07 RXCUI 314154 Drug removed
253 plans
  • H0029-007-000
  • H0029-008-000
  • H0029-010-000
  • H0062-011-000
  • H0062-012-000
  • H0074-004-000
  • H0111-004-000
  • H0174-004-000
  • H0174-006-000
  • H0174-009-000
  • H0174-022-000
  • H0174-023-000
  • H0174-024-000
  • H0174-025-000
  • H0174-026-000
  • H0351-066-000
  • H0351-068-000
  • H0712-005-000
  • H0712-029-000
  • H0908-001-000
  • H0908-004-000
  • H0908-006-000
  • H0908-007-000
  • H0908-008-000
  • H0913-013-000
  • H0913-015-000
  • H1032-202-000
  • H1032-240-000
  • H1032-241-000
  • H1032-242-000
  • H1032-243-000
  • H1032-244-001
  • H1032-244-002
  • H1032-245-001
  • H1032-245-002
  • H1112-006-000
  • H1112-033-000
  • H1112-043-000
  • H1112-046-000
  • H1112-047-000
  • and 213 more
 T4 Non-preferred drug to not covered 253 +$100.00 increase at modal case range $66.67 to $100.00 or more 78.2 High
ciclopirox 7.7 MG/ML Topical Cream 68462-0297-35 RXCUI 309289 Drug removed
238 plans
  • H0029-007-000
  • H0029-008-000
  • H0029-010-000
  • H0062-011-000
  • H0062-012-000
  • H0074-004-000
  • H0111-004-000
  • H0174-004-000
  • H0174-006-000
  • H0174-009-000
  • H0174-022-000
  • H0174-023-000
  • H0174-024-000
  • H0174-025-000
  • H0174-026-000
  • H0351-066-000
  • H0351-068-000
  • H0712-005-000
  • H0712-029-000
  • H0908-001-000
  • H0908-004-000
  • H0908-006-000
  • H0908-007-000
  • H0908-008-000
  • H0913-013-000
  • H0913-015-000
  • H1032-202-000
  • H1032-240-000
  • H1032-241-000
  • H1032-242-000
  • H1032-243-000
  • H1032-244-001
  • H1032-244-002
  • H1032-245-001
  • H1032-245-002
  • H1112-006-000
  • H1112-033-000
  • H1112-043-000
  • H1112-046-000
  • H1112-047-000
  • and 198 more
 T4 Non-preferred drug to not covered 238 +$100.00 increase at modal case range $66.67 to $100.00 or more 78.2 High
NDA019430 0.3 ML epinephrine 1 MG/ML Auto-Injector 49502-0102-02 RXCUI 1870207 Drug removed
24 plans
  • H2630-001-000
  • H2630-002-000
  • H2942-001-000
  • H2942-002-000
  • H2942-003-000
  • H3660-028-000
  • H3660-029-000
  • H3660-044-000
  • H3660-050-000
  • H3660-053-001
  • H3660-053-002
  • H3660-057-000
  • H5163-001-000
  • H5163-002-000
  • H5163-003-000
  • H5163-004-000
  • H6368-001-000
  • H6368-002-000
  • H7620-001-000
  • H8051-001-000
  • H8764-001-000
  • H8764-002-000
  • H8764-003-000
  • H8764-004-000
 T4 Non-preferred drug to not covered 24 +$100.00 increase at modal case range $83.33 to $100.00 or more 75.8 High
vancomycin 125 MG Oral Capsule 23155-0858-78 RXCUI 313570 Drug removed
310 plans
  • H0342-001-000
  • H0354-001-000
  • H0354-027-000
  • H0354-028-000
  • H0354-029-000
  • H0354-030-000
  • H0439-002-000
  • H0439-003-001
  • H0439-003-002
  • H0439-006-000
  • H0439-008-000
  • H0439-009-000
  • H0439-010-000
  • H0439-011-000
  • H0439-012-000
  • H0439-013-000
  • H0439-015-001
  • H0439-015-002
  • H0439-016-000
  • H0439-017-000
  • H0439-018-000
  • H0439-019-000
  • H0439-020-000
  • H0439-021-000
  • H0439-022-000
  • H0439-023-000
  • H0439-024-000
  • H0672-005-000
  • H0672-006-000
  • H0672-009-000
  • H0672-010-000
  • H0672-013-000
  • H0672-015-000
  • H0672-016-000
  • H0672-017-000
  • H0672-018-000
  • H0672-024-000
  • H2108-022-000
  • H2108-029-000
  • H2108-030-000
  • and 270 more
 T3 Preferred brand to not covered 310 +$40.00 to +$95.00 increase at modal case range $26.67 to $100.00 or more 75.5 High
erythromycin ethylsuccinate 400 MG Oral Tablet 24338-0110-03 RXCUI 686405 Drug removed
300 plans
  • H0439-002-000
  • H0439-012-000
  • H0439-022-000
  • H0439-023-000
  • H0544-002-000
  • H0544-004-000
  • H0544-005-000
  • H0544-010-000
  • H0544-014-000
  • H0544-015-000
  • H0544-019-000
  • H0544-020-000
  • H0544-056-000
  • H0544-058-000
  • H0544-061-000
  • H0544-062-000
  • H0544-063-000
  • H0544-064-000
  • H0544-065-000
  • H0544-066-000
  • H0544-069-000
  • H0544-091-000
  • H0544-095-000
  • H0544-096-000
  • H0544-098-000
  • H0544-108-000
  • H0629-001-000
  • H0629-002-000
  • H0629-003-000
  • H0629-004-000
  • H0672-009-000
  • H0672-010-000
  • H0672-015-000
  • H0672-018-000
  • H0907-001-000
  • H0907-003-000
  • H1212-001-000
  • H1212-002-000
  • H1423-001-000
  • H1423-002-000
  • and 260 more
 T3 Preferred brand to not covered 300 +$40.00 to +$95.00 increase at modal case range $26.67 to $100.00 or more 75.5 High
brimonidine tartrate 1 MG/ML Ophthalmic Solution 60505-0577-01 RXCUI 861204 Drug removed
269 plans
  • H0104-012-000
  • H0104-014-000
  • H0104-015-000
  • H0107-003-000
  • H0107-004-000
  • H0571-001-000
  • H0571-005-000
  • H0571-007-000
  • H0571-010-000
  • H0571-011-000
  • H0976-001-000
  • H0976-002-000
  • H0978-001-000
  • H0978-002-000
  • H0978-010-000
  • H0978-011-000
  • H0982-002-000
  • H0982-007-000
  • H0982-008-000
  • H0982-009-000
  • H0982-010-000
  • H0982-012-000
  • H0982-013-000
  • H0982-016-000
  • H0982-017-000
  • H0982-018-000
  • H0982-019-000
  • H0982-020-000
  • H0982-021-000
  • H0982-022-000
  • H0982-023-000
  • H0982-024-000
  • H0982-025-000
  • H0982-026-000
  • H0982-027-000
  • H0982-028-000
  • H0982-030-000
  • H0982-031-000
  • H0982-032-000
  • H0982-033-000
  • and 229 more
 T4 Non-preferred drug to not covered 269 +$95.00 to +$100.00 increase at modal case range $25.00 to $100.00 or more 75.4 High
0.5 ML diazepam 5 MG/ML Rectal Gel 68682-0650-20 RXCUI 801957 Drug removed
4967 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 4,927 more
 T4 Non-preferred drug to not covered 4967 +$25.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
vancomycin 125 MG Oral Capsule 23155-0858-78 RXCUI 313570 Drug removed
4590 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 4,550 more
 T4 Non-preferred drug to not covered 4590 +$75.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
72 HR fentanyl 0.025 MG/HR Transdermal System 47781-0424-47 RXCUI 245134 Drug removed
4519 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 4,479 more
 T4 Non-preferred drug to not covered 4519 +$25.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
72 HR fentanyl 0.05 MG/HR Transdermal System 47781-0426-47 RXCUI 245135 Drug removed
4519 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 4,479 more
 T4 Non-preferred drug to not covered 4519 +$25.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
vilazodone hydrochloride 20 MG Oral Tablet 62332-0233-30 RXCUI 1086778 Drug removed
4499 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 4,459 more
 T4 Non-preferred drug to not covered 4499 +$90.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
vilazodone hydrochloride 40 MG Oral Tablet 62332-0234-30 RXCUI 1086784 Drug removed
4458 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 4,418 more
 T4 Non-preferred drug to not covered 4458 +$90.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
0.4 ML enoxaparin sodium 100 MG/ML Prefilled Syringe 16714-0016-10 RXCUI 854235 Drug removed
4439 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 4,399 more
 T4 Non-preferred drug to not covered 4439 +$75.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
lacosamide 150 MG Oral Tablet 62332-0173-60 RXCUI 809992 Drug removed
4345 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 4,305 more
 T4 Non-preferred drug to not covered 4345 +$75.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
lacosamide 200 MG Oral Tablet 62332-0174-60 RXCUI 809996 Drug removed
4345 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 4,305 more
 T4 Non-preferred drug to not covered 4345 +$75.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
tadalafil 5 MG Oral Tablet 43598-0575-30 RXCUI 403957 Drug removed
3994 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 3,954 more
 T4 Non-preferred drug to not covered 3994 +$25.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
tretinoin 0.25 MG/ML Topical Cream 00574-2225-45 RXCUI 106302 Drug removed
3920 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 3,880 more
 T4 Non-preferred drug to not covered 3920 +$75.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
oxacillin 1000 MG Injection 64679-0698-01 RXCUI 1743547 Drug removed
3823 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 3,783 more
 T4 Non-preferred drug to not covered 3823 +$75.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
estradiol 0.1 MG/ML Vaginal Cream 66993-0002-10 RXCUI 310169 Drug removed
3668 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 3,628 more
 T3 Preferred brand to not covered 3668 +$30.00 to +$95.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
ciprofloxacin 3 MG/ML / dexamethasone 1 MG/ML Otic Suspension 43598-0326-75 RXCUI 403908 Drug removed
3179 plans
  • H0029-007-000
  • H0029-008-000
  • H0029-009-000
  • H0029-010-000
  • H0029-011-000
  • H0062-011-000
  • H0062-012-000
  • H0074-001-000
  • H0074-004-000
  • H0104-012-000
  • H0104-014-000
  • H0104-015-000
  • H0107-003-000
  • H0107-004-000
  • H0111-001-000
  • H0111-004-000
  • H0154-011-000
  • H0154-015-001
  • H0154-015-002
  • H0154-017-000
  • H0154-020-000
  • H0169-001-000
  • H0169-002-000
  • H0169-003-000
  • H0169-004-000
  • H0169-006-000
  • H0169-008-000
  • H0169-009-000
  • H0169-010-000
  • H0174-004-000
  • H0174-006-000
  • H0174-009-000
  • H0174-010-000
  • H0174-014-000
  • H0174-015-000
  • H0174-016-000
  • H0174-017-000
  • H0174-018-000
  • H0174-019-000
  • H0174-020-000
  • and 3,139 more
 T4 Non-preferred drug to not covered 3179 +$90.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
24 HR amphetamine aspartate 2.5 MG / amphetamine sulfate 2.5 MG / dextroamphetamine saccharate 2.5 MG / dextroamphetamine sulfate 2.5 MG Extended Release Oral Capsule 00228-3059-11 RXCUI 861221 Drug removed
3153 plans
  • H0029-007-000
  • H0029-008-000
  • H0029-010-000
  • H0062-011-000
  • H0062-012-000
  • H0074-004-000
  • H0104-016-000
  • H0107-005-000
  • H0107-007-000
  • H0107-010-000
  • H0111-004-000
  • H0154-011-000
  • H0154-015-001
  • H0154-015-002
  • H0154-017-000
  • H0154-020-000
  • H0169-001-000
  • H0169-002-000
  • H0169-003-000
  • H0169-004-000
  • H0169-006-000
  • H0169-008-000
  • H0169-009-000
  • H0169-010-000
  • H0174-004-000
  • H0174-006-000
  • H0174-009-000
  • H0174-022-000
  • H0174-023-000
  • H0174-024-000
  • H0174-025-000
  • H0174-026-000
  • H0251-002-000
  • H0251-004-000
  • H0251-008-000
  • H0294-002-000
  • H0294-004-000
  • H0294-015-000
  • H0294-016-000
  • H0294-017-000
  • and 3,113 more
 T4 Non-preferred drug to not covered 3153 +$75.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
24 HR amphetamine aspartate 7.5 MG / amphetamine sulfate 7.5 MG / dextroamphetamine saccharate 7.5 MG / dextroamphetamine sulfate 7.5 MG Extended Release Oral Capsule 31722-0195-01 RXCUI 861232 Drug removed
3153 plans
  • H0029-007-000
  • H0029-008-000
  • H0029-010-000
  • H0062-011-000
  • H0062-012-000
  • H0074-004-000
  • H0104-016-000
  • H0107-005-000
  • H0107-007-000
  • H0107-010-000
  • H0111-004-000
  • H0154-011-000
  • H0154-015-001
  • H0154-015-002
  • H0154-017-000
  • H0154-020-000
  • H0169-001-000
  • H0169-002-000
  • H0169-003-000
  • H0169-004-000
  • H0169-006-000
  • H0169-008-000
  • H0169-009-000
  • H0169-010-000
  • H0174-004-000
  • H0174-006-000
  • H0174-009-000
  • H0174-022-000
  • H0174-023-000
  • H0174-024-000
  • H0174-025-000
  • H0174-026-000
  • H0251-002-000
  • H0251-004-000
  • H0251-008-000
  • H0294-002-000
  • H0294-004-000
  • H0294-015-000
  • H0294-016-000
  • H0294-017-000
  • and 3,113 more
 T4 Non-preferred drug to not covered 3153 +$75.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
acetaminophen 21.7 MG/ML / hydrocodone bitartrate 0.67 MG/ML Oral Solution 64950-0375-16 RXCUI 856944 Drug removed
3002 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 2,962 more
 T4 Non-preferred drug to not covered 3002 +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
lurasidone hydrochloride 60 MG Oral Tablet 16729-0348-10 RXCUI 1431235 Drug removed
2983 plans
  • H0029-007-000
  • H0029-008-000
  • H0029-009-000
  • H0029-010-000
  • H0029-011-000
  • H0062-011-000
  • H0062-012-000
  • H0074-001-000
  • H0074-004-000
  • H0104-012-000
  • H0104-014-000
  • H0104-015-000
  • H0104-016-000
  • H0107-003-000
  • H0107-004-000
  • H0107-005-000
  • H0107-007-000
  • H0107-010-000
  • H0111-001-000
  • H0111-004-000
  • H0154-011-000
  • H0154-015-001
  • H0154-015-002
  • H0154-017-000
  • H0154-020-000
  • H0174-004-000
  • H0174-006-000
  • H0174-009-000
  • H0174-010-000
  • H0174-014-000
  • H0174-015-000
  • H0174-016-000
  • H0174-017-000
  • H0174-018-000
  • H0174-019-000
  • H0174-020-000
  • H0174-021-000
  • H0174-022-000
  • H0174-023-000
  • H0174-024-000
  • and 2,943 more
 T4 Non-preferred drug to not covered 2983 +$25.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
lurasidone hydrochloride 80 MG Oral Tablet 16729-0349-10 RXCUI 1040041 Drug removed
2983 plans
  • H0029-007-000
  • H0029-008-000
  • H0029-009-000
  • H0029-010-000
  • H0029-011-000
  • H0062-011-000
  • H0062-012-000
  • H0074-001-000
  • H0074-004-000
  • H0104-012-000
  • H0104-014-000
  • H0104-015-000
  • H0104-016-000
  • H0107-003-000
  • H0107-004-000
  • H0107-005-000
  • H0107-007-000
  • H0107-010-000
  • H0111-001-000
  • H0111-004-000
  • H0154-011-000
  • H0154-015-001
  • H0154-015-002
  • H0154-017-000
  • H0154-020-000
  • H0174-004-000
  • H0174-006-000
  • H0174-009-000
  • H0174-010-000
  • H0174-014-000
  • H0174-015-000
  • H0174-016-000
  • H0174-017-000
  • H0174-018-000
  • H0174-019-000
  • H0174-020-000
  • H0174-021-000
  • H0174-022-000
  • H0174-023-000
  • H0174-024-000
  • and 2,943 more
 T4 Non-preferred drug to not covered 2983 +$25.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
24 HR desvenlafaxine succinate 50 MG Extended Release Oral Tablet 70436-0012-04 RXCUI 1874559 Drug removed
2870 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 2,830 more
 T3 Preferred brand to not covered 2870 +$30.00 to +$95.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
metronidazole 7.5 MG/ML Topical Cream 59651-0770-46 RXCUI 311678 Drug removed
2683 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 2,643 more
 T4 Non-preferred drug to not covered 2683 +$75.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
erythromycin ethylsuccinate 400 MG Oral Tablet 24338-0110-03 RXCUI 686405 Drug removed
2660 plans
  • H0154-011-000
  • H0154-015-001
  • H0154-015-002
  • H0154-017-000
  • H0154-020-000
  • H0169-001-000
  • H0169-002-000
  • H0169-003-000
  • H0169-004-000
  • H0169-006-000
  • H0169-008-000
  • H0169-009-000
  • H0169-010-000
  • H0251-002-000
  • H0251-004-000
  • H0251-008-000
  • H0294-002-000
  • H0294-004-000
  • H0294-015-000
  • H0294-016-000
  • H0294-017-000
  • H0294-018-000
  • H0294-027-000
  • H0294-032-000
  • H0294-048-000
  • H0294-049-000
  • H0294-050-000
  • H0294-051-000
  • H0321-002-000
  • H0321-004-000
  • H0342-001-000
  • H0354-001-000
  • H0354-027-000
  • H0354-028-000
  • H0354-029-000
  • H0354-030-000
  • H0413-001-000
  • H0413-002-000
  • H0413-003-000
  • H0421-001-000
  • and 2,620 more
 T4 Non-preferred drug to not covered 2660 +$75.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
febuxostat 40 MG Oral Tablet 72205-0028-30 RXCUI 834235 Drug removed
2416 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 2,376 more
 T3 Preferred brand to not covered 2416 +$15.00 to +$95.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
fluocinolone acetonide 0.1 MG/ML Otic Solution 45802-0009-10 RXCUI 1191299 Drug removed
2400 plans
  • H0104-012-000
  • H0104-014-000
  • H0104-015-000
  • H0104-016-000
  • H0107-003-000
  • H0107-004-000
  • H0107-005-000
  • H0107-007-000
  • H0107-010-000
  • H0169-001-000
  • H0169-002-000
  • H0169-003-000
  • H0169-004-000
  • H0169-006-000
  • H0169-008-000
  • H0169-009-000
  • H0169-010-000
  • H0251-002-000
  • H0251-004-000
  • H0251-008-000
  • H0294-002-000
  • H0294-004-000
  • H0294-015-000
  • H0294-016-000
  • H0294-017-000
  • H0294-018-000
  • H0294-027-000
  • H0294-032-000
  • H0294-048-000
  • H0294-049-000
  • H0294-050-000
  • H0294-051-000
  • H0321-002-000
  • H0321-004-000
  • H0354-001-000
  • H0354-027-000
  • H0354-028-000
  • H0354-029-000
  • H0354-030-000
  • H0421-001-000
  • and 2,360 more
 T4 Non-preferred drug to not covered 2400 +$75.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
fluocinolone acetonide 0.1 MG/ML Otic Solution [Flac] 39328-0079-20 RXCUI 2045201 Drug removed
2332 plans
  • H0104-012-000
  • H0104-014-000
  • H0104-015-000
  • H0104-016-000
  • H0107-003-000
  • H0107-004-000
  • H0107-005-000
  • H0107-007-000
  • H0107-010-000
  • H0169-001-000
  • H0169-002-000
  • H0169-003-000
  • H0169-004-000
  • H0169-006-000
  • H0169-008-000
  • H0169-009-000
  • H0169-010-000
  • H0251-002-000
  • H0251-004-000
  • H0251-008-000
  • H0294-002-000
  • H0294-004-000
  • H0294-015-000
  • H0294-016-000
  • H0294-017-000
  • H0294-018-000
  • H0294-027-000
  • H0294-032-000
  • H0294-048-000
  • H0294-049-000
  • H0294-050-000
  • H0294-051-000
  • H0321-002-000
  • H0321-004-000
  • H0342-001-000
  • H0354-001-000
  • H0354-027-000
  • H0354-028-000
  • H0354-029-000
  • H0354-030-000
  • and 2,292 more
 T4 Non-preferred drug to not covered 2332 +$75.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
loteprednol etabonate 5 MG/ML Ophthalmic Suspension 62756-0232-90 RXCUI 311382 Drug removed
2301 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 2,261 more
 T4 Non-preferred drug to not covered 2301 +$90.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
ivabradine 1 MG/ML Oral Solution [Corlanor] 55513-0813-28 RXCUI 2168596 Drug removed
2259 plans
  • H0104-016-000
  • H0107-005-000
  • H0107-007-000
  • H0107-010-000
  • H0154-011-000
  • H0154-015-001
  • H0154-015-002
  • H0154-017-000
  • H0154-020-000
  • H0342-001-000
  • H0413-001-000
  • H0413-002-000
  • H0413-003-000
  • H0423-001-000
  • H0504-015-000
  • H0504-017-000
  • H0504-021-000
  • H0504-026-000
  • H0504-028-000
  • H0504-038-000
  • H0504-039-000
  • H0504-040-000
  • H0504-041-000
  • H0504-043-000
  • H0504-047-000
  • H0504-050-000
  • H0523-022-000
  • H0523-065-000
  • H0523-070-000
  • H0523-073-000
  • H0523-074-000
  • H0523-075-000
  • H0523-083-000
  • H0523-085-000
  • H0523-086-000
  • H0523-088-000
  • H0523-089-000
  • H0523-091-000
  • H0523-092-000
  • H0524-003-000
  • and 2,219 more
 T4 Non-preferred drug to not covered 2259 $0.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
84 HR estradiol 0.00208 MG/HR Transdermal System 70710-1193-08 RXCUI 242891 Drug removed
2101 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 2,061 more
 T3 Preferred brand to not covered 2101 +$15.00 to +$95.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
clobetasol propionate 0.5 MG/ML Topical Solution 51672-1293-03 RXCUI 861487 Drug removed
2071 plans
  • H0029-007-000
  • H0029-008-000
  • H0029-010-000
  • H0062-011-000
  • H0062-012-000
  • H0074-004-000
  • H0104-016-000
  • H0107-005-000
  • H0107-007-000
  • H0107-010-000
  • H0111-004-000
  • H0154-011-000
  • H0154-015-001
  • H0154-015-002
  • H0154-017-000
  • H0154-020-000
  • H0174-004-000
  • H0174-006-000
  • H0174-009-000
  • H0174-022-000
  • H0174-023-000
  • H0174-024-000
  • H0174-025-000
  • H0174-026-000
  • H0332-004-000
  • H0332-009-000
  • H0351-066-000
  • H0351-068-000
  • H0354-001-000
  • H0354-027-000
  • H0354-028-000
  • H0354-029-000
  • H0354-030-000
  • H0413-001-000
  • H0413-002-000
  • H0413-003-000
  • H0423-001-000
  • H0439-003-001
  • H0439-003-002
  • H0439-006-000
  • and 2,031 more
 T4 Non-preferred drug to not covered 2071 +$75.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
midodrine hydrochloride 10 MG Oral Tablet 60505-1325-01 RXCUI 993462 Drug removed
2051 plans
  • H0029-007-000
  • H0029-008-000
  • H0029-010-000
  • H0062-011-000
  • H0062-012-000
  • H0074-004-000
  • H0104-016-000
  • H0107-005-000
  • H0107-007-000
  • H0107-010-000
  • H0111-004-000
  • H0154-011-000
  • H0154-015-001
  • H0154-015-002
  • H0154-017-000
  • H0154-020-000
  • H0174-004-000
  • H0174-006-000
  • H0174-009-000
  • H0174-022-000
  • H0174-023-000
  • H0174-024-000
  • H0174-025-000
  • H0174-026-000
  • H0351-066-000
  • H0351-068-000
  • H0354-001-000
  • H0354-027-000
  • H0354-028-000
  • H0354-029-000
  • H0354-030-000
  • H0413-001-000
  • H0413-002-000
  • H0413-003-000
  • H0423-001-000
  • H0439-003-001
  • H0439-003-002
  • H0439-006-000
  • H0439-008-000
  • H0439-009-000
  • and 2,011 more
 T4 Non-preferred drug to not covered 2051 +$90.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
lurasidone hydrochloride 60 MG Oral Tablet 16729-0348-10 RXCUI 1431235 Drug removed
1904 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 1,864 more
 T3 Preferred brand to not covered 1904 +$40.00 to +$95.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
lurasidone hydrochloride 80 MG Oral Tablet 16729-0349-10 RXCUI 1040041 Drug removed
1904 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 1,864 more
 T3 Preferred brand to not covered 1904 +$40.00 to +$95.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
5000 MG testosterone 0.01 MG/MG Topical Gel 00591-3217-30 RXCUI 1597129 Drug removed
1846 plans
  • H0169-001-000
  • H0169-002-000
  • H0169-003-000
  • H0169-004-000
  • H0169-006-000
  • H0169-008-000
  • H0169-009-000
  • H0169-010-000
  • H0251-002-000
  • H0251-004-000
  • H0251-008-000
  • H0294-002-000
  • H0294-004-000
  • H0294-015-000
  • H0294-016-000
  • H0294-017-000
  • H0294-018-000
  • H0294-027-000
  • H0294-032-000
  • H0294-048-000
  • H0294-049-000
  • H0294-050-000
  • H0294-051-000
  • H0321-002-000
  • H0321-004-000
  • H0421-001-000
  • H0432-003-000
  • H0432-004-000
  • H0432-009-000
  • H0432-013-000
  • H0432-017-000
  • H0504-015-000
  • H0504-017-000
  • H0504-021-000
  • H0504-026-000
  • H0504-028-000
  • H0504-038-000
  • H0504-039-000
  • H0504-040-000
  • H0504-041-000
  • and 1,806 more
 T3 Preferred brand to not covered 1846 +$40.00 to +$95.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
5000 MG testosterone 0.01 MG/MG Topical Gel 00591-3217-30 RXCUI 1597129 Drug removed
1764 plans
  • H0029-007-000
  • H0029-008-000
  • H0029-010-000
  • H0062-011-000
  • H0062-012-000
  • H0074-004-000
  • H0104-012-000
  • H0104-014-000
  • H0104-015-000
  • H0104-016-000
  • H0107-003-000
  • H0107-004-000
  • H0107-005-000
  • H0107-007-000
  • H0107-010-000
  • H0111-004-000
  • H0154-011-000
  • H0154-015-001
  • H0154-015-002
  • H0154-017-000
  • H0154-020-000
  • H0174-004-000
  • H0174-006-000
  • H0174-009-000
  • H0174-022-000
  • H0174-023-000
  • H0174-024-000
  • H0174-025-000
  • H0174-026-000
  • H0302-001-000
  • H0302-006-000
  • H0302-008-000
  • H0332-004-000
  • H0332-009-000
  • H0342-001-000
  • H0351-066-000
  • H0351-068-000
  • H0354-001-000
  • H0354-027-000
  • H0354-028-000
  • and 1,724 more
 T4 Non-preferred drug to not covered 1764 +$75.00 to +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
fluocinolone acetonide 0.1 MG/ML Otic Solution 45802-0009-10 RXCUI 1191299 Drug removed
1719 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 1,679 more
 T3 Preferred brand to not covered 1719 +$30.00 to +$95.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
nystatin 100000 UNT/ML / triamcinolone acetonide 1 MG/ML Topical Cream 51672-1263-02 RXCUI 1053753 Drug removed
1639 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 1,599 more
 T4 Non-preferred drug to not covered 1639 +$100.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
24 HR amphetamine aspartate 2.5 MG / amphetamine sulfate 2.5 MG / dextroamphetamine saccharate 2.5 MG / dextroamphetamine sulfate 2.5 MG Extended Release Oral Capsule 00228-3059-11 RXCUI 861221 Drug removed
1385 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 1,345 more
 T3 Preferred brand to not covered 1385 +$40.00 to +$95.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated
24 HR amphetamine aspartate 7.5 MG / amphetamine sulfate 7.5 MG / dextroamphetamine saccharate 7.5 MG / dextroamphetamine sulfate 7.5 MG Extended Release Oral Capsule 31722-0195-01 RXCUI 861232 Drug removed
1385 plans
  • H0028-007-000
  • H0028-014-000
  • H0028-015-000
  • H0028-016-000
  • H0028-017-000
  • H0028-019-000
  • H0028-021-000
  • H0028-024-000
  • H0028-028-000
  • H0028-029-000
  • H0028-030-000
  • H0028-032-000
  • H0028-035-000
  • H0028-036-000
  • H0028-037-000
  • H0028-039-000
  • H0028-041-000
  • H0028-042-000
  • H0028-043-001
  • H0028-043-002
  • H0028-046-000
  • H0028-051-000
  • H0028-053-001
  • H0028-053-003
  • H0028-054-001
  • H0028-054-002
  • H0028-055-000
  • H0028-056-000
  • H0028-059-000
  • H0028-060-000
  • H0028-062-000
  • H0028-063-000
  • H0028-065-000
  • H0028-066-000
  • H0028-067-000
  • H0028-070-000
  • H0028-072-000
  • H0028-074-001
  • H0028-074-002
  • H0028-076-000
  • and 1,345 more
 T3 Preferred brand to not covered 1385 +$40.00 to +$95.00 increase at modal case range $0.00 to $100.00 or more 73.3 Elevated

A group is one drug with one combination of changes and one tier movement, counted across every plan it affects. Severity is a 0 to 100 sorting score combining the size of the range, its direction, how many plans it reaches, and whether a utilization restriction was added. Bands: High at 75, Elevated at 50, Moderate at 25, Low at 0. The score takes 150 distinct value(s) across 1,367 group(s) here; ties are broken by affected plan count, then range width, then distance from zero.

Changes by type

1,030,491 pairs
Change type Drug and plan pairs
Drug added 481,042
Drug removed 465,646
Prior auth added 79,050
Quantity limit loosened 2,424
Prior auth removed 1,369
Tier down 346
Step therapy removed 323
Quantity limit removed 301
Quantity limit added 7

Ordered by frequency. One drug and plan pair can carry several change types at once, so these counts add up to more than the number of changes.