Changes to covered medicines

There are recent changes to our formulary list, also called a preferred drug list (see box). The changes found in this list will be added to our Drug Formulary list athorizonNJhealth.com/covered_drugs. This list includes an explanation and listing of step therapy, quantity/age limitations and drugs that require prior authorization (approval). Paper copies are available upon request.Here is a list of recent changes:

Here is a list of recent changes:

Covered Change Description

Brand (Generic) Drug Name

Alternatives(if applicable)

Covered

Insulin Lispro Kwikpen 75/25

Covered

Focalin XR (dexmethylphenidate ER)

Covered

Onfi (clobazam) tablets

Covered

Otovel (ciprofloxacin/fluocinolone)

Covered

Jelmyto (mitomycin)

Covered

Koselugo (selumetinib)

Covered

Tabrecta (capmatinib)

Covered

Retevmo (selpercatinib)

Covered

Rhinocort Allergy (budesonide)

Covered

Lyrica Solution (pregabalin)

Covered

Lunesta (eszopiclone)

Covered

Ambien CR (zolpidem ER)

Covered

Rapaflo (silodosin)

Covered

Micardis (telmisartan)

Covered

Tricor 48mg (fenofibrate)

Covered

Avsola (infliximab-axxq)

Covered

Evrysdi (risdiplam)

Covered

Oriahnn (elagolix, estradiol, and norethindrone acetate)

Covered

Enspryng (satralizumab-mwge)

Covered

Dojolvi (triheptanoin)

Not Covered

Cipro HC (ciprofloxacin/hydrocortisone)

generic Ciprodex

Not Covered

Cortisporin (neomycin/polymixin/hydrocortisone) suspension

generic Cortisporin solutionn

Please talk with your Primary Care Provider (PCP) about these changes. If your PCP decides that, for medical reasons, you must take a drug that is not on the formulary list or needs pre-approval, including a brand name medication exception, he or she can call us and ask for special permission (prior authorization) for you to get the drug. Please note that Horizon NJ Health maximum days supply limit is 30 days.