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Masks Strongly Recommended but Not Required in Maryland, Starting Immediately

Due to the downward trend in respiratory viruses in Maryland, masking is no longer required but remains strongly recommended in Johns Hopkins Medicine clinical locations in Maryland. Read more.

Johns Hopkins Health Plans

Non-Covered Medications

Prescription medications removed from the TRICARE pharmacy benefit program.

Drug Class Products not covered/removed from TRICARE Formulary Formulary Alternatives Effective Date of Change
Cardiovascular Agents Miscellaneous colchicine low dose (LODOCO 0.5 mg tablets
  • colchicine 0.6 mg tablets (generic Colcrys)
  • colchicine 0.6 mg caps (generic Mitigare
 6/12/2024
PAH: PDE-5 Inhibitors sildenafil 10 mg/mL oral
suspension (Liqrev)
  • sildenafil tabs
  • sildenafil 10 mg/mL oral suspension
    (generic Revatio)
  • tadalafil oral suspension (Tadliq)
 02/28/2024
Binders
Chelators
Antidotes 		trientine
tetrahydrochloride tabs
(Cuvrior)
  • trientine hydrochloride caps
  • penicillamine
 02/28/2024
Sleep Disorders: Insomnia Agents zolpidem 7.5 mg caps
  • zolpidem IR 5 mg, 10 mg tabs
  • zolpidem ER 6.25 mg, 12.5 mg tabs
  • zaleplon 5 mg and 10 mg caps
  • eszopiclone 1 mg, 2 mg and 3 mg tabs
 02/28/2024
Ophthalmic Dry Eye Agentsloteprednol etabonate 0.25% ophthalmic suspension (Eysuvis)
  • cyclosporine 0.05% ophthalmic emulsion unit-dose (generic Restasis)
  • cyclosporine 0.05% ophthalmic emulsion multi-dose (Restasis Multidose)
  • cyclosporine 0.09% ophthalmic solution (Cequa)
  • lifitegrast 5% ophthalmic solution (Xiidra)
  • loteprednol 0.2% ophthalmic suspension (Alrex, generic)
  • loteprednol 0.5% ophthalmic suspension (Lotemax, generic)
 11/22/2023
Diureticsfurosemide SC injection (Fuoscix)
  • furosemide
  • bumetanide
  • ethacrynic acid
  • torsemide
 08/30/2023
Benign Prostatic Hyperplasia Agents; 5-alpha Reductase Inhibitors finasteride/ tadalafil (Entadfi)
  • finasteride tab
  • dutasteride tab
  • tadalafil tab
 05/31/2023
Nasal Allergy Agents: Corticosteroids olopatadine 665 mcg /mometasone 25 mcg nasal spray (Ryaltris Nasal Spray)
  • azelastine (Astelin, Astepro)
  • olopatadine (Patanase)
  • fluticasone/azelastine (Dymista)
  • fluticasone propionate (Flonase)
  • mometasone (Nasonex)
  • ipratropium (Atrovent)
  • budesonide (Rhinocort)
  • triamcinolone (Nasacort)
  • beclomethasone (Beconase AQ, QNASL)
  • ciclesonide (Omnaris, Zetonna)
  • flunisolide (Nasarel)
 05/31/2023
Skeletal Muscle Relaxants baclofen oral solution (Lyvispah)
  • baclofen oral solution (Ozobax)
  • baclofen oral suspension (Fleqsuvy)
  • baclofen tablets
 03/01/2023
Acne Agents: Topical Acne & Rosacea benzoyl peroxide 5% cream (Epsolay)
  • benzoyl peroxide gel OTC and Rx versions
  • azaleic acid 15% gel (Finacea gel)
  • metronidazole 1% gel
  • brimonidine 0.33% gel (Mirvaso)
  • ivermectin 1% cream (Soolantra)
  • minocycline 1.5% topical foam (Zilxi)
  • minocycline 4% foam (Amzeeq)
  • minocycline 50 mg tablets
 03/01/2023
Nephrology Agents Miscellaneous budesonide (Tarpeyo)
  • prednisone
  • methylprednisolone 
  • budesonide delayed release capsules (Entocort EC, generics)
 11/30/2022
Narcotic Analgesics and Combinations celecoxib/tramadol (Seglentis)
  • tramadol
  • celecoxib
 11/30/2022
Anticholinergics-Antispasmodics glycopyrrolate (Dartisla ODT)
  • glycopyrrolate tablets glycopyrrolate oral solution (Cuvposa)
  • omeprazole
  • famotidine
 11/30/2022
Endocrine Agents Miscellaneous levoketoconazole(Recorlev)
  • ketoconazole
  • metyrapone (Metopirone)
  • osilodrostat (Isturisa)
  • pasireotide (Signifor LAR –medical benefit)
 11/30/2022
Diuretics torsemide (Soaanz)
  • torsemide
  • furosemide
  • bumetanide
  • ethacrynic acid
 11/30/2022
Acne Agents: Topical Acne &
Rosacea		 tretinoin 0.1%/benzoyl peroxide3% topical cream(Twyneo)
  • tretinoin cream
  • benzoyl peroxide cream
 11/30/2022
Pain Agents: NSAIDs Celecoxib oral solution (Elyxyb)
  • Celecoxib tablets
  • Ibuprofen
  • Naproxen
  • Diclofenac
  • Numerous other NSAIDs or combo products
 08/24/2022
Antianxiety Agents: Benzodiazepines Lorazepam ER capsule (Loreev XR)
  • Lorazepam IR tablets
  • Alprazolam IR and XR tablets
 06/15/2022
Migraine Agents Dihydroergotamine mesylate nasal spray (Trudhesa)
  • DHE nasal spray
  • Sumatriptan nasal and oral
  • Rizatriptan
  • Zolmitriptan
  • Eletriptan
 06/15/2022
Antilipidemic-1s Rosuvastatin/ ezetimibe (Roszet)
  • Rosuvastatin with ezetimibe
  • Atorvastatin with ezetimibe
  • Simvastatin/ezetimibe (Vytorin)
  • Evolocumab (Repatha)
  • Alirocumab (Praluent)
 06/15/2022
Anticonvulsants-Antimania Agents Levetiracetam (Elepsia XR)
  • Levetiracetam ER
  • Lamotrigine XR
  • Topiramate ER
 06/15/2022
Corticosteroids-Immune Modulators: High Potency Clobetasol propionate 0.05% lotion metered dose pump (Impeklo)
  • Betamethasone/propylene glycol 0.05% lotion
  • Betamethasone dipropionate 0.05% gel
  • Clobetasol propionate/emollient 0.05 % (emulsion) foam
  • Clobetasol propionate 0.05% solution, lotion, gel, foam, spray, and shampoo
  • Fluocinonide 0.05% solution and gel
 06/15/2022
Psoriasis Agents Calcipotriene/ betamethasone dipropionate 0.005% /0.064% topical cream (Wynzora)
  • Vitamin D analog (calcipotriene 0.005% cream, ointment or solution) with a high potency topical corticosteroid (clobetasol propionate 0.05% ointment, cream, solution and gel
  • Fluocinonide 0.05% cream, gel, and solution
  •  Calcipotriene 0.005% / betamethasone 0.064% foam (Enstilar) [Nonformulary]
 06/15/2022
GI-1 Agents Budesonide ER 9 mg capsules (Ortikos)
  • Budesonide ER tablets (Entocort EC, generics
  • Other corticosteroids
 06/02/2021
Corticosteroids Dexamethasone 20 mg tables (Hemady)
  • Dexamethasone generics 0.5, 0.75, 1, 1.5, 2, 4, 6 mg tabs
 06/02/2021
Pulmonary I Agents Inhaled Corticosteroids (ICS) Fluticasone propionate dry powder inhaler oral (ArmonAir Digihaler)
  • Fluticasone (Flovent Diskus)
  • Fluticasone (Flovent HFA)
  • Fluticasone furoate (Arnuity Ellipta) [non formulary]
  • Beclomethasone (QVAR) [non formulary]
  • Budesonide (Pulmicort Flexhaler) [non formulary]
  • Ciclesonide (Alvesco) [non formulary]
  • Flunisolide (Aerospan) [non formulary]
  • Mometasone (Asmanex Twisthaler [non formulary]
 06/02/2021
Pulmonary I Agents ICS/Long-Acting Beta Agonists (LABA) Fluticasone propionate / salmeterol dry powder inhaler oral (AirDuo Digihaler)
  • Fluticasone/salmeterol (Advair Diskus)
  • Fluticasone/salmeterol (Advair HFA)
  • Fluticasone/vilanterol (Breo Ellipta) [non formulary]
  • Mometasone/formoterol (Dulera) [non formulary]
  • Budesonide/formoterol (Symbicort) [non formulary]
  • Fluticasone/salmeterol (AirDuo Respiclick) [non formulary]
 06/02/2021
Calcium Channel Blockers Levamlodipine (Conjupri)
  • Amlodipine
  • Felodipine
  • Nifedipine
  • Diltiazem
  • Verapamil
 06/02/2021
GI-2 Agents Metoclopramide nasal spray (Gimoti)
  • Metoclopramide oral tablet (Reglan generics)
  • Metoclopramide oral solution (Reglan, generics)
  • Metoclopramide orally disintegrating tablet (Reglan ODT)
 06/02/2021
Topical Psoriasis Agents Calcipotriene 0.005%­ Betamethasone 0.064% Suspension (Taclonex, Generic) Scalp Psoriasis:
  • Calcipotriene 0.005% solution
  • Clobetasol 0.05% solution, shampoo
  • Fluocinonide 0.05% solution
  • Calcipotriene 0.005%-betamethasone 0.064% foam (Enstilar) [Nonformulary]
Psoriasis involving areas other than the scalp:
  • Calcipotriene 0.005% ointment, cream, solution
  • Clobetasol 0.05% ointment, cream
  • Fluocinonide 0.05% cream, ointment
 02/24/2021
High-Potency Topical Corticosteroids Halcinonide 0.1% topical solution (Halog)
  • Betamethasone propylene glycol 0.05% cream
  • Clobetasol propionate 0.05% cream and ointment
  • Clobetasol propionate/emollient 0.05% cream
  • Desoximetasone 0.25% cream and ointment
  • Fluocinonide 0.05% cream and ointment
  • Fluocinonide/emollient base 0.05% cream
  • Halobetasol propionate 0.05% ointment
 2/24/2021
Acne Agents: Topical Acne and Rosacea Tazarotene 0.045% lotion (Arazlo)
  • Adapalene 0.1% lotion, gel, cream
  • Adapalene 0.3% gel
  • Clindamycin phosphate 1% gel, cream, lotion, and solution
  • Clindamycin/ benzoyl peroxide 1.2% -5% gel
  • Tazarotene 0.1% cream • tretinoin 0.025%, 0.05%, and 0.1% cream
  • Tetinoin 0.01% and 0.025% gel
 2/24/2021
Pain Agents Class; NSAIDs Subclass Consensi (Amlodipine-celecoxib)
  • Dihydropyridine calcium channel blockers: amlodipine, felodipine, nifedipine, isradipine PLUS
  • NSAIDs: celecoxib, diclofenac, ibuprofen, meloxicam, naproxen, (also includes other NSAIDs)
 8/26/2020
Pain Agents Class; NSAIDs Subclass
  • Zipsor liquid-filled capsules (diclofenac potassium)
  • Zorvolex (diclofenac submicronized)
  • Fenoprofen capsules
  • Tivorbex (indomethacin submicronized)
  • Vivlodex (meloxicam submicronized)
 NSAIDs: celecoxib, diclofenac, indomethacin, meloxicam, naproxen, (also includes other NSAIDs) 8/26/2020
Pain Agents Class; NSAIDs Subclass Duexis tablets (ibuprofen-famotidine)
  • H2 blockers: famotidine, ranitidine, cimetidine, nizatidine PLUS
  • NSAIDs: celecoxib, diclofenac, ibuprofen, meloxicam, naproxen, (also includes other NSAIDs)
 8/26/2020
Pain Agents Class; Pain Topical Subclass
  • Pennsaid 2% (diclofenac 2% solution)
  • Flector, generics (diclofenac 1.3% patch)
  • Oral NSAIDs: celecoxib, diclofenac, indomethacin, meloxicam, naproxen, (also includes other NSAIDs)
  • Diclofenac 1.5% solution
  • Diclofenac 1% gel
 8/26/2020
Pain Agents Class; Pain Topical Subclass ZTlido (lidocaine 1.8% patch) Lidocaine 5% patch 8/26/2020
Pulmonary: Short Acting Beta-2 Agonists (SABA) ProAir Digihaler (albuterol dry powder inhaler)
  • Albuterol MDI (ProAir HFA)
  • Albuterol DPI (ProAir Respiclick)
  • Albuterol MDI (Proventil HFA) [Nonformulary]
  • Albuterol MDI (Ventolin HFA) [Nonformulary]
  • Levalbuterol MDI (Xopenex HFA) [Nonformulary]
 8/26/2020
Acne Agents: Topical Acne and Rosacea Enzoclear (benzoyl peroxide 9.8% foam)
  • Clindamycin/benzoyl peroxide 1.2% -5% gel (Duac, generics)
  • Clindamycin/benzoyl peroxide 1% -5% gel (Benzaclin, generics)
  • Clindamycin/benzoyl peroxide 1% -5% gel kit (Duac CS Kit)
 8/26/2020
Anti-Infectives: Miscellaneous Talicia (omeprazole magnesium-amoxicillin-rifabutin)
  • Omeprazole PLUS amoxicillin PLUS rifabutin (given separately)
  • Omeprazole PLUS clarithromycin PLUS amoxicillin
  • Bismuth subsalicylate OTC PLUS metronidazole PLUS tetracycline PLUS PPI
 8/26/2020
Rapid Acting Insulins Insulin plus niacinamide (Fiasp)
  • Insulin aspart (Novolog)
  • Insulin lispro (Humalog or authorized generic lispro)
  • Insulin lispro (Admelog) [nonformulary]
  • Insulin glulisine (Apidra) [nonformulary]
 07/01/2020
Pulmonary-2 Agents: COPD Formoterol/aclidinium (Duaklir Pressair)
  • Umeclidinium/vilanterol (Anoro Ellipta)
  • Tiotropium/olodaterol (Stiolto Respimat)
  • Glycopyrrolate/formoterol (Bevespi Aerosphere) [nonformulary]
 06/10/2020
Migraine Agents: Triptans Sumatriptan nasal spray (Tosymra)
  • Sumatriptan nasal spray (Imitrex, generics)
  • Sumatriptan nasal powder (Onzetra Xsail)
  • Zolmitriptan nasal spray (Zomig)
 06/10/2020
GI2 Agents: CIC and IBS-C Tegaserod (Zelnorm)
  • Linaclotide (Linzess)
  • Plecanatide (Trulance)
  • Lubiprostone (Amitiza)
  • Pruclaopride (Motegrity) [nonformulary]
 06/10/2020
PDE-5 inhibitor
  • Avanafil tablet (Stendra)
  • Brand Viagra tablet
  • Brand Cialis tablet
  • Vardenafil tablet (Levitra and generics)
  • Vardenafil oral disintegrating tablet (ODT) (Staxyn and generics)
  • Sildenafil tablet (generic Viagra only)
  • Tadalafil tablet (generic Cialis only)
 06/03/2020
ADHD Methylphenidate ER sprinkle capsules (Adhansia XR)
  • Methylphenidate ER (Aptensio XR sprinkle capsule) for patients with swallowing difficulties
  • Methylphenidate ER oral suspension (Quillivant XR suspension) for patients with swallowing difficulties
  • Methylphenidate ER osmotic controlled release oral delivery system (OROS) (Concerta, generics)
  • Methylphenidate long-acting (Ritalin LA, generics)
  • Methylphenidate controlled delivery (CD) (Metadate CD, generics)
  • Dexmethylphenidate ER (Focalin XR, generics)
  • Mixed amphetamine salts ER (Adderall XR, generics)
 03/04/2020
High-Potency Topical Corticosteroids
  • Clobetasol propionate 0.025% cream (Impoyz)
  • Diflorasone diacetate/emollient 0.05% cream (Apexicon-E)
  • Halcinonide 0.1% cream (Halog)
  • Betamethasone/propylene glycol 0.05% cream
  • Clobetasol propionate 0.05% cream
  • Clobetasol propionate/emollient 0.05% cream
  • Desoximetasone 0.25% cream
  • Fluocinonide 0.05% cream
  • Fluocinonide/emollient base 0.05% cream
 03/04/2020
High-Potency Topical Corticosteroids Halcinonide 0.1% ointment (Halog)
  • Betamethasone dipropionate 0.05% ointment
  • Betamethasone/propylene glycol 0.05% ointment
  • Clobetasol propionate 0.05% ointment
  • Desoximetasone 0.25% ointment
  • Fluocinonide 0.05% ointment
  • Halobetasol propionate 0.05% ointment
 03/04/2020
High-Potency Topical Corticosteroids
  • Clobetasol propionate 0.05% shampoo/ cleanser (kit) (Clodan kit)
  • Halobetasol propionate 0.05% lotion (Ultravate)
  • Halobetasol propionate 0.05% foam (authorized generic for Lexette) (see Feb 2019 for brand Lexette recommendation)
  • Betamethasone propylene glycol 0.05% lotion
  • Betamethasone dipropionate 0.05% gel
  • Clobetasol propionate/emollient 0.05 % emulsion foam
  • Clobetasol propionate 0.05% solution, lotion, gel, foam, spray, and shampoo
  • Fluocinonide 0.05% solution and gel
 03/04/2020
PPIs
  • Dexlansoprazole (Dexilant)
  • Esomeprazole strontium
  • Esomeprazole
  • Omeprazole
  • Pantoprazole
  • Rabeprazole
 11/28/2019
High-Potency Topical Corticosteroids Halobetasol propionate 0.05% foam (Lexette brand)
  • Betamethasone/propylene glycol 0.05% lotion
  • Betamethasone dipropionate 0.05% gel
  • Clobetasol propionate/emollient 0.05% emulsion foam
  • Clobetasol propionate 0.05% solution, lotion, gel, foam, spray, and shampoo
 10/01/2019
Diabetes Non- Insulin Drugs – Biguanides Subclass Metformin ER gastric retention 24 hours (Glumetza)
  • Metformin IR (Glucophage generic)
  • Metformin ER (Glucophage XR generic)
 10/01/2019
Pain Agents – Combinations Naproxen / Esomeprazole (Vimovo)
  • PPIs: omeprazole, pantoprazole, esomeprazole, rabeprazole PLUS
  • NSAIDs: celecoxib, diclofenac, indomethacin, meloxicam, naproxen, (also includes other NSAIDs)
 10/01/2019