Formulary Changes
Nebraska Total Care continually evaluates our Value-Add Formulary (PDF) to make sure our members receive clinically appropriate and cost conscious drug therapy.
Effective 01/01/2026:
Freestyle Libre continuous glucose monitors will be the sole preferred product on the Nebraska Total Care Value-Add Formulary and will continue to require a prior authorization. Dexcom G6 and Dexcom G7 Products will no longer be offered on the formulary and coverage exceptions may be approved when clinical criteria requirements are met. Please see our Pharmacy Policy section of the provider website for coverage criteria of continuous glucose monitors.
Effective 10/1/2025:
AccuCheck test strips will be preferred, and OneTouch Ultra and OneTouch Verio test strips will be non-formulary. Free AccuCheck meters are available to our members with a prescription.
Effective 02/07/2025:
The following products will no longer be available on the Nebraska Total Care Medicaid Value Add Formulary:
- Guardian Link Continuous Glucose Monitor
- MiniLink Continuous Glucose Monitor
- Paradigm Continuous Glucose Monitor
Effective 02/01/2025:
The following medications will no longer require prior authorization: desvenlafaxine, lurasidone, vilazodone.
Effective 07/01/2024:
Covid test kits are no longer covered on the Nebraska Total Care Value Add formulary.
Effective 06/18/2024:
Freestyle Libre 3 is a preferred product on the Nebraska Total Care Value Add formulary.
Effective 10/01/2023:
The following vaccines have been added to the Nebraska Total Care Value Add formulary. Please check the Value Add formulary document for any limitations of coverage.
- Abrysvo
- ACAM2000
- Acthib
- Arexvy
- Biothrax
- Dengvaxia
- Engerix-B
- Havrix
- Heplisav-B
- Hiberix
- Imovax Rabies
- Ipol
- Ixiaro
- Jynneos
- Kinrix
- M-M-R-II
- Pediarix
- Pedvax HIB
- Pentacel
- Prehevrbio
- Priorix
- Proquad
- Quadracel
- Rabavert
- Recombivax HB
- Rotarix
- Rotateq
- Stamaril
- Typhim VI
- Vaqta
- Varivax
- Vaxchora
- Vaxelis
- Vivotif
- YF-Vax
Effective 08/08/2023:
Over-the-counter fish oil products will no longer be covered. Prescription-only fish oil products will continue to be covered.
Effective 05/31/2023:
Brand name Tylenol products are no longer on the Nebraska Total Care Value-Add Formulary.
Effective 04/17/2023:
Dexcom G7 is preferred on the Nebraska Total Care Value- Add Formulary.