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Pharmacy

Select Drug Program® Formulary updates 

September 1, 2011    


The Select Drug Program Formulary is a list of medications approved by the U.S. Food and Drug Administration that were chosen for formulary coverage based on their medical effectiveness, safety, and value. The list changes periodically as the Pharmacy and Therapeutics Committee reviews the formulary to ensure its continued effectiveness. The most recent changes are listed below.

Generic additions

These generic drugs recently became available in the marketplace. When these generic drugs became available, we began covering them at the appropriate generic formulary level of cost-sharing:
Generic drug Brand drug Formulary chapter Effective date
AmethiaTM Seasonique® 11. Female, Hormone Replacement, Birth Control August 1, 2011
budesonide Entocort® EC 8. Stomach, Ulcer, & Bowel Meds July 1, 2011
cyclobenzaprine Amrix® 3. Pain, Nervous System, & Psych May 20, 2011
doxycycline monohydrate Adoxa® 1. Antibiotics & Other Drugs Used for Infection June 3, 2011
epinastine HCl Elestat® 12. Eye Medications May 6, 2011
latanoprost Xalatan® 12. Eye Medications March 18, 2011
levofloxacin Levaquin® 1. Antibiotics & Other Drugs Used for Infection June 24, 2011
methylergonovine maleate Methergine® 11. Female, Hormone Replacement, Birth Control June 17, 2011
sumatriptan succinate AlsumaTM 3. Pain, Nervous System, & Psych July 1, 2011
triamcinolone acetonide Nasacort® AQ 13. Allergy, Cough & Cold, Lung Meds June 17, 2011

Brand additions

These brand drugs were added to the formulary as of the dates indicated below and are covered at the appropriate brand formulary level of cost-sharing:
Brand drug Formulary chapter Effective date
Campral® 16. Diagnostic & Miscellaneous Agents September 1, 2011
Edurant® 1. Antibiotics & Other Drugs Used for Infection May 23, 2011
Viramune XR® 1. Antibiotics & Other Drugs Used for Infection September 1, 2011

Brand deletions

These brand drugs will be covered at the appropriate non-formulary level of cost-sharing: Effective October 1, 2011.
Brand drug Formulary chapter Effective date
Levaquin® levofloxacin 1. Antibiotics & Other Drugs Used for Infection
Methergine® methylergonovine maleate 11. Female, Hormone Replacement, Birth Control
Xalatan® latanoprost 12. Eye Medications

The generic drugs for the above brand drugs are on our formulary and available at the generic formulary level of cost-sharing.





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