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Pharmacy

Select Drug Program Formulary updates 

August 29, 2013    


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
acyclovir ointment Zovirax ointment 5. Skin Medications April 5, 2013
buprenorphine hcl/naloxone hcl Suboxone 3. Pain, Nervous System, & Psych March 8, 2013
dihydroergotamine mesylate Migranal 3. Pain, Nervous System, & Psych April 12, 2013
fenofibrate Antara 4. Heart, Blood Pressure, & Cholesterol March 1, 2013
fluvoxamine Luvox CR 3. Pain, Nervous System, & Psych March 15, 2013
mafenide acetate Sulfamylon 5. Skin Medications February 22, 2013
mupirocin calcium cream Bactroban cream 5. Skin Medications February 1, 2013
travoprost Travatan 12. Eye Medications April 19, 2013
tretinoin gel Retin-A Micro 5. Skin Medications March 22, 2013

Brand deletions

These brand drugs will be covered at the appropriate non-formulary level of cost-sharing: Effective October 1, 2013.
Brand drug Generic drug Formulary chapter
Augmentin suspension amoxicillin/potassium clavulanate 1. Antibiotics & Other Drugs Used for Infection
Bactroban cream mupirocin calcium cream 5. Skin Medications
Suboxone buprenorphine hcl/naloxone hcl 3. Pain, Nervous System, & Psych
Zovirax ointment acyclovir ointment 5. Skin Medications
The generic drugs for the above brand drugs are on our formulary and available at the generic formulary level of cost-sharing.

Brand deletions

These brand drugs will be covered at the appropriate non-formulary level of cost-sharing: Effective October 1, 2013.
Brand drug Formulary therapeutic alternatives Formulary chapter
Actoplus Met XR pioglitazone/metformin 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
Ceftin suspension cefprozil suspension, cefaclor suspension 1. Antibiotics & Other Drugs Used for Infection
Mepron tinidazole tablets 1. Antibiotics & Other Drugs Used for Infection
Proventil HFA ProAir HFA 13. Allergy, Cough & Cold, Lung Meds
Rebetol solution ribasphere, ribavirin capsules 1. Antibiotics & Other Drugs Used for Infection
There is no generic equivalent for the above brand drugs; however, there are therapeutic alternative drugs. These therapeutic alternative drugs are available at the appropriate formulary level of cost-sharing.





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