[

For members enrolled in an AmeriHealth prescription drug program, prior authorization and quantity limit requirements will be applied to certain drugs. The purpose of prior authorization is to ensure that drugs are medically necessary and are being used appropriately. Quantity limits are designed to allow a sufficient supply of medication based upon the maximum daily dose and length of therapy approved by the U.S. Food and Drug Administration for a particular drug. The most recent updates are reflected below.

Drugs requiring prior authorization

The prior authorization requirement for the following non-formulary drugs was effective at the time the drugs became available in the marketplace:

Brand drug Generic drug Drug category Effective date Invokana^TM Not available Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones April 5, 2013 Kazano^? Not available Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones February 1, 2013 Kynamro^? Not available Heart, Blood Pressure, & Cholesterol March 1, 2013 Nesina^? Not available Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones February 1, 2013 Oseni^? Not available Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones February 1, 2013 Pomalyst^? Not available Cancer & Organ Transplant Drugs February 14, 2013 Signifor^? Not available Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones March 15, 2013 Sirturo^TM Not available Antibiotics & Other Drugs Used for Infection April 26, 2013 Tecfidera^TM Not available Bone, Joint, & Muscle April 5, 2013

The following non-formulary drugs have been added to the list of drugs requiring prior authorization. Members taking these drugs prior to the effective date are not affected:
Effective October 1, 2013.

Brand drug Generic drug Drug category Cystaran^TM Not available Eye Medications Fulyzaq^TM Not available Stomach, Ulcer, & Bowel Meds Procysbi^? Not available Urinary & Prostate Meds Ravicti^TM Not available Stomach, Ulcer, & Bowel Meds

Drugs requiring prior authorization

The following non-formulary drugs have been added to the list of drugs requiring prior authorization:
Effective October 1, 2013.

Brand drug Generic drug Drug category Proventil^? HFA Not available Allergy, Cough & Cold, Lung Meds Ventolin^?HFA Not available Allergy, Cough & Cold, Lung Meds Xoponex^? HFA Not available Allergy, Cough & Cold, Lung Meds

The following drugs have been added to the list of drugs requiring prior authorization and apply to all members:
Effective October 1, 2013.

  Chantix^? Compound products containing any of the following bulk powders: cholestyramine, cyclobenzaprine, gabapentin, or ketamine Compound products with total ingredient cost equal to or greater than $300 per prescription Nicotine patches, nicotine gums, nicotine lozenges, nicotine inhalers, nicotine sprays Zyban^?, buproprion hcl

Drugs with quantity limits

Quantity limits will be added for the following drugs:
Effective October 1, 2013.

Brand drug Generic drug Quantity limit (per 30 days) All applicable products Female condoms #15 All applicable products diaphragms #1/365 days All applicable products nicotine gum #300 All applicable products nicotine lozenge #300 All applicable products nicotine inhaler cartridges #300 All applicable products smoking cessation patches #30 Chantix^? Not available #60 Cystaran^TM Not available 4 bottles Edluar^TM Not available 30 tablets Lunesta^? 1mg Not available 60 tablets Lunesta^? 2mg and 3mg Not available 30 tablets Zyban^? buproprion hcl #60

]