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:
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calcipotriene
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Dovonex? cream
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5. Skin Medications
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June 1, 2012
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ciprofloxacin
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Cetraxal?
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6. Ear, Nose, Throat Medications
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August 3, 2012
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clindamycin/benzol peroxide
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Duac?
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5. Skin Medications
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June 29, 2012
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clozapine ODT
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Fazaclo?
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3. Pain, Nervous System, &
Psych
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September 7, 2012
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desloratadine
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Clarinex?
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13. Allergy, Cough & Cold, Lung
Meds
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July 6, 2012
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levalbuterol
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Xopenex?
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13. Allergy, Cough & Cold, Lung
Meds
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August 24, 2012
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levonorgestrel
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Plan B One-Step?
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11. Female, Hormone Replacement,
& Birth Control
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July 20, 2012
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montelukast sodium
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Singulair?
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13. Allergy, Cough & Cold, Lung
Meds
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August 10, 2012
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pioglitazone
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Actos?
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7. Diabetes, Thyroid, Steroids,
& Other Miscellaneous Hormones
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August 20, 2012
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pioglitazone hcl/
metformin
hcl
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Actoplus Met?
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7. Diabetes, Thyroid, Steroids,
& Other Miscellaneous Hormones
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August 20, 2012
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spinosad
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NatrobaTM
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5. Skin Medications
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August 3, 2012
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tolterodine tartrate
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Detrol?
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14. Urinary and Prostate Meds
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June 29, 2012
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Brand additions
These brand drugs were added to the
formulary and are covered at the appropriate brand formulary level of
cost-sharing:
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Betaseron?
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9. Biotechnology
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October 1, 2012
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Travatan Z?
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12. Eye Medications
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July 13, 2012
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Xifaxan 550mg?
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1. Antibiotics & Other Drugs
Used for Infection
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August 1, 2012
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Brand deletions
These brand drugs will be covered at
the appropriate non-formulary level of cost-sharing:
Effective January 1, 2013.
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Actoplus Met?
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pioglitazone hcl/metformin hcl
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7. Diabetes, Thyroid, Steroids,
& Other Miscellaneous Hormones
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Actos?
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pioglitazone
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7. Diabetes, Thyroid, Steroids,
& Other Miscellaneous Hormones
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Dovonex? cream
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calcipotriene
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5. Skin Medications
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Singulair?
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montelukast sodium
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13. Allergy, Cough & Cold, Lung
Meds
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The generic drugs for the above brand
drugs are on our formulary and available at the generic formulary level of
cost-sharing.
This brand drug will be covered
at the appropriate non-formulary level of cost-sharing:
Effective January 1, 2013.
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Humatrope?
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Norditropin?
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7. Diabetes, Thyroid, Steroids,
& Other Miscellaneous Hormones
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