TitleWeb Select Drug Program® Formulary updates
Professional; Facility; Ancillary
May 31, 2013
Page Content [
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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betamethasone valerate
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Luxiq?
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5. Skin Medications
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January 4, 2013
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candesartan/hydrochlorothiazide
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Atacand HCT?
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4. Heart, Blood Pressure, &
Cholesterol
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December 7, 2012
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diclofenac sodium/misoprostol
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Arthrotec? 50, Arthrotec?
75
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3. Pain, Nervous System, &
Psych
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November 2, 2012
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fenofibrate nanocrystallized
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Tricor?
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4. Heart, Blood Pressure, &
Cholesterol
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November 19, 2012
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griseofulvin, microsize
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Grifulvin V?
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1. Antibiotics & Other Drugs
Used for Infection
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December 7, 2012
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griseofulvin ultramicrosize
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Gris-PEG?
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1. Antibiotics & Other Drugs
Used for Infection
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November 16, 2012
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lamotrigine
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Lamictal?
XRTM
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3. Pain, Nervous System, &
Psych
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January 11, 2013
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nitroglycerin
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NitromistTM
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4. Heart, Blood Pressure, &
Cholesterol
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December 7, 2012
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oxymorphone hcl
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Opana ER?
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3. Pain, Nervous System, &
Psych
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December 28, 2012
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phenytoin, chewable tablets
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Dilantin?, chewable tablets
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3. Pain, Nervous System, &
Psych
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December 28, 2012
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pioglitazone/glimepiride
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DuetactTM
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4. Heart, Blood Pressure, &
Cholesterol
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January 11, 2013
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rizatriptan benzoate
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Maxalt?, Maxalt MLT?
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3. Pain, Nervous System, &
Psych
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January 3, 2013
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sildenafil citrate
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Revatio?
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4. Heart, Blood Pressure, &
Cholesterol
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November 9, 2012
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tranexamic acid
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Lysteda?
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11. Female, Hormone Replacement,
& Birth Control
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January 11, 2013
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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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Combivent Respimat?
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6. Ear, Nose, Throat Medications
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June 1, 2013
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DelzicolTM
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8. Stomach, Ulcer, & Bowel
Meds
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May 1, 2013
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Dulera?
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13. Allergy, Cough & Cold, Lung
Meds
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June 1, 2013
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Myrbetriq?
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14. Urinary & Prostate Meds
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June 1, 2013
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Brand deletions
These brand drugs will be
covered at the appropriate non-formulary level of cost-sharing:
Effective July 1,
2013.
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Dilantin?, chewable tablets
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phenytoin, chewable tablets
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3. Pain, Nervous System, &
Psych
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Grifulvin V?
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griseofulvin, microsize
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1. Antibiotics & Other Drugs
Used for Infection
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Gris-PEG?
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griseofulvin ultramicrosize
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1. Antibiotics & Other Drugs
Used for Infection
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Maxalt?, Maxalt MLT?
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rizatriptan benzoate
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3. Pain, Nervous System, &
Psych
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Tricor?
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fenofibrate nanocrystallized
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4. Heart, Blood Pressure, &
Cholesterol
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VoSpire ER?
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albuterol sulfate er
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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 July 1,
2013.
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Maxair?
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ProAir? HFA, Proventil? HFA
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13. Allergy, Cough & Cold, Lung
Meds
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There is no generic
equivalent for the above brand drug; however, there are therapeutic alternative
drugs. These therapeutic alternative drugs are available at the appropriate
formulary level of cost-sharing.
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