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The Select Drug Program Formulary, which is available for commercial
members, 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 |
| dutasteride/tamsulosin hcl | Jalyn® | 13. Urinary & Prostate Meds | November 23, 2015 |
| imatinib mesylate* | Gleevec® | 2. Cancer & Organ Transplant Drugs | January 25, 2016 |
| lamotrigine odt | Lamictal® ODT | 3. Pain, Nervous System, & Psych | November 2, 2015 |
| linezolid susp* | Zyvox® susp | 1. Antibiotics & Other Drugs Used for Infection | November 23, 2015 |
| metoclopramide odt | Metozolv® ODT | 8. Stomach, Ulcer, & Bowel Meds | November 2, 2015 |
| molindone hcl | Moban® | 3. Pain, Nervous System, & Psych | November 23, 2015 |
| nevirapine er | Viramune® XR | 1. Antibiotics & Other Drugs Used for Infection | November 16, 2015 |
| norgestimate-ethinyl estradiol | Ortho Tri-Cyclen Lo® | 10. Female, Hormone Replacement, & Birth
Control | January 11, 2016 |
| olopatadine hcl 0.1% | Patanol® 0.1% | 11. Eye Medications | December 14, 2015 |
| pramipexole er 2.25 mg | Mirapex® ER 2.25 mg | 3. Pain, Nervous System, & Psych | November 30, 2015 |
| repaglinide-metformin hcl | Prandimet? | 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous
Hormones | November 23, 2015 |
| tobramycin/nebulizer | Kitabis® Pak | 12. Allergy, Cough & Cold, Lung Meds | November 9, 2015 |
*Generic requires prior authorization.
Brand additions
Effective July 1, 2016, this brand drug will be added to the
formulary and covered at the appropriate brand formulary level of
cost-sharing:
| Brand drug |
Generic drug |
Formulary chapter |
| Cimzia® | Not available | 9. Bone, Joint, & Muscle |
Brand deletions
Effective July 1, 2016, these brand drugs will be covered at the
appropriate non-formulary level of cost-sharing:
| Brand drug |
Generic drug |
Formulary chapter |
| Gleevec® | imatinib mesylate | 2. Cancer & Organ Transplant Drugs |
| Mirapex® ER 2.25 mg | pramipexole er 2.25 mg | 3. Pain, Nervous System, & Psych |
| Ortho Tri-Cyclen Lo® | norgestimate-ethinyl estradiol | 10. Female, Hormone Replacement, & Birth
Control |
| Patanol®
0.1%
| olopatadine hcl 0.1% | 11. Eye Medications |
The generic drugs for the listed brand drugs are on our formulary and available
at the generic formulary level of cost-sharing.
Effective July 1, 2016, these brand drugs will be covered at the
appropriate non-formulary level of cost-sharing:
| Brand drug |
Formulary therapeutic
alternative |
Formulary chapter |
| Acanya® |
clindamycin phos-benzoyl perox 1%-5% gel |
5. Skin Medications |
| Enbrel®† |
Cimzia®, Humira® | 9. Bone, Joint, & Muscle |
†Our preferred formulary tumor necrosis
factor inhibitor will change from Enbrel® to
Cimzia® effective July 1, 2016. Please note that your
AmeriHealth patients who are currently receiving Enbrel® will
not need a new prior authorization; however, they may be subject to a higher
level of cost-sharing.
There are no generic equivalents for the above brand drugs; however, there
are formulary therapeutic alternative drugs. These therapeutic alternative
drugs are available at the appropriate formulary level of cost-sharing. We
encourage you to discuss formulary alternatives with your patients.
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