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
AmethiaTM
Seasonique?
11. Female, Hormone Replacement, Birth Control
August 1, 2011
budesonide
Entocort? EC
8. Stomach, Ulcer, & Bowel Meds
July 1, 2011
cyclobenzaprine
Amrix?
3. Pain, Nervous System, & Psych
May 20, 2011
doxycycline monohydrate
Adoxa?
1. Antibiotics & Other Drugs Used for Infection
June 3, 2011
epinastine HCl
Elestat?
12. Eye Medications
May 6, 2011
latanoprost
Xalatan?
12. Eye Medications
March 18, 2011
levofloxacin
Levaquin?
1. Antibiotics & Other Drugs Used for Infection
June 24, 2011
methylergonovine maleate
Methergine?
11. Female, Hormone Replacement, Birth Control
June 17, 2011
sumatriptan succinate
AlsumaTM
3. Pain, Nervous System, & Psych
July 1, 2011
triamcinolone acetonide
Nasacort? AQ
13. Allergy, Cough & Cold, Lung Meds
June 17, 2011
Brand additions
These brand drugs were added to the formulary as of the dates indicated below
and are covered at the appropriate brand formulary level of cost-sharing:
Brand drug
Formulary chapter
Effective date
Campral?
16. Diagnostic & Miscellaneous Agents
September 1, 2011
Edurant?
1. Antibiotics & Other Drugs Used for Infection
May 23, 2011
Viramune XR?
1. Antibiotics & Other Drugs Used for Infection
September 1, 2011
Brand deletions
These brand drugs will be covered at the appropriate non-formulary level of
cost-sharing: Effective October 1, 2011.
Brand drug
Formulary chapter
Effective date
Levaquin?
levofloxacin
1. Antibiotics & Other Drugs Used for Infection
Methergine?
methylergonovine maleate
11. Female, Hormone Replacement, Birth Control
Xalatan?
latanoprost
12. Eye Medications
The generic drugs for the above brand drugs are on our formulary and available
at the generic formulary level of cost-sharing.