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Prescription drug updates

September 1, 2015

For commercial members enrolled in an Independence 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 drugGeneric drugFormulary chapterEffective date
Cholbam® Not available8. Stomach, Ulcer, & Bowel MedsApril 6, 2015
Corlanor® Not available4. Heart, Blood Pressure, & Cholesterol April 27, 2015
Cosentyx™ Not available 5. Skin MedicationsFebruary 9, 2015
Cresemba® Not available 1. Antibiotics & Other Drugs Used for Infection March 30, 2015
Entresto™Not available4. Heart, Blood Pressure, & Cholesterol July 13, 2015
Evekeo™ Not available3. Pain, Nervous System, & PsychFebruary 2, 2015
Farydak®Not available2. Cancer & Organ Transplant Drugs March 9, 2015
Glyxambi® Not available 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones February 9, 2015
Ibrance® Not available 2. Cancer & Organ Transplant DrugsFebruary 9, 2015
Jadenu™ Not available 15. Diagnostics & Miscellaneous Agents April 13, 2015
Lenvima?Not available 2. Cancer & Organ Transplant DrugsFebruary 23, 2015
N/A fentanyl 37.5 mcg, 62.5 mcg, 87.5 mcg/hr patch3. Pain, Nervous System, & Psych March 2, 2015
Natesto™ Not available7. Diabetes, Thyroid, Steroids, & Other Miscellaneous HormonesMarch 16, 2015
Natpara®Not available 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous HormonesApril 6, 2015
Novoeight®Not available4. Heart, Blood Pressure, & Cholesterol March 16, 2015
Saxenda® Not available3. Pain, Nervous System, & Psych April 13, 2015
Zubsolv® 8.6-2.1 mg Not available3. Pain, Nervous System, & Psych February 9, 2015

Effective October 1, 2015, the following non-formulary drugs will be added to the list of drugs requiring prior authorization:

Brand drugGeneric drugFormulary chapter
Inderal® LA propranolol er 4. Heart, Blood Pressure, & Cholesterol
Oracea® doxycycline ir-dr 1. Antibiotics & Other Drugs Used for Infection
Pennsaid® 2% dropsNot available 9. Bone, Joint, & Muscle
Tenoretic® atenolol/chlorthalidone4. Heart, Blood Pressure, & Cholesterol
Tenormin®atenolol 4. Heart, Blood Pressure, & Cholesterol
Viibryd® Not available 3. Pain, Nervous System, & Psych
Wellbutrin® XLbupropion hcl xl 3. Pain, Nervous System, & Psych
Zorvolex® Not available 9. Bone, Joint, & Muscle

Effective October 1, 2015, the following drug category has been added to the list of drugs requiring prior authorization, and these requirements apply to all members:

Category
Compound products with total ingredient cost equal to or greater than $75 per prescription*
*All compounds will be covered at the appropriate non-formulary brand level of cost-sharing.

Drugs with quantity limits

Quantity limits were/will be added or updated for the following drugs as of the date indicated below:

Brand drug Generic drug Quantity limit Effective date
Aciphex® tabsrabeprazole tabs60 tabs per 30 days October 1, 2015
Cresemba® Not available68 caps per 30 daysMarch 30, 2015
Dexilant® Not available 60 caps per 30 daysOctober 1, 2015
Dilaudid® 1 mg/ml liquidhydromorphone 1 mg/ml liquid 360 ml per 30 days October 1, 2015
Entresto?Not available60 tabs per 30 daysJuly 13, 2015
Evekeo? 5 mg Not available90 tabs per 30 daysFebruary 2, 2015
Evekeo? 10 mg Not available 180 tabs per 30 days February 2, 2015
N/A fentanyl 37.5 mcg, 62.5 mcg, 87.5 mcg/hr patch 15 patches per 30 days March 2, 2015
Nexium® capsesomeprazole caps 60 caps per 30 daysOctober 1, 2015
Prevacid® capslansoprazole caps 60 caps per 30 daysOctober 1, 2015
Prilosec® capsomeprazole caps 60 caps per 30 daysOctober 1, 2015
Protonix® tabs pantoprazole tabs60 tabs per 30 days October 1, 2015
Restasis® Not available 60 droperettes per 30 daysOctober 1, 2015
Tussionex® ER susp hydrocodone/chlorpheniramine ER susp 120 ml per 30 daysOctober 1, 2015
Zubsolv® 8.6-2.1 mg Not available60 tabs per 30 daysFebruary 9, 2015

Drugs no longer requiring prior authorization

Effective July 1, 2015, the prior authorization requirement was removed for the following drugs:

Brand drug Generic drug Formulary chapter
Chantix® Not available15. Diagnostics & Miscellaneous Agents
Toujeo Solostar® Not available 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
various nicotine gum, lozenges, patches, and sprays 15. Diagnostics & Miscellaneous Agents
Zyban® bupropion 15. Diagnostics & Miscellaneous Agents

For additional information on pharmacy policies and programs, please visit the Pharmacy Information page.


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