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Prescription drug updates

June 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
Afrezza®Not available7. Diabetes, Thyroid, Steroids, & Other Miscellaneous HormonesDecember 29, 2014
Arnuity Ellipta®Not available12. Allergy, Cough & Cold, Lung MedsDecember 22, 2014
Belsomra®Not available3. Pain, Nervous System, & PsychDecember 8, 2014
Embeda® 60-2.4 mg, 80-3.2 mg, 100-4 mgNot available3. Pain, Nervous System, & PsychJanuary 19, 2015
HysinglaTMNot available3. Pain, Nervous System, & PsychDecember 15, 2014
LynparzaTMNot available2. Cancer & Organ Transplant DrugsDecember 29, 2014
Viekira PakTMNot available1. Antibiotics & Other Drugs Used for InfectionDecember 29, 2014
Xigduo XRTMNot available7. Diabetes, Thyroid, Steroids, & Other Miscellaneous HormonesNovember 3, 2014

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

Brand drugGeneric drugFormulary chapter
Differin® Cream/Geladapalene cream/gel5. Skin Medications
Embeda® 20-0.8 mg, 30-1.2 mg, 50-2 mgNot available3. Pain, Nervous System, & Psych
Solaraze® Geldiclofenac gel*5. Skin Medications

*Generic requires prior authorization.

Drugs with quantity limits

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

Brand drugGeneric drugQuantity LimitEffective date
Belsomra®Not available30 tabs per 30 daysJuly 1, 2015
Embeda®Not available60 caps per 30 daysJanuary 19, 2015
Hysingla?Not available30 tabs per 30 daysDecember 15, 2014
Obredon®Not available450 ml per 30 daysJanuary 19, 2015
Suboxone® Film 2-0.5 mg, 4-1 mgNot available720 films per 365 daysJune 1, 2015
Suboxone® Film 8-2 mgNot available540 films per 365 daysJune 1, 2015
Suboxone® Film 12-3 mgNot available360 films per 365 daysJune 1, 2015
Trezix®Not available180 caps per 30 daysDecember 15, 2014
Vituz®Not available450 ml per 30 daysJuly 1, 2015

Drug no longer requiring prior authorization

Effective May 1, 2015, prior authorization was removed for the following drug:

Brand drugGeneric drugFormulary chapter
Suboxone® FilmNot available3. Pain, Nervous System, & Psych

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


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