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Prescription drug updates

December 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 drug Formulary chapterEffective date
DaklinzaNot available 1. Antibiotics & Other Drugs Used for Infection August 3, 2015
Entresto Not available 4. Heart, Blood Pressure, & Cholesterol July 13, 2015
Ixinity® Not available 15. Diagnostics & Miscellaneous Agents June 1, 2015
Orkambi Not available 12. Allergy, Cough & Cold, Lung MedsJuly 13, 2015
Rexulti® Not available 3. Pain, Nervous System, & Psych July 20, 2015
Stiolto Respimat Not available 12. Allergy, Cough & Cold, Lung Meds June 1, 2015
Technivie Not available 1. Antibiotics & Other Drugs Used for Infection August 3, 2015
Tivorbex Not available 9. Bone, Joint, & MuscleMay 11, 2015
Zomacton 5 mg vial Not available 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous HormonesMay 11, 2015

Effective January 1, 2016, the following non-formulary drugs will be added to the list of drugs requiring prior authorization:

Brand drugGeneric drug Formulary chapter
Carac® Not available 5. Skin Medications
Duexis® Not available 8. Stomach, Ulcer, & Bowel Meds
Fortamet® Not available 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
Janumet® Not available 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
Janumet® XR Not available 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
Januvia® Not available 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
Onglyza® Not available 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
Proctocort® 30 mg supp Not available 5. Skin Medications
Relpax® Not available 3. Pain, Nervous System, & Psych

Drugs with quantity limits

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

Brand drugGeneric drug Quantity LimitEffective date
Aptensio XR Not available 30 capsules per 30 days May 11, 2015
Axert® 6.25 mg almotriptan maleate 6.25 mg 12 tablets per 30 days January 1, 2016
Chantix® Not available 180 days supply per 365 days January 1, 2016
Evekeo 10 mg Not available 120 tablets per 30 days July 1, 2015
Ritalin® LA 60 mg Not available 30 capsules per 30 daysJuly 6, 2015
Tuzistra XR Not available 240 ml per 30 days June 15, 2015
Various nicotine gum, inhalers, lozenges 180 days supply per 365 days January 1, 2016
Various nicotine patches180 days supply per 365 days January 1, 2016
Zegerid® omeprazole sodium bicarbonate 60 capsules per 30 days January 1, 2016
Zyban® 150 mg buproprion hcl sr 150 mg 180 days supply per 365 days January 1, 2016

Drugs no longer requiring prior authorization

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

Brand drugGeneric drug Formulary chapter
Vimpat® Not available 3. Pain, Nervous System, & Psych

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


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