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The Independence Pharmacy and Therapeutics Committee periodically reviews
the Select Drug Program Formulary to ensure the selection of clinically safe,
clinically effective, and economically advantageous medications for our
members. Effective July 1, 2017, based on a recent review,
Independence will no longer cover the following five medications under the
pharmacy benefit:
| Drug | Components | Reason for exclusion |
|---|
| Duexis® | Ibuprofen 800
mg/famotidine 26.6 mg tablet | Combination of ibuprofen and famotidine;
no advantage over the individual components. |
| Glumetza® | Metformin modified,
extended release 500 mg, 1000 mg tablet | Extended release formulation of
metformin; other extended release products are available. |
| Vimovo® | Naproxen 375 mg/
esomeprazole 20 mg tablet
Naproxen 500 mg/
esomeprazole 20 mg tablet | Combination of naproxen and esomeprazole; no
advantage over the individual components; esomeprazole 20 mg is available over
the counter. |
| Yosprala® | Omeprazole 40
mg/aspirin
81 mg tablet
Omeprazole 40 mg/aspirin 325 mg tablet | Combination of aspirin and
omeprazole; no advantage over the individual components. |
| Zegerid® capsules | Omeprazole 40
mg/sodium bicarbonate 1100 mg | Combination of omeprazole and sodium
bicarbonate offers no advantage over omeprazole alone or other proton pump
inhibitors. |
As part of the review, it was determined that these medications no longer
meet the medical necessity criteria, as defined in the member benefit book, and
are not eligible for a medical necessity formulary exception review. Members
who currently take these medications will be sent a letter advising them to
contact their physician to discuss alternatives and to obtain a new
prescription for medications covered under their prescription drug benefit.
If you have any questions, please call Customer Service at
1-800-ASK-BLUE.
]