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The Select Drug Program Formulary, which is available for commercial members, 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
azelastine	Astepro®	6. Ear, Nose, Throat Medications	May 16, 2014
budesonide	Rhinocort® Aqua	6. Ear, Nose, Throat Medications	May 16, 2014
diclofenac sodium	Pennsaid®	9. Bone, Joint, & Muscle	June 6, 2014
fenofibrate	Lipofen®	4. Heart, Blood Pressure, & Cholesterol	May 9, 2014
hydromorphone ER*	Exalgo®	3. Pain, Nervous System, & Psych	May 22, 2014
methoxsalen	Oxsoralen-ultra®	5. Skin Medications	June 27, 2014
oxycodone ER	Oxycontin®	3. Pain, Nervous System, & Psych	October 6, 2014
risedronate	Actonel® 150 mg	9. Bone, Joint, & Muscle	June 13, 2014
testosterone*	Testim®, Vogelxo?	7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones	June 20, 2014
topiramate ER	Qudexy? XR	3. Pain, Nervous System, & Psych	July 11, 2014
valsartan	Diovan®	4. Heart, Blood Pressure, & Cholesterol	July 8, 2014

*Generic requires prior authorization.

Brand addition

This brand drug was added to the formulary as of the date indicated below and is covered at the appropriate brand formulary level of cost-sharing:

Brand drug	Formulary chapter	Effective date
Dilantin® Infatabs®	3. Pain, Nervous System, & Psych	November 1, 2014

*Generic requires prior authorization.

Brand addition

This brand drug was added to the formulary as of the date indicated below and is covered at the appropriate brand formulary level of cost-sharing:

Brand drug	Formulary chapter	Effective date
Dilantin® Infatabs®	3. Pain, Nervous System, & Psych	November 1, 2014

Brand deletions

Effective January 1, 2015, these brand drugs will be covered at the appropriate non-formulary level of cost-sharing:

Brand drug	Generic drug	Formulary chapter
Actonel® 150 mg	risedronate	9. Bone, Joint, & Muscle
Astepro®	azelastine	6. Ear, Nose, Throat Medications
Diovan®	valsartan	4. Heart, Blood Pressure, & Cholesterol
Levoxyl®	levothyroxine	7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
Mestinon® IR	pyridostigmine	3. Pain, Nervous System, & Psych
Oxsoralen-ultra®	methoxsalen	5. Skin Medications
Oxycontin®	oxycodone ER	3. Pain, Nervous System, & Psych
Unithroid®	levothyroxine	7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
Vandazole®	metronidazole	10. Female, Hormone Replacement, & Birth Control

The generic drugs for the above brand drugs are available at the generic formulary level of cost-sharing.

Effective January 1, 2015, these brand drugs will be covered at the appropriate non-formulary level of cost-sharing:

Brand drug	Formulary therapeutic alternatives	Formulary chapter
Alphanate®	Advate®, Helixate® FS	4. Heart, Blood Pressure, & Cholesterol
Bebulin®	Rixubis®	4. Heart, Blood Pressure, & Cholesterol
Hemofil-M®	Advate®, Helixate® FS	4. Heart, Blood Pressure, & Cholesterol
Koate®-DVI	Advate®, Helixate® FS	4. Heart, Blood Pressure, & Cholesterol
Monoclate-P®	Advate®, Helixate® FS	4. Heart, Blood Pressure, & Cholesterol
Nasonex®	budesonide, fluticasone propionate	6. Ear, Nose, Throat Medications
Profilnine®	Rixubis®	4. Heart, Blood Pressure, & Cholesterol

There is no generic equivalent for the above brand drugs; however, there are formulary therapeutic alternative drugs. These therapeutic alternative drugs are available at the appropriate formulary level of cost-sharing.

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