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 |
|---|
| amlodipine-valsartan | Exforge® | 4. Heart,
Blood Pressure, & Cholesterol | October 6, 2014 |
| amoxicillin ER | Moxatag® | 1. Antibiotics
& Other Drugs Used for Infection | August 18, 2014 |
| entecavir | Baraclude® | 1. Antibiotics &
Other Drugs Used for Infection | September 8, 2014 |
| fluorouracil | Carac® | 5. Skin
Medications | October 20, 2014 |
| olopatadine | Patanase® | 6. Ear, Nose,
Throat Medications | October 27, 2014 |
| testosterone* | Fortesta® | 7. Diabetes,
Thyroid, Steroids, & Other Miscellaneous Hormones | September 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 |
|---|
| Plegridy™ | 3. Pain, Nervous System, &
Psych | February 1, 2015 |
Brand deletions
Effective April 1, 2015, this brand drug will be covered at
the appropriate non-formulary level of cost-sharing:
| Brand drug | Generic drug | Formulary chapter |
|---|
| Prometrium® | progesterone | 10. Female,
Hormone Replacement, & Birth Control |
The generic drug for the above brand drug is available at the generic
formulary level of cost-sharing.
Effective April 1, 2015, this brand drug will be covered at
the appropriate non-formulary level of cost-sharing:
| Brand drug | Formulary therapeutic alternative | Formulary
chapter |
|---|
| Viagra® | Cialis® | 13.
Urinary & Prostate Meds |
There is no generic equivalent for the above brand drug, however, there is a
formulary therapeutic alternative drug. This therapeutic alternative drug is
available at the appropriate formulary level of cost-sharing.