Select Drug Program® Formulary updates

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Select Drug Program^® Formulary updates

November 30, 2012

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The Select Drug Program Formulary 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
calcipotriene	Dovonex? cream	5. Skin Medications	June 1, 2012
ciprofloxacin	Cetraxal?	6. Ear, Nose, Throat Medications	August 3, 2012
clindamycin/benzol peroxide	Duac?	5. Skin Medications	June 29, 2012
clozapine ODT	Fazaclo?	3. Pain, Nervous System, & Psych	September 7, 2012
desloratadine	Clarinex?	13. Allergy, Cough & Cold, Lung Meds	July 6, 2012
levalbuterol	Xopenex?	13. Allergy, Cough & Cold, Lung Meds	August 24, 2012
levonorgestrel	Plan B One-Step?	11. Female, Hormone Replacement, & Birth Control	July 20, 2012
montelukast sodium	Singulair?	13. Allergy, Cough & Cold, Lung Meds	August 10, 2012
pioglitazone	Actos?	7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones	August 20, 2012
pioglitazone hcl/ metformin hcl	Actoplus Met?	7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones	August 20, 2012
spinosad	NatrobaTM	5. Skin Medications	August 3, 2012
tolterodine tartrate	Detrol?	14. Urinary and Prostate Meds	June 29, 2012

Brand additions

These brand drugs were added to the formulary and are covered at the appropriate brand formulary level of cost-sharing:

Brand drug	Formulary chapter	Effective date
Betaseron?	9. Biotechnology	October 1, 2012
Travatan Z?	12. Eye Medications	July 13, 2012
Xifaxan 550mg?	1. Antibiotics & Other Drugs Used for Infection	August 1, 2012

Brand deletions

These brand drugs will be covered at the appropriate non-formulary level of cost-sharing:

Effective January 1, 2013.

Brand drug	Generic drug	Formulary chapter
Actoplus Met?	pioglitazone hcl/metformin hcl	7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
Actos?	pioglitazone	7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
Dovonex? cream	calcipotriene	5. Skin Medications
Singulair?	montelukast sodium	13. Allergy, Cough & Cold, Lung Meds

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

This brand drug will be covered at the appropriate non-formulary level of cost-sharing:

Effective January 1, 2013.

Brand drug

Formulary therapeutic alternative

Formulary chapter

Humatrope?

Norditropin?

7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones