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 acamprosate calcium Campral^® 3. Pain, Nervous System, & Psych August 16, 2013 adefovir dipivoxil Hepsera^® 1. Antibiotics & Other Drugs Used for Infection August 16, 2013 ceftibuten Cedax^® 1. Antibiotics & Other Drugs Used for Infection August 23, 2013 clonidine HCl ER* Kapvay^TM 3. Pain, Nervous System, & Psych September 6, 2013 gatifloxacin Zymaxid^TM 11. Eye Medications September 20, 2013 hydrocortisone butyrate/emoll Locoid Lipocream^® 5. Skin Medications September 20, 2013 lidocaine Lidoderm^® 3. Pain, Nervous System, & Psych September 27, 2013 lomustine n/a 2. Cancer & Organ Transplant Drugs July 25, 2013 niacin ER Niaspan^® 4. Heart, Blood Pressure, & Cholesterol September 27, 2013 paricalcitol Zemplar^® 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones September 27, 2013 sulfacetamide sodium Ovace^® Plus 5. Skin Medications October 4, 2013 sulfacetamide sodium/sulfur AVAR-e^TM LS cream 5. Skin Medications October 4, 2013 temozolomide* Temodar^® 2. Cancer & Organ Transplant Drugs October 11, 2013 voriconazole susp Vfend^® susp 1. Antibiotics & Other Drugs Used for Infection October 18, 2013

*Generic requires prior authorization

Brand additions

Effective February 1, 2014, these brand drugs were added to the formulary and are covered at the appropriate brand formulary level of cost-sharing: Brand drug Formulary chapter Acanya^® 5. Skin Medications Beyaz^® 10. Female, Hormone Replacement, & Birth Control Celebrex^® 9. Bone, Joint, & Muscle Differin^® 0.3% topical gel 5. Skin Medications First^®-Progesterone VGS 25, VGS 400 10. Female, Hormone Replacement, & Birth Control Generess^® FE 10. Female, Hormone Replacement, & Birth Control Lo Loestrin? FE 10. Female, Hormone Replacement, & Birth Control Minastrin^® 24 FE 10. Female, Hormone Replacement, & Birth Control Natazia^® 10. Female, Hormone Replacement, & Birth Control Ortho Tri-Cyclen^® Lo 10. Female, Hormone Replacement, & Birth Control Tazorac^® 5. Skin Medications Zovirax^® cream 5. Skin Medications

Brand deletions

Effective April 1, 2014, these brand drugs will be covered at the appropriate non-formulary level of cost-sharing: Brand drug Generic drug Formulary chapter Campral^® acamprosate calcium 3. Pain, Nervous System, & Psych Depo-Provera^® 150 mg medroxyprogesterone acetate 10. Female, Hormone Replacement, & Birth Control Hepsera^® adefovir dipivoxil 1. Antibiotics & Other Drugs Used for Infection Niaspan^® niacin ER 4. Heart, Blood Pressure, & Cholesterol Temodar^® temozolomide 2. Cancer & Organ Transplant Drugs Vfend^® susp voriconazole susp 1. Antibiotics & Other Drugs Used for Infection

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

Brand deletions

Effective April 1, 2014, these brand drugs will be covered at the appropriate non-formulary level of cost-sharing: Brand drug Formulary therapeutic alternatives Formulary chapter Depo-Provera^® 104 mg medroxyprogesterone acetate 10. Female, Hormone Replacement, & Birth Control Emend^® granisetron, ondansetron 8. Gastroenterology Estring^® Premarin^® Vaginal Cream 10. Female, Hormone Replacement, & Birth Control Repronex^® Menopur^®, chorionic gonadotropin 15. Diagnostics & Miscellaneous Agents

There are no generic equivalents 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.]