For members enrolled in an IBC prescription drug program, prior authorization and quantity limit requirements will be applied to certain drugs. The purpose of prior authorization is to ensure that drugs are medically necessary and are being used appropriately. Quantity limits are designed to allow a sufficient supply of medication based upon the maximum daily dose and length of therapy approved by the U.S. Food and Drug Administration for a particular drug. The most recent updates are reflected below.

Drugs requiring prior authorization

The prior authorization requirement for the following non-formulary drugs was effective at the time the drugs became available in the marketplace: Brand Generic drug Drug category Effective date Mekinist^? Not available Cancer & Organ Transplant Drugs June 21, 2013 Tafinlar^? Not available Cancer & Organ Transplant Drugs June 14, 2013 VecamylTM Not available Heart, Blood Pressure, & Cholesterol May 3, 2013

The following non-formulary drugs have been added to the list of drugs requiring prior authorization. Members taking these drugs prior to the effective date are not affected: Effective January 1, 2014. Brand drug Generic drug Drug category Adrenaclick^?, Auvi-Q^? epinephrine pen Allergy, Cough & Cold, Lung Meds Alodox^? doxycycline Antibiotics & Other Drugs Used for Infection AvidoxyTM, Monodox^?, Adoxa^? doxycycline monohydrate Antibiotics & Other Drugs Used for Infection Doryx^? DR, Vibramycin^? doxycycline hyclate Antibiotics & Other Drugs Used for Infection Esomeprazole Strontium Not available Heart, Blood Pressure, & Cholesterol Minocin^? minocycline hcl Antibiotics & Other Drugs Used for Infection Novarel^?, Pregnyl^? chorionic gonadotropin, human Diagnostics & Miscellaneous Rescula^? Not available Eye Medications

Drug no longer requiring prior authorization

Effective November 1, 2013, prior authorization was removed for the following drug: Brand drug Generic drug Drug category Vascepa^? Not available Heart, Blood Pressure, & Cholesterol

Drugs with quantity limits

Effective January 1, 2014, quantity limits will be added for the following drugs: Brand drug Generic drug Quantity limit (per 30 days) All applicable products blood glucose monitors 1 per year All applicable products diabetic test strips 200 per 30 days All applicable products lancets 200 per 30 days All applicable products insulin injecting devices 2 per year All applicable products insulin syringes and pen needles 200 per 30 days Ella^? ulipristal acetate 3 per 30 days Firazyr^? Not available 27 ml per 30 days (9 syringes) My Way^?, Next Choice^? One Dose, Plan B^? One-Step levonorgestrel 1.5 mg 3 per 30 days Not available hydrocodone/chlorpheniramine 450 ml per 30 days Nicotrol^? NS nicotine nasal spray 80 ml per 30 days Plan B^? levonorgestrel .075 mg 6 per 30 days