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Select Drug Program® Formulary updates

May 31, 2013

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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

betamethasone valerate

Luxiq?

5. Skin Medications

January 4, 2013

candesartan/hydrochlorothiazide

Atacand HCT?

4. Heart, Blood Pressure, & Cholesterol

December 7, 2012

diclofenac sodium/misoprostol

Arthrotec? 50, Arthrotec? 75

3. Pain, Nervous System, & Psych

November 2, 2012

fenofibrate nanocrystallized

Tricor?

4. Heart, Blood Pressure, & Cholesterol

November 19, 2012

griseofulvin, microsize

Grifulvin V?

1. Antibiotics & Other Drugs Used for Infection

December 7, 2012

griseofulvin ultramicrosize

Gris-PEG?

1. Antibiotics & Other Drugs Used for Infection

November 16, 2012

lamotrigine

Lamictal? XRTM

3. Pain, Nervous System, & Psych

January 11, 2013

nitroglycerin

NitromistTM

4. Heart, Blood Pressure, & Cholesterol

December 7, 2012

oxymorphone hcl

Opana ER?

3. Pain, Nervous System, & Psych

December 28, 2012

phenytoin, chewable tablets

Dilantin?, chewable tablets

3. Pain, Nervous System, & Psych

December 28, 2012

pioglitazone/glimepiride

DuetactTM

4. Heart, Blood Pressure, & Cholesterol

January 11, 2013

rizatriptan benzoate

Maxalt?, Maxalt MLT?

3. Pain, Nervous System, & Psych

January 3, 2013

sildenafil citrate

Revatio?

4. Heart, Blood Pressure, & Cholesterol

November 9, 2012

tranexamic acid

Lysteda?

11. Female, Hormone Replacement, & Birth Control

January 11, 2013


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

Combivent Respimat?

6. Ear, Nose, Throat Medications

June 1, 2013

DelzicolTM

8. Stomach, Ulcer, & Bowel Meds

May 1, 2013

Dulera?

13. Allergy, Cough & Cold, Lung Meds

June 1, 2013

Myrbetriq?

14. Urinary & Prostate Meds

June 1, 2013


Brand deletions

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

Effective July 1, 2013.

Brand drug

Generic drug

Formulary chapter

Dilantin?, chewable tablets

phenytoin, chewable tablets

3. Pain, Nervous System, & Psych

Grifulvin V?

griseofulvin, microsize

1. Antibiotics & Other Drugs Used for Infection

Gris-PEG?

griseofulvin ultramicrosize

1. Antibiotics & Other Drugs Used for Infection

Maxalt?, Maxalt MLT?

rizatriptan benzoate

3. Pain, Nervous System, & Psych

Tricor?

fenofibrate nanocrystallized

4. Heart, Blood Pressure, & Cholesterol

VoSpire ER?

albuterol sulfate er

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 July 1, 2013.

Brand drug

Formulary therapeutic alternative

Formulary chapter

Maxair?

ProAir? HFA, Proventil? HFA

13. Allergy, Cough & Cold, Lung Meds

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

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