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The Select Drug Program Formulary, which is available for commercial members, is a list of medications approved bythe 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 formularyto 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, webegan covering them at the appropriate generic formulary level of cost-sharing:
| Generic drug | Brand drug | Formulary chapter | Effective date |
|---|
| armodafinil* | Nuvigil® | 3. Pain, Nervous System, & Psych | June 6, 2016 |
| | | |
clindamycin phos-tretinoin
1.2% - 0.025% gel | Veltin® 1.2% - 0.025% gel or
Ziana™ 1.2% - 0.025% gel | 5. Skin Medications | July 11, 2016 |
clindamycin-benzoyl peroxide
1% - 5% gel w/ pump | benzaclin pump | 5. Skin Medications | May 9, 2016 |
| dofetilide | Tikosyn® | 4. Heart, Blood Pressure, & Cholesterol | June 13, 2016 |
| doxycycline hyclate 50 mg | Doryx® 50 mg and200 mg dr tablet | 1. Antibiotics & Other Drugs Used for Infection | May 30, 2016 |
| ethacrynic acid | Edecrin® | 4. Heart, Blood Pressure, & Cholesterol | July 11, 2016 |
| miglitol | Glyset® | 7. Diabetes, Thyroid, Steroids, & OtherMiscellaneous Hormones | May 23, 2016 |
| nilutamide | Nilandron® | 2. Cancer & Organ Transplant Drugs | July 25, 2016 |
omeprazole-sodium
bicarbonate 20 mg - 1,680 mg
and 40 mg - 1,680 mg packet* | Zegerid® 20 mg - 1,680mg and 40 mg - 1,680 mgpacket | 8. Stomach, Ulcer, & Bowel Meds | July 25, 2016 |
| pramipexole er 3.75 mg | Mirapex ER™ 3.75 mg | 3. Pain, Nervous System, & Psych | July 18, 2016 |
*Generic requires prior authorization.
Brand additions
Effective October 1, 2016, these brand drugs were added to the formulary and covered at the appropriate brandformulary level of cost-sharing:
| Brand drug | Formulary chapter |
|---|
|
| Simponi® | 9. Bone, Joint, & Muscle |
|
| Stelara®† | 9. Bone, Joint, & Muscle |
|
†Covered under pharmacy and medical benefit.
Brand deletions
Effective January 1, 2017, these brand drugs will be covered at the appropriate non-formulary level of cost-sharing:
| Brand drug | Generic drug | Formulary chapter |
|---|
|
| Edecrin® | ethacrynic acid | 4. Heart, Blood Pressure, & Cholesterol |
|
| Mirapex ER™ 3.75 mg | pramipexole er 3.75 mg | 3. Pain, Nervous System, & Psych |
The generic drugs for the above brand drugs are on our formulary and available at the generic formulary level ofcost-sharing.
Generic deletions
Effective January 1, 2017, these drugs will be covered at the appropriate non-preferred level of cost-sharing:
| Non-preferred drug | Formulary therapeutic alternative | Formulary chapter |
|---|
|
| Apexicon® E | betamethasone dipropionate, fluocinolone acetonidem,triamcinolone acetonide | 5. Skin Medications |
|
| Clodan® | clobetasol propionate | 5. Skin Medications |
|
| frovatriptan | almotriptan malate, sumatriptan, zolmitriptan | 3. Pain, Nervous System, & Psych |
|
metformin ER
(generic Glumetza®) | metformin ER (generic Glucophage® XR and Fortamet®) | 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones |
|
| omeprazole-sodiumbicarbonate | omeprazaole, lansoprazole, pantoprazole sodium | 8. Stomach, Ulcer, & Bowel Meds |
|
| oxiconazole | econazole nitrate, ketoconazole | 5. Skin Medications |
|
| Trianex® | betamethasone dipropionate, fluocinolone acetonide,triamcinolone acetonide | 3. Pain, Nervous System, & Psych |
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For additional information on pharmacy policies and programs, go to our website.
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