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:
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Bosulif?
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Not available
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Cancer
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September 14, 2012
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Xtandi?
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Not available
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Cancer
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September 7, 2012
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ZetonnaTM
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Not available
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Ear, Nose, Throat Medications
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June 8, 2012
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The following drugs will
be added to the list of drugs requiring prior authorization for new
prescriptions. Members taking these drugs immediately prior to the effective
date are not affected.
Effective January 1, 2013.
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Extavia?
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Not available
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Biotechnology
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Rebif?
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Not available
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Biotechnology
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ZioptanTM
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Not available
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Eye Medications
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Drugs with quantity
limits
Quantity limits will be added for
the following drugs:
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N/A
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codeine 30mg/5ml solution
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Pain, Nervous System, & Psych
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1800 ml
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December 1, 2012
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BinostoTM
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Not available
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Bone, Joint, & Muscle
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5 tabs
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October 15, 2012
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