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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 acyclovir ointment Zovirax^? ointment 5. Skin Medications April 5, 2013 buprenorphine hcl/naloxone hcl Suboxone^? 3. Pain, Nervous System, & Psych March 8, 2013 dihydroergotamine mesylate Migranal^? 3. Pain, Nervous System, & Psych April 12, 2013 fenofibrate Antara^? 4. Heart, Blood Pressure, & Cholesterol March 1, 2013 fluvoxamine Luvox CR^? 3. Pain, Nervous System, & Psych March 15, 2013 mafenide acetate Sulfamylon^? 5. Skin Medications February 22, 2013 mupirocin calcium cream Bactroban^? cream 5. Skin Medications February 1, 2013 travoprost Travatan^? 12. Eye Medications April 19, 2013 tretinoin gel Retin-A Micro^? 5. Skin Medications March 22, 2013

Brand deletions

These brand drugs will be covered at the appropriate non-formulary level of cost-sharing:
Effective October 1, 2013.

Brand drug Generic drug Formulary chapter Augmentin^? suspension amoxicillin/potassium clavulanate 1. Antibiotics & Other Drugs Used for Infection Bactroban^? cream mupirocin calcium cream 5. Skin Medications Suboxone^? buprenorphine hcl/naloxone hcl 3. Pain, Nervous System, & Psych Zovirax^? ointment acyclovir ointment 5. Skin Medications

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

Brand deletions

These brand drugs will be covered at the appropriate non-formulary level of cost-sharing:
Effective October 1, 2013.

Brand drug Formulary therapeutic alternatives Formulary chapter Actoplus Met XR^? pioglitazone/metformin 7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones Ceftin^? suspension cefprozil suspension, cefaclor suspension 1. Antibiotics & Other Drugs Used for Infection Mepron^? tinidazole tablets 1. Antibiotics & Other Drugs Used for Infection Proventil^? HFA ProAir^? HFA 13. Allergy, Cough & Cold, Lung Meds Rebetol^? solution ribasphere, ribavirin capsules 1. Antibiotics & Other Drugs Used for Infection There is no generic equivalent for the above brand drugs; however, there are therapeutic alternative drugs. These therapeutic alternative drugs are available at the appropriate formulary level of cost-sharing.

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