The Select Drug Program Formulary is a list of medications for commercial members that have been 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 abacavir/lamivudine/zidovudine Trizivir^® 1. Antibiotics & Other Drugs Used for Infection December 23, 2013 dexmethylphenidate hcl xr Focalin^TM XR 3. Pain, Nervous System, & Psych November 25, 2013 diclofenac sodium Solaraze^® 9. Bone, Joint, & Muscle December 2, 2013 duloxetine Cymbalta^® 3. Pain, Nervous System, & Psych December 16, 2013 fluocinonide Vanos^® 5. Skin Medications January 20, 2014 hydrocod-cpm-pseudoephedrine Zutripro^TM 12. Allergy, Cough & Cold, Lung Meds January 20, 2014 lamivudine Epivir HBV^® 1. Antibiotics & Other Drugs Used for Infection January 13, 2014 lomedia 24 fe Not available 10. Female, Hormone Replacement, & Birth Control January 6, 2014 moderiba* Ribapak^® 1. Antibiotics & Other Drugs Used for Infection January 13, 2014 mycophenolic acid Myfortic^® 2. Cancer & Organ Transplant Drugs January 13, 2014 Not available Klor-Con^® 25 meq Packets 14. Vitamins & Electrolytes May 1, 2014 potassium citrate er Urocit^®-K 13. Urinary & Prostate Meds January 13, 2014 rabeprazole Aciphex^® 8. Stomach, Ulcer, & Bowel Meds November 18, 2013 sirolimus Rapamune^® 2. Cancer & Organ Transplant Drugs January 20, 2014 telmisartan Micardis^® 4. Heart, Blood Pressure, & Cholesterol January 13, 2014 telmisartan-amlodipine Twynsta^® 4. Heart, Blood Pressure, & Cholesterol January 13, 2014 tobramycin Tobi^® 1. Antibiotics & Other Drugs Used for Infection November 25, 2013 tolterodine tartrate er Detrol^® LA 13. Urinary & Prostate Meds January 13, 2014

*Generic drug requires prior authorization.

Brand additions

Effective May 1, 2014, these brand drugs were added to the formulary and are covered at the appropriate brand formulary level of cost-sharing:

Brand drug Formulary chapter Asmanex^® 12. Allergy, Cough & Cold, Lung Meds Ciprodex^® 6. Ear, Nose, Throat Medications Estring^® 10. Female, Hormone Replacement, & Birth Control Tecfidera^® 3. Pain, Nervous System, & Psych

Brand deletions

Effective July 1, 2014, these brand drugs will be covered at the appropriate non-formulary level of cost-sharing:

Brand drug Generic drug Formulary chapter Cymbalta^® duloxetine 3. Pain, Nervous System, & Psych Epivir HBV^® lamivudine 1. Antibiotics & Other Drugs Used for Infection Rapamune^® 0.5 mg tab sirolimus 2. Cancer & Organ Transplant Drugs Tobi^® tobramycin 1. Antibiotics & Other Drugs Used for Infection Trizivir^® abacavir/lamivudine/zidovudine 1. Antibiotics & Other Drugs Used for Infection

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

Brand deletions

Effective July 1, 2014, these brand drugs will be covered at the appropriate non-formulary level of cost-sharing:

Brand drug Formulary therapeutic alternatives Formulary chapter Advair^® Dulera^®, Symbicort^® 12. Allergy, Cough & Cold, Lung Meds Ciloxan^® Vigamox^TM, ciprofloxacin 11. Eye Medications Cipro^® HC Ciprodex^® 6. Ear, Nose, Throat Medications Flovent^® Qvar^®, Asmanex^® 12. Allergy, Cough & Cold, Lung Meds Pulmicort Flexhaler^® Qvar^®, Asmanex^® 12. Allergy, Cough & Cold, Lung Meds

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