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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BrilintaTM
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Not available
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Heart, Blood Pressure, &
Cholesterol
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October 4, 2011
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Firazyr?
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Not available
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Heart, Blood Pressure, &
Cholesterol
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August 26, 2011
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GraliseTM
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Not available
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Pain, Nervous System, & Psych
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August 19, 2011
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HorizantTM
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Not available
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Pain, Nervous System, & Psych
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July 27, 2011
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IncivekTM
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Not available
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Antibiotics and Other Drugs Used for
Infection
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August 8, 2011
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Lazanda?
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Not available
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Pain, Nervous System, & Psych
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September 30, 2011
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Orencia?
SQ
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Not available
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Bones, Joints, & Muscles
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October 4, 2011
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VictrelisTM
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Not available
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Antibiotics and Other Drugs Used for
Infection
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August 8, 2011
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Xalkori?
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Not available
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Cancer & Organ Transplant
Drugs
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September 2, 2011
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Xarelto?
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Not available
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Heart, Blood Pressure, &
Cholesterol
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August 29, 2011
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Zelboraf?
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Not available
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Cancer & Organ Transplant
Drugs
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August 17, 2011
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The following non-formulary drugs will
be added to the list of drugs requiring prior authorization. Members taking
these drugs immediately prior to the effective date are not affected:
Effective December 1, 2011.
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NexiclonTMXR
Suspension
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Not available
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Heart, Blood Pressure, &
Cholesterol
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TradjentaTM
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Not available
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Diabetes
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Drugs with quantity limits
Quantity limits will be added for the following drugs:
Effective December 1, 2011.
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DificidTM
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Not available
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20 tablets per 10 days
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Sprix?
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Not available
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5 bottles per 30 days
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