TitleWeb Select Drug Program® Formulary updates
Professional; Facility; Ancillary
September 1, 2015
Page Content The Select Drug Program Formulary, which is available for commercial members, 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 |
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adapalene lotion | Differin® Lotion | 5. Skin Medications | April 6, 2015 | cefixime susp 100 mg/5 ml and 200 mg/5 ml | Suprax® Susp 100 mg/5 ml and 200 mg/5 ml | 1. Antibiotics & Other Drugs Used for Infection | April 27, 2015 | dexmethylphenidate hcl er 10 mg | Focalin® XR 10 mg | 3. Pain, Nervous System, & Psych | February 9, 2015 | doxycycline ir-dr | Oracea® | 1. Antibiotics & Other Drugs Used for Infection | April 6, 2015 | esomeprazole magnesium* | Nexium® | 8. Stomach, Ulcer, & Bowel Meds | February 23, 2015 | lamotrigine odt | Lamictal® ODT | 3. Pain, Nervous System, & Psych | February 2, 2015 | metaxalone 400 mg | N/A | 9. Bone, Joint, & Muscle | April 6, 2015 | methylphenidate hcl chewable tabs | Methylin® Chewable Tabs | 3. Pain, Nervous System, & Psych | March 16, 2015 | metoclopramide hcl | Metozolv® ODT | 8. Stomach, Ulcer, & Bowel Meds | April 13, 2015 | naproxen cr | Naprelan® CR | 9. Bone, Joint, & Muscle | March 16, 2015 | noreth-ethinyl estradiol/iron | Generess® FE | 10. Female, Hormone Replacement, & Birth Control | April 6, 2015 | pramipexole er 0.375 mg | Mirapex® ER 0.375 mg | 3. Pain, Nervous System, & Psych | April 27, 2015 | pramipexole er 0.75 mg and 1.5 mg | Mirapex® ER 0.75 mg and 1.5 mg | 3. Pain, Nervous System, & Psych | February 16, 2015 | trandolapril-verapamil er | Tarka® | 4. Heart, Blood Pressure, & Cholesterol | March 2, 2015 | triamcinolone acetonide spray | Kenalog® Spray | 5. Skin Medications | April 27, 2015 | *Generic requires prior authorization. Brand deletions Effective October 1, 2015, these brand drugs will be covered at the appropriate non-formulary level of cost-sharing: Brand drug | Generic drug | Formulary chapter |
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Generess® FE | noreth-ethinyl estradiol/iron | 10. Female, Hormone Replacement, & Birth Control | Mirapex® ER | pramipexole er | 3. Pain, Nervous System, & Psych | Oracea® | doxycycline ir-dr | 1. Antibiotics & Other Drugs Used for Infection |
The generic drugs for the above brand drugs are on our formulary and available at the generic formulary level of cost-sharing. Effective October 1, 2015, these brand drugs will be covered at the appropriate non-formulary level of cost-sharing: Brand drug | Formulary therapeutic alternative | Formulary chapter |
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Alkeran® | cyclophosphamide | 2. Cancer & Organ Transplant Drugs | Epivir® HBV Sol | adefovir, entecavir, lamivudine | 1. Antibiotics & Other Drugs Used for Infection | Fareston® | exemestane, letrozole, tamoxifen | 2. Cancer & Organ Transplant Drugs | Hexalen® | etoposide, letrozole, tamoxifen | 2. Cancer & Organ Transplant Drugs | Kristalose® | lactulose solution | 8. Stomach, Ulcer, & Bowel Meds | Myleran® | cyclophosphamide, Gleevec® | 2. Cancer & Organ Transplant Drugs | Novoseven® RT | Advate®, Feiba® NF, Hexilate® FS, Recombinate® | 4. Heart, Blood Pressure, & Cholesterol | Rixubis® | AlphaNine® SD, BeneFix®, Humate-P® | 4. Heart, Blood Pressure, & Cholesterol | Viramune® XR 100 mg | Atripla®, Complera®, nevirapine 200 mg, Sustiva® | 1. Antibiotics & Other Drugs Used for Infection | Wilate® | AlphaNine® SD, BeneFix®, Humate-P® | 4. Heart, Blood Pressure, & Cholesterol |
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. We encourage you to discuss formulary alternatives with your patients.
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