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
cevimeline hcl
Evoxac
?
16. Diagnostics & Miscellaneous Agents
October 12, 2012
entacapone
Comtan
?
3. Pain, Nervous System, & Psych
September 28, 2012
mb hydrogel
Aurstat
TM
5. Skin Medications
October 12, 2012
methylphenidate hcl
Metadate CD
?
3. Pain, Nervous System, & Psych
September 28, 2012
tiagabine hcl
Gabitril
?
3. Pain, Nervous System, & Psych
October 26, 2012
trospium chloride
Sanctura XR
?
14. Urinary & Prostate Meds
October 19, 2012
valsartan/hydrochlorothiazide
Diovan HCT
?
4. Heart, Blood Pressure, & Cholesterol
September 28, 2012
Brand additions
These brand drugs were added
to the formulary and are covered at the appropriate brand formulary level of
cost-sharing:
Generic drug
Formulary chapter
Effective date
Stribild
TM
1. Antibiotics & Other Drugs Used for Infection
August 30, 2012
Vytorin
?
4. Heart, Blood Pressure, & Cholesterol
January 1, 2012
Brand deletions
These brand drugs will be
covered at the appropriate non-formulary level of cost-sharing:
Effective
April 1, 2013.
Generic drug
Formulary chapter
Effective date
Diovan HCT
?
valsartan/hydrochlorothiazide
4. Heart, Blood Pressure, & Cholesterol
Levaquin
?
levofloxacin
1. Antibiotics & Other Drugs Used for Infection
Nardil
?
phenelzine sulfate
3. Pain, Nervous System, & Psych
Neurontin Solution
?
gabapentin solution
3. Pain, Nervous System, & Psych
Vfend
?
voriconazole
1. Antibiotics & Other Drugs Used for Infection
Xalatan
?
latanoprost
12. Eye Medications
The generic drugs for the above brand drugs are on our formulary and available
at the generic formulary level of cost-sharing.