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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.
Reminder about the Preventive
Medication Program included in our prescription drug plan
Certain preventive medications, as described in the
Patient Protection and Affordable Care Act (PPACA),
including generic products and those brand products that do not have a generic
equivalent, are covered without cost-sharing with a doctor?s prescription when
provided by a participating retail or mail-order pharmacy. Coverage includes
certain products within the following drug categories: (1) aspirin to prevent
cardiovascular disease for men age 45-79 and women age 55-79, (2) breast cancer
chemotherapy prevention for women, (3) fluoride supplementation for children 6
months through 6 years, (4) folic acid supplementation for women planning or
capable of pregnancy, (5) iron supplementation for children ages 6
to 12 months who are at increased risk for iron deficiency anemia, (6) tobacco
interventions for adults who use tobacco products, and (7) vitamin D
supplementation for ages 65 and over to prevent falls.
Contraceptives, mandated by the Women?s Preventive
Services provision of the PPACA, are covered at 100 percent when provided by a
participating provider for generic products and for those brand products that
do not have a generic equivalent. Brand contraceptive products with a generic
equivalent are covered at the brand cost-sharing level for the member?s
plan.
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
acitretin
Soriatane?
5. Skin Medications
July 25, 2013
alendronate sodium solution
Fosamax? solution
10. Female, Hormone Replacement, &
Birth Control
April 26, 2013
candesartan cilexetil
Atacand?
4. Heart, Blood Pressure, & Cholesterol
May 23, 2013
chorionic gonadotropin
Novarel?/Pregnyl?
15. Diagnostics & Miscellaneous
January 1, 2014
dihydrocodeine/aspirin/caffeine
Synalgos?-DC
3. Pain, Nervous System, & Psych
May 31, 2013
fenofibric acid (choline)
Trilipix?
4. Heart, Blood Pressure, & Cholesterol
July 19, 2013
metronidazole topical gel
Metrogel?
5. Skin Medications
July 3, 2013
omeprazole suspension
First?-Omeprazole
8. Stomach, Ulcer, & Bowel Meds
June 28, 2013
quazepam
Doral?
3. Pain, Nervous System, & Psych
July 12, 2013
repaglinide
Prandin?
7. Diabetes, Thyroid, Steroids, & Other
Miscellaneous Hormones
July 25, 2013
riluzole
Rilutek?
3. Pain, Nervous System, & Psych
June 7, 2013
zolmitriptan
Zomig?, Zomig-ZMT?
3. Pain, Nervous System, & Psych
May 17, 2013
Brand additions
These brand drugs were added to the formulary as of the dates indicated
below and are covered at the appropriate
brand formulary level of cost-sharing:
Brand drug
Formulary chapter
Effective date
Advate?
15. Diagnostics & Miscellaneous
January 1, 2014
Alphanate?
15. Diagnostics & Miscellaneous
January 1, 2014
Alphanine? SD
15. Diagnostics & Miscellaneous
January 1, 2014
Bebulin?
15. Diagnostics & Miscellaneous
January 1, 2014
BeneFIX?
15. Diagnostics & Miscellaneous
January 1, 2014
Cialis?
13. Urinary & Prostate Meds
October 1, 2013
Feiba NF?
15. Diagnostics & Miscellaneous
January 1, 2014
Helixate? FS
15. Diagnostics & Miscellaneous
January 1, 2014
Hemofil? M
15. Diagnostics & Miscellaneous
January 1, 2014
Humate-P?
15. Diagnostics & Miscellaneous
January 1, 2014
Koate?-DVI
15. Diagnostics & Miscellaneous
January 1, 2014
Kogenate? FS
15. Diagnostics & Miscellaneous
January 1, 2014
Lialda?
3. Pain, Nervous System, & Psych
November 1, 2013
LiptruzetTM
4. Heart, Blood Pressure, & Cholesterol
November 1, 2013
Monoclate-P?
15. Diagnostics & Miscellaneous
January 1, 2014
Mononine?
15. Diagnostics & Miscellaneous
January 1, 2014
NovoSeven? RT
15. Diagnostics & Miscellaneous
January 1, 2014
Profilnine? SD
15. Diagnostics & Miscellaneous
January 1, 2014
RecombinateTM
15. Diagnostics & Miscellaneous
January 1, 2014
Vascepa?
4. Heart, Blood Pressure, & Cholesterol
November 1, 2013
Wilate?
15. Diagnostics & Miscellaneous
January 1, 2014
Xarelto?
4. Heart, Blood Pressure, & Cholesterol
November 1, 2013
Xyntha?
15. Diagnostics & Miscellaneous
January 1, 2014
Brand deletions
Effective January 1, 2014, these brand drugs will be covered at the
appropriate non-formulary level of cost-sharing:
Brand drug
Formulary therapeutic alternatives
Formulary chapter
Cortef
? 5mg, 10mg
hydrocortisone
9. Bone, Joint, & Muscle
Efudex
?
fluorouracil
5. Skin Medications
Lanoxin
?
digoxin
4. Heart, Blood Pressure, & Cholesterol
Metrogel
?
metronidazole topical gel
5. Skin Medications
Prandin
?
repaglinide
7. Diabetes, Thyroid, Steroids, & Other
Miscellaneous Hormones
Trilipix
?
fenofibric acid (choline)
4. Heart, Blood Pressure, & Cholesterol
The generic drugs for the above brand drugs are on our formulary and
available at the generic formulary level of
cost-sharing.
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