TitleWeb Select Drug Program® Formulary updates
Professional; Facility; Ancillary
August 31, 2016
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 update | Effective date |
alogliptin benz/metformin hcl | Kazano® | 7.
Diabetes, Thyroid, Steroids, & Other
Miscellaneous Hormones | March 28,
2016 |
alogliptin benz/pioglitazone | Oseni® | 7.
Diabetes, Thyroid, Steroids, & Other
Miscellaneous Hormones | March 28,
2016 |
alogliptin benzoate | Nesina® | 7. Diabetes,
Thyroid, Steroids, & Other
Miscellaneous Hormones | March 28,
2016 |
carbamazepine | Tegretol®-XR | 3. Pain,
Nervous System, & Psych | March 28, 2016 |
cyclopentolate hcl | Cyclogyl® | 11. Eye
Medications | February 22, 2016 |
darifenacin er | Enablex® | 13. Urinary &
Prostate Medications | March 21, 2016 |
diclofenac sodium gel | Voltaren® Gel | 5.
Skin Medications | March 28, 2016 |
doxepin hcl | Zonalon® | 5. Skin
Medications | March 14, 2016 |
flurandrenolide | Cordran® | 5. Skin
Medications | April 25, 2016 |
frovatriptan succinate | Frova® | 3. Pain,
Nervous System, & Psych | April 4, 2016 |
metformin hcl er | Glumetza® | 7. Diabetes,
Thyroid, Steroids, & Other
Miscellaneous Hormones | February 8, 2016 |
mometasone furoate* | Nasonex® | 6. Ear,
Nose, Throat Medications | March 28, 2016 |
naftifine hcl | Naftin® | 5. Skin
Medications | February 8, 2016 |
oxiconazole nitrate | Oxistat® | 5. Skin
Medications | March 14, 2016 |
oxycodone hcl er 15 mg,
30 mg*, 60 mg* | Oxycontin® 15 mg,
30 mg, 60 mg | 3. Pain, Nervous System, & Psych | March 21,
2016 |
rosuvastatin | Crestor® | 4. Heart, Blood
Pressure, & Cholesterol | May 9, 2016 |
zolpidem tartrate | Intermezzo® | 3. Pain,
Nervous System, & Psych | March 28, 2016 |
*Generic requires prior authorization.
Brand additions
These brand drugs were/will be added to the formulary and covered at the
appropriate brand formulary level of
cost-sharing:
Brand drug | Formulary chapter | Effective date |
Letairis® | 4. Heart, Blood Pressure, &
Cholesterol | October 1, 2016 |
Linzess® | 8. Stomach, Ulcer, & Bowel
Meds | September 1, 2016 |
Movantik? | 8. Stomach, Ulcer, & Bowel Meds | September 1,
2016 |
Praluent® | 4. Heart, Blood Pressure, &
Cholesterol | August 1, 2016 |
Brand deletions
Effective October 1, 2016, these brand drugs will be
covered at the appropriate non-formulary level of cost-sharing:
Brand drug | Generic drug | Formulary chapter |
Enablex® | darifenacin er | 13. Urinary &
Prostate Meds |
Crestor® | rosuvastatin | 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.
Effective October 1, 2016, these brand drugs will be
covered at the appropriate non-formulary level of cost-sharing:
Brand drug | Formulary therapeutic alternative | Formulary
chapter |
Alphanine® | BeneFIX® | 4.
Heart, Blood Pressure, & Cholesterol |
Emcyt® | bicalutamide, flutamide | 2. Cancer
& Organ Transplant Drugs |
Feiba® | BeneFIX®,
Mononine® | 4. Heart, Blood Pressure, &
Cholesterol |
Fuzeon® | Selzentry® | 1.
Antibiotics & Other Drugs Used for Infection |
Lysodren® | etoposide | 2. Cancer & Organ
Transplant Drugs |
Pegasys® | Not available | 1. Antibiotics &
Other Drugs Used for Infection |
Pegintron? | Not available | 1. Antibiotics & Other Drugs
Used for Infection |
Tamiflu® | amantadine, rimantadine | 1.
Antibiotics & Other Drugs Used for Infection |
Vascepa? | omega-3 acid ethyl esters | 4. Heart, Blood
Pressure, & Cholesterol |
Xifaxan® | ciprofloxacin, neomycin | 1.
Antibiotics & Other Drugs Used for Infection |
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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