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Select Drug Program® Formulary updates

August 31, 2016

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 drugBrand drugFormulary updateEffective date
alogliptin benz/metformin hclKazano®7. Diabetes, Thyroid, Steroids, & Other
Miscellaneous Hormones
March 28, 2016
alogliptin benz/pioglitazoneOseni®7. Diabetes, Thyroid, Steroids, & Other
Miscellaneous Hormones
March 28, 2016
alogliptin benzoateNesina®7. Diabetes, Thyroid, Steroids, & Other
Miscellaneous Hormones
March 28, 2016
carbamazepineTegretol®-XR3. Pain, Nervous System, & PsychMarch 28, 2016
cyclopentolate hclCyclogyl®11. Eye MedicationsFebruary 22, 2016
darifenacin erEnablex®13. Urinary & Prostate MedicationsMarch 21, 2016
diclofenac sodium gelVoltaren® Gel5. Skin MedicationsMarch 28, 2016
doxepin hclZonalon®5. Skin MedicationsMarch 14, 2016
flurandrenolideCordran®5. Skin MedicationsApril 25, 2016
frovatriptan succinateFrova®3. Pain, Nervous System, & PsychApril 4, 2016
metformin hcl erGlumetza®7. Diabetes, Thyroid, Steroids, & Other Miscellaneous HormonesFebruary 8, 2016
mometasone furoate*Nasonex®6. Ear, Nose, Throat MedicationsMarch 28, 2016
naftifine hclNaftin®5. Skin MedicationsFebruary 8, 2016
oxiconazole nitrateOxistat®5. Skin MedicationsMarch 14, 2016
oxycodone hcl er 15 mg, 30 mg*, 60 mg*Oxycontin® 15 mg, 30 mg, 60 mg3. Pain, Nervous System, & PsychMarch 21, 2016
rosuvastatinCrestor®4. Heart, Blood Pressure, & CholesterolMay 9, 2016
zolpidem tartrateIntermezzo®3. Pain, Nervous System, & PsychMarch 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 drugFormulary chapterEffective date
Letairis®4. Heart, Blood Pressure, & CholesterolOctober 1, 2016
Linzess®8. Stomach, Ulcer, & Bowel MedsSeptember 1, 2016
Movantik?8. Stomach, Ulcer, & Bowel MedsSeptember 1, 2016
Praluent®4. Heart, Blood Pressure, & CholesterolAugust 1, 2016

Brand deletions

Effective October 1, 2016, these brand drugs will be covered at the appropriate non-formulary level of cost-sharing:

Brand drugGeneric drugFormulary chapter
Enablex®darifenacin er13. Urinary & Prostate Meds
Crestor®rosuvastatin4. 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 drugFormulary therapeutic alternativeFormulary chapter
Alphanine®BeneFIX®4. Heart, Blood Pressure, & Cholesterol
Emcyt®bicalutamide, flutamide2. Cancer & Organ Transplant Drugs
Feiba®BeneFIX®, Mononine®4. Heart, Blood Pressure, & Cholesterol
Fuzeon®Selzentry®1. Antibiotics & Other Drugs Used for Infection
Lysodren®etoposide2. Cancer & Organ Transplant Drugs
Pegasys®Not available1. Antibiotics & Other Drugs Used for Infection
Pegintron?Not available1. Antibiotics & Other Drugs Used for Infection
Tamiflu®amantadine, rimantadine1. Antibiotics & Other Drugs Used for Infection
Vascepa?omega-3 acid ethyl esters4. Heart, Blood Pressure, & Cholesterol
Xifaxan®ciprofloxacin, neomycin1. 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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