For commercial members enrolled in an IBC prescription drug program, prior
authorization and quantity limit requirements will be applied to certain drugs.
The purpose of prior authorization is to ensure that drugs are medically
necessary
and are being used appropriately. Quantity limits are designed to allow a
sufficient
supply of medication based upon the maximum daily dose and length of therapy
approved by the U.S. Food and Drug Administration for a particular drug. The
most recent updates are reflected below.
Drugs requiring prior authorization
The prior authorization requirement for the following non-formulary drugs
was effective at the time the drugs became
available in the marketplace:
Brand drug
Generic drug
Drug category
Effective date
Farxiga?
Not available
Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones
January 27, 2014
Imbruvica?
Not available
Cancer & Organ Transplant Drugs
November 18, 2013
Olysio?
Not available
Antibiotics & Other Drugs Used for Infection
December 2, 2013
Otrexup?
Not available
Bone, Joint, & Muscle
December 30, 2013
Sovaldi?
Not available
Antibiotics & Other Drugs Used for Infection
December 16, 2013
Stendra?
Not available
Urinary & Prostate Meds
January 13, 2014
The following drugs have been added to the list of drugs requiring prior
authorization:
Brand drug
Generic drug
Drug category
Effective date
Adasuave
®
Not available
Pain, Nervous System, & Psych
July 1, 2014
Advair
®
Not available
Allergy, Cough & Cold, Lung Meds
July 1, 2014
Aerospan?
Not available
Allergy, Cough & Cold, Lung Meds
July 1, 2014
Alvesco
®
Not available
Allergy, Cough & Cold, Lung Meds
July 1, 2014
Exalgo?
Not available
Pain, Nervous System, & Psych
July 1, 2014
Fetzima?
Not available
Pain, Nervous System, & Psych
July 1, 2014
Flovent
®
Not available
Allergy, Cough & Cold, Lung Meds
July 1, 2014
Pulmicort Flexhaler
®
Not available
Allergy, Cough & Cold, Lung Meds
July 1, 2014
Drugs with quantity limits
Quantity limits will be added for the following drugs:
Brand drug
Generic drug
Quantity limit
Effective date
Aciphex
®
rabeprazole*
30 tabs per 30 days
November 18, 2013
Focalin? XR
dexmethylphenidate hcl*
30 tabs per 30 days
November 25, 2013
Stendra?
Not available
8 tabs per 30 days
January 13, 2014
Zomig
® Spray 2.5 mg
Not available
9 bottles per 30 days
July 1, 2014
*Quantity limits currently exist for brand drugs and will
apply to generics at the dates indicated above.
Drug no longer requiring prior authorization
Prior authorization was removed for the following drug:
Brand drug
Generic drug
Formulary chapter
Effective date
Tecfidera
®
Not available
Pain, Nervous System, & Psych
May 1, 2014
For additional information on pharmacy policies and programs, please visit
our Pharmacy
Information web page.