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
abacavir sulfate
Ziagen
?
1. Antibiotics & Other Drugs Used for
Infection
June 1, 2012
carbidopa/levodopa/
entacapone
Stalevo
?
3. Pain, Nervous System, & Psych
April 6, 2012
clopidogrel
Plavix
?
4. Heart, Blood Pressure, & Cholesterol
May 18, 2012
fluvastatin sodium
Lescol
?
4. Heart, Blood Pressure, & Cholesterol
April 13, 2012
irbesartan
Avapro
?
4. Heart, Blood Pressure, & Cholesterol
April 3, 2012
irbesartan/hctz
Avalide
?
4. Heart, Blood Pressure, & Cholesterol
April 3, 2012
modafinil
Provigil
?
3. Pain, Nervous System, & Psych
April 4, 2012
nevirapine
Viramune
?
1. Antibiotics & Other Drugs Used for
Infection
May 24, 2012
olanzapine/fluoxetine hcl
Symbyax
?
3. Pain, Nervous System, & Psych
June 22, 2012
ropinirole
Requip XL
?
3. Pain, Nervous System, & Psych
May 24, 2012
tinidazole
Tindamax
?
1. Antibiotics & Other Drugs Used for
Infection
May 4, 2012
vancomycin
Vancocin
?
1. Antibiotics & Other Drugs Used for
Infection
April 13, 2012
Brand additions
These brand drugs were added to the formulary and are covered at the
appropriate brand formulary level of cost-sharing:
Effective July 1, 2012.
Brand Drug
Formulary chapter
Pegasys
?
9. Biotechnology
Relpax
?
3. Pain, Nervous System, & Psych
Vyvanse
?
3. Pain, Nervous System, & Psych
Brand deletions
These brand drugs will be covered at the appropriate non-formulary level of
cost-sharing:
Effective October 1, 2012.
Brand Drug
Generic Drug
Formulary chapter
Viramune
?
nevirapine
1. Antibiotics & Other Drugs Used for Infection
Ziagen
?
abacavir sulfate
1. Antibiotics & Other Drugs Used for Infection
The generic drugs for the above brand drugs are on our formulary and available
at the generic formulary level of cost-sharing.
This brand drug will be covered at the appropriate non-formulary level
of cost-sharing:
Effective October 1, 2012.
Brand Drug
Formulary therauputic alternative
Formulary chapter
Treximet
?
sumatriptan
3. Pain, Nervous System, & Psych