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 chapter
Effective date
aripiprazole 1 mg/ml
Abilify® 1 mg/ml
3. Pain, Nervous System, & Psych
August 24, 2015
aripiprazole odt 10 mg and 15 mg
Not available
3. Pain, Nervous System, & Psych
October 12, 2015
budesonide 1 mg/2 ml
Pulmicort® 1 mg/2 ml
12. Allergy, Cough & Cold, Lung Meds
August 3, 2015
dihydrocodein-acetaminoph-caff
Trezix?
3. Pain, Nervous System, & Psych
August 17, 2015
dutasteride
Avodart®
13. Urinary & Prostate Meds
October 19, 2015
fenofibrate 40 mg
Fenoglide® 40 mg
4. Heart, Blood Pressure, & Cholesterol
September 28, 2015
fluvastatin er
Lescol® XL
4. Heart, Blood Pressure, & Cholesterol
September 21, 2015
megestrol acetate
Megace® ES
2. Cancer & Organ Transplant Drugs
August 3, 2015
memantine hcl 2 mg/ml
Namenda® 2 mg/ml
3. Pain, Nervous System, & Psych
October 19, 2015
naproxen sodium cr 375 mg
Naprelan® 375 mg
3. Pain, Nervous System, & Psych
August 31, 2015
paliperidone er
Invega®
3. Pain, Nervous System, & Psych
September 28, 2015
phenoxybenzamine hcl
Dibenzyline®
4. Heart, Blood Pressure, & Cholesterol
August 17, 2015
pimozide
Orap®
3. Pain, Nervous System, & Psych
October 5, 2015
pramipexole di-hcl 4.5 mg
Mirapex ER® 4.5 mg
3. Pain, Nervous System, & Psych
August 17, 2015
rivastigmine 9.5 mg/24 hr, 13.3 mg/24 hr, and 4.6 mg/24 hr
Exelon® 9.5 mg/24 hr, 13.3 mg/24 hr, and 4.6 mg/24 hr
3. Pain, Nervous System, & Psych
September 7, 2015
tetrabenazine*
Xenazine®
3. Pain, Nervous System, & Psych
August 31, 2015
tretinoin
Atralin®
5. Skin Medications
September 7, 2015
*Generic requires prior
authorization.
Brand deletions
Effective April 1, 2016, these brand drugs will be covered
at the appropriate non-formulary level of cost-sharing:
Brand drug
Generic drug
Formulary chapter
Abilify® 1 mg/ml
aripiprazole 1 mg/ml
3. Pain, Nervous System, & Psych
Mirapex ER® 4.5 mg
pramipexole di-hcl 4.5 mg
3. Pain, Nervous System, & Psych
Namenda® 2 mg/ml
memantine hcl 2 mg/ml
3. Pain, Nervous System, & Psych
The generic drugs for the above brand drugs are on our formulary and
available at the generic formulary level of cost-sharing.