TitleWeb Select Drug Program® Formulary updates
Professional; Facility; Ancillary
December 1, 2014
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 chapter |
Effective date |
azelastine | Astepro® | 6. Ear, Nose,
Throat Medications | May 16, 2014 |
budesonide | Rhinocort® Aqua | 6. Ear,
Nose, Throat Medications | May 16, 2014 |
diclofenac sodium | Pennsaid® | 9.
Bone, Joint, & Muscle | June 6, 2014 |
fenofibrate | Lipofen® | 4. Heart,
Blood Pressure, & Cholesterol | May 9, 2014 |
hydromorphone ER* | Exalgo® | 3. Pain,
Nervous System, & Psych | May 22, 2014 |
methoxsalen | Oxsoralen-ultra® | 5.
Skin Medications | June 27, 2014 |
oxycodone ER | Oxycontin® | 3. Pain,
Nervous System, & Psych | October 6, 2014 |
risedronate | Actonel® 150 mg | 9.
Bone, Joint, & Muscle | June 13, 2014 |
testosterone* | Testim®, Vogelxo? | 7.
Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones | June
20, 2014 |
topiramate ER | Qudexy? XR | 3. Pain, Nervous System,
& Psych | July 11, 2014 |
valsartan | Diovan® | 4. Heart, Blood
Pressure, & Cholesterol | July 8, 2014 |
*Generic requires prior
authorization.
Brand addition
This brand drug was added to the formulary as of the date indicated below
and is covered at the appropriate brand formulary level of cost-sharing:
Brand drug | Formulary chapter | Effective date |
Dilantin® Infatabs® | 3. Pain,
Nervous System, & Psych | November 1, 2014 |
*Generic requires prior authorization.
Brand addition
This brand drug was added to the formulary as of the date indicated below
and is covered at the appropriate brand
formulary level of cost-sharing:
Brand drug | Formulary chapter | Effective date |
Dilantin® Infatabs® | 3. Pain,
Nervous System, & Psych | November 1, 2014 |
Brand deletions
Effective January 1, 2015, these brand drugs will be
covered at the appropriate non-formulary level of cost-sharing:
Brand drug | Generic drug | Formulary chapter |
Actonel® 150 mg | risedronate | 9.
Bone, Joint, & Muscle |
Astepro® | azelastine | 6. Ear, Nose,
Throat Medications |
Diovan® | valsartan | 4. Heart, Blood
Pressure, & Cholesterol |
Levoxyl® | levothyroxine | 7. Diabetes,
Thyroid, Steroids, & Other Miscellaneous Hormones |
Mestinon® IR | pyridostigmine | 3.
Pain, Nervous System, & Psych |
Oxsoralen-ultra® | methoxsalen | 5.
Skin Medications |
Oxycontin® | oxycodone ER | 3. Pain,
Nervous System, & Psych |
Unithroid® | levothyroxine | 7.
Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones |
Vandazole® | metronidazole | 10.
Female, Hormone Replacement, & Birth Control |
The generic drugs for the above brand drugs are available at the generic
formulary level of cost-sharing.
Effective January 1, 2015, these brand drugs will be
covered at the appropriate non-formulary level of cost-sharing:
Brand drug | Formulary therapeutic alternatives |
Formulary chapter |
Alphanate® | Advate®,
Helixate® FS | 4. Heart, Blood Pressure, &
Cholesterol |
Bebulin® | Rixubis® | 4.
Heart, Blood Pressure, & Cholesterol |
Hemofil-M® | Advate®,
Helixate® FS | 4. Heart, Blood Pressure, &
Cholesterol |
Koate®-DVI | Advate®,
Helixate® FS | 4. Heart, Blood Pressure, &
Cholesterol |
Monoclate-P® | Advate®,
Helixate® FS | 4. Heart, Blood Pressure, &
Cholesterol |
Nasonex® | budesonide, fluticasone propionate
| 6. Ear, Nose, Throat Medications |
Profilnine® | Rixubis® |
4. Heart, Blood Pressure, & Cholesterol |
There is no generic equivalent 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.]
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