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Select Drug Program® Formulary updates

June 1, 2016

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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
dutasteride/tamsulosin hclJalyn®13. Urinary & Prostate MedsNovember 23, 2015
imatinib mesylate*Gleevec®2. Cancer & Organ Transplant DrugsJanuary 25, 2016
lamotrigine odtLamictal® ODT3. Pain, Nervous System, & PsychNovember 2, 2015
linezolid susp*Zyvox® susp1. Antibiotics & Other Drugs Used for InfectionNovember 23, 2015
metoclopramide odtMetozolv® ODT8. Stomach, Ulcer, & Bowel MedsNovember 2, 2015
molindone hclMoban®3. Pain, Nervous System, & PsychNovember 23, 2015
nevirapine erViramune® XR1. Antibiotics & Other Drugs Used for InfectionNovember 16, 2015
norgestimate-ethinyl estradiolOrtho Tri-Cyclen Lo®10. Female, Hormone Replacement, & Birth ControlJanuary 11, 2016
olopatadine hcl 0.1%Patanol® 0.1%11. Eye MedicationsDecember 14, 2015
pramipexole er 2.25 mgMirapex® ER 2.25 mg3. Pain, Nervous System, & PsychNovember 30, 2015
repaglinide-metformin hclPrandimet?7. Diabetes, Thyroid, Steroids, & Other Miscellaneous HormonesNovember 23, 2015
tobramycin/nebulizerKitabis® Pak12. Allergy, Cough & Cold, Lung MedsNovember 9, 2015
*Generic requires prior authorization.

Brand additions

Effective July 1, 2016, this brand drug will be added to the formulary and covered at the appropriate brand formulary level of cost-sharing:

Brand drug Generic drug Formulary chapter
Cimzia®Not available9. Bone, Joint, & Muscle

Brand deletions

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

Brand drug Generic drug Formulary chapter
Gleevec®imatinib mesylate2. Cancer & Organ Transplant Drugs
Mirapex® ER 2.25 mgpramipexole er 2.25 mg3. Pain, Nervous System, & Psych
Ortho Tri-Cyclen Lo®norgestimate-ethinyl estradiol10. Female, Hormone Replacement, & Birth Control
Patanol® 0.1% olopatadine hcl 0.1% 11. Eye Medications

The generic drugs for the listed brand drugs are on our formulary and available at the generic formulary level of cost-sharing.

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

Brand drug Formulary therapeutic alternative Formulary chapter
Acanya® clindamycin phos-benzoyl perox 1%-5% gel 5. Skin Medications
Enbrel®† Cimzia®, Humira®9. Bone, Joint, & Muscle

Our preferred formulary tumor necrosis factor inhibitor will change from Enbrel® to Cimzia® effective July 1, 2016. Please note that your Independence patients who are currently receiving Enbrel® will not need a new prior authorization; however, they may be subject to a higher level of cost-sharing.

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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