For 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 drugs was effective at the time the drugs became
available in the marketplace:
|
|
|
|
Ferriprox®
|
Not available
|
Miscellaneous
|
November 23, 2011
|
JakafiTM
|
Not available
|
Cancer
|
November 18, 2011
|
Effective April 1, 2012, the
following drugs will be added to the list of drugs requiring prior
authorization. Members taking these drugs immediately prior to the effective
date are not affected:
|
|
|
Copegus®
|
ribavarin
|
Stomach, Ulcer, & Bowel Meds
|
Peg-Intron®
|
Not available
|
Stomach, Ulcer, & Bowel Meds
|
Pegasys®
|
Not available
|
Stomach, Ulcer, & Bowel Meds
|
Rebetol®
|
ribavarin
|
Stomach, Ulcer, & Bowel Meds
|
RibaPak®
|
ribavarin
|
Stomach, Ulcer, & Bowel Meds
|
Ribasphere®
|
ribavarin
|
Stomach, Ulcer, & Bowel Meds
|
RibaTab®
|
ribavarin
|
Stomach, Ulcer, & Bowel Meds
|
Drugs with quantity limits
Effective April 1, 2012, quantity
limits will be added for the following drugs:
|
|
|
Aciphex®
|
Not available
|
30 tabs
|
DexilantTM
|
Not available
|
30 caps
|
Nexium®
|
Not available
|
30 caps, packets
|
Prevacid®
|
lansoprazole
|
30 caps, tabs
|
Prilosec®
|
omeprazole
|
30 caps, tabs, packets
|
Protonix®
|
pantoprazole
|
30 tabs, packets
|
Zegerid®
|
Not available
|
30 caps, packets
|