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Select Drug Program® Formulary updates

March 2, 2015

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 DrugBrand DrugFormulary ChapterEffective Date
amlodipine-valsartanExforge®4. Heart, Blood Pressure, & CholesterolOctober 6, 2014
amoxicillin ERMoxatag® 1. Antibiotics & Other Drugs Used for InfectionAugust 18, 2014
entecavirBaraclude® 1. Antibiotics & Other Drugs Used for InfectionSeptember 8, 2014
fluorouracilCarac® 5. Skin MedicationsOctober 20, 2014
olopatadinePatanase® 6. Ear, Nose, Throat MedicationsOctober 27, 2014
testosterone*Fortesta®7. Diabetes, Thyroid, Steroids, & Other Miscellaneous HormonesSeptember 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 drugFormulary chapterEffective Date
Plegridy3. Pain, Nervous System, & PsychFebruary 1, 2015

Brand deletions

Effective April 1, 2015, this brand drug will be covered at the appropriate non-formulary level of cost-sharing:

Brand drugGeneric drugFormulary chapter
Prometrium®progesterone10. Female, Hormone Replacement, & Birth Control

The generic drug for the above brand drug is available at the generic formulary level of cost-sharing.

Effective April 1, 2015, this brand drug will be covered at the appropriate non-formulary level of cost-sharing:

Brand drugFormulary therapeutic alternativeFormulary chapter
Viagra®Cialis®13. Urinary & Prostate Meds

There is no generic equivalent for the above brand drug, however, there is a formulary therapeutic alternative drug. This therapeutic alternative drug is available at the appropriate formulary level of cost-sharing.


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