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Select Drug Program® Formulary updates

March 1, 2012

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The Select Drug Program Formulary 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

Amethia Lo, Camrese Lo

LoSeasoniqueTM

11. Female, Hormone Replacement, Birth Control

December 12, 2011

atorvastastin/amlodipine

Caduet®

4. Heart, Blood Pressure, & Cholesterol

November 12, 2011

eprosartan

Teveten®

4. Heart, Blood Pressure, & Cholesterol

December 23, 2011

flucytosine

Ancobon®

1. Antibiotics & Other Drugs Used for Infection

November 4, 2011

lamivudine

Epivir®

1. Antibiotics & Other Drugs Used for Infection

December 12, 2011

lamivudine/zidovudine

Combivir®

1. Antibiotics & Other Drugs Used for Infection

December 30, 2011

methylphenidate ER

Ritalin LA®

3. Pain, Nervous System, & Psych

December 23, 2011

morphine extended-release

Kadian®

3. Pain, Nervous System, & Psych

November 11, 2011

olanzapine

Zyprexa®

3. Pain, Nervous System, & Psych

October 21, 2011

olanzapine ODT

Zyprexa Zydis®

3. Pain, Nervous System, & Psych

October 21, 2011

tramadol ER

Ryzolt®

3. Pain, Nervous System, & Psych

December 23, 2011

trimipramine

Surmontil®

3. Pain, Nervous System, & Psych

November 18, 2011

Brand additions

These brand drugs were added to the formulary as of the date indicated below and are covered at the appropriate brand formulary level of cost-sharing:

Brand drug

Formulary chapter

Effective date

CompleraTM

1. Antibiotics & Other Drugs Used for Infection

January 1, 2012

Lotemax® opthalmic ointment

12. Eye Medications

January 1, 2012

Tamiflu® 6mg/ml suspension

1. Antibiotics & Other Drugs Used for Infection

January 1, 2012

Brand deletions

Effective April 1, 2012, these brand drugs will be covered at the appropriate non-formulary level of cost-sharing:

Brand drug

Generic drug

Formulary chapter

Combivir®

lamivudine/zidovudine

1. Antibiotics & Other Drugs Used for Infection

Epivir®

lamivudine

1. Antibiotics & Other Drugs Used for Infection

Zyprexa®

olanzapine

3. Pain, Nervous System, & Psych

Zyprexa Zydis®

olanzapine ODT

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.

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