TitleWeb Select Drug Program® Formulary updates
Professional; Facility; Ancillary
March 1, 2012
Page Content [ 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:
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Amethia Lo, Camrese Lo
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LoSeasoniqueTM
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11. Female, Hormone
Replacement, Birth Control
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December 12, 2011
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atorvastastin/amlodipine
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Caduet®
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4. Heart, Blood Pressure, &
Cholesterol
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November 12, 2011
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eprosartan
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Teveten®
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4. Heart, Blood Pressure, &
Cholesterol
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December 23, 2011
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flucytosine
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Ancobon®
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1. Antibiotics & Other Drugs
Used for Infection
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November 4, 2011
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lamivudine
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Epivir®
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1. Antibiotics & Other Drugs
Used for Infection
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December 12, 2011
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lamivudine/zidovudine
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Combivir®
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1. Antibiotics & Other Drugs
Used for Infection
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December 30, 2011
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methylphenidate ER
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Ritalin LA®
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3. Pain, Nervous System, &
Psych
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December 23, 2011
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morphine extended-release
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Kadian®
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3. Pain, Nervous System, &
Psych
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November 11, 2011
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olanzapine
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Zyprexa®
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3. Pain, Nervous System, &
Psych
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October 21, 2011
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olanzapine ODT
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Zyprexa Zydis®
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3. Pain, Nervous System, &
Psych
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October 21, 2011
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tramadol ER
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Ryzolt®
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3. Pain, Nervous System, &
Psych
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December 23, 2011
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trimipramine
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Surmontil®
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3. Pain, Nervous System, &
Psych
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November 18, 2011
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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:
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CompleraTM
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1. Antibiotics & Other Drugs
Used for Infection
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January 1, 2012
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Lotemax® opthalmic
ointment
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12. Eye Medications
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January 1, 2012
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Tamiflu® 6mg/ml
suspension
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1. Antibiotics & Other Drugs
Used for Infection
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January 1, 2012
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Brand deletions
Effective April 1, 2012, these brand
drugs will be covered at the appropriate non-formulary level of
cost-sharing:
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Combivir®
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lamivudine/zidovudine
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1. Antibiotics & Other Drugs
Used for Infection
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Epivir®
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lamivudine
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1. Antibiotics & Other Drugs
Used for Infection
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Zyprexa®
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olanzapine
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3. Pain, Nervous System, &
Psych
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Zyprexa Zydis®
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olanzapine ODT
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3. Pain, Nervous System, &
Psych
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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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