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Select Drug Program® Formulary updates

November 30, 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

calcipotriene

Dovonex? cream

5. Skin Medications

June 1, 2012

ciprofloxacin

Cetraxal?

6. Ear, Nose, Throat Medications

August 3, 2012

clindamycin/benzol peroxide

Duac?

5. Skin Medications

June 29, 2012

clozapine ODT

Fazaclo?

3. Pain, Nervous System, & Psych

September 7, 2012

desloratadine

Clarinex?

13. Allergy, Cough & Cold, Lung Meds

July 6, 2012

levalbuterol

Xopenex?

13. Allergy, Cough & Cold, Lung Meds

August 24, 2012

levonorgestrel

Plan B One-Step?

11. Female, Hormone Replacement, & Birth Control

July 20, 2012

montelukast sodium

Singulair?

13. Allergy, Cough & Cold, Lung Meds

August 10, 2012

pioglitazone

Actos?

7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones

August 20, 2012

pioglitazone hcl/
metformin hcl

Actoplus Met?

7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones

August 20, 2012

spinosad

NatrobaTM

5. Skin Medications

August 3, 2012

tolterodine tartrate

Detrol?

14. Urinary and Prostate Meds

June 29, 2012

Brand additions

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

Brand drug

Formulary chapter

Effective date

Betaseron?

9. Biotechnology

October 1, 2012

Travatan Z?

12. Eye Medications

July 13, 2012

Xifaxan 550mg?

1. Antibiotics & Other Drugs Used for Infection

August 1, 2012

Brand deletions

These brand drugs will be covered at the appropriate non-formulary level of cost-sharing:

Effective January 1, 2013.

Brand drug

Generic drug

Formulary chapter

Actoplus Met?

pioglitazone hcl/metformin hcl

7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones

Actos?

pioglitazone

7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones

Dovonex? cream

calcipotriene

5. Skin Medications

Singulair?

montelukast sodium

13. Allergy, Cough & Cold, Lung Meds

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


This brand drug will be covered at the appropriate non-formulary level of cost-sharing:

Effective January 1, 2013.

Brand drug

Formulary therapeutic alternative

Formulary chapter

Humatrope?

Norditropin?

7. Diabetes, Thyroid, Steroids, & Other Miscellaneous Hormones

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