HMO and PPO Updates May Commercial Results

Transcription

1 HMO and PPO Updates May Commercial Results ELIQUIS Non Triple Tier Formular y 4th Tier Applicable Traditional Alternatives warfarin, Xarelto, Pradaxa TAMIFLU - EXPANDED INDICATION 2 No 2 No No None JUXTAPID Pending atorvastatin, simvastatin, Zetia, Crestor* VASCEPA 3 No 2 No Yes BOTOX/BOTOX COSMETIC *NEW INDICATION* Medical EDURANT 3 Yes 2 No Yes 4 Capsules per Day 1 tablet per day atorvastatin, fenofibrate, fluvastatin, gemfibrozil, lovastatin, pravastatin, simvastatin, Niaspan, Tricor, Trilipix, Lovaza oxybutynin, oxybutynin XL, tolterodine, trospium, Vesicare, Intelence, nevirapine, Rescriptor, Sustiva

2 HMO and PPO Updates May Commercial Results Triple Tier Formular y 4th Tier Applicable Traditional EXJADE *NEW INDICATION* 3 Yes 2 Yes No None KAZANO 3 No 2 Yes No NESINA 3 No 2 Yes No OSENI 3 No 2 Yes No POMALYST 3 Yes 2 Yes Yes AUVI-Q 2 No 2 No Yes ABILIFY MAINTENA Medical 21 tablets per 28 days 2 autoinjectors per fill Alternatives pioglitazone, Januvia*, Janumet, Janumet XR pioglitazone, Januvia*, Janumet, Janumet XR pioglitazone, Januvia*, Janumet, Janumet XR Revlimid, Thalomid EpiPen Abilify, olanzapine, quetiapine, Seroquel XR, risperidone, ziprasidone

3 HMO and PPO Updates May Commercial Results Triple Tier Formular y 4th Tier Applicable Traditional Alternatives ZORTRESS 3 Yes 2 Yes No azathioprine, mycophenolate mofetil, Gengraf, Rapamune, tacrolimus, Cellcept, Prograd, Neoral, Sandimmune JETREA Medical None KADCYLA Medical Tykerb, Xeloda STIVARGA *NEW INDICATION* 3 Yes 2 Yes Yes 120 per 30 days Gleevec, Sutent

4 GHP Family Member Updates May GHP Family Results GHP Family Tier Detailed Limits ABILIFY MAINTENA Medical Yes AUVI-Q No Yes 2 per fill EpiPen ELIQUIS Non Non No No Pradaxa (PA), Xarelto (PA) - PA = JETREA Medical Yes JUXTAPID Non Non No No Atorvastatin, Simvastatin, Zetia KADCYLA Medical Yes KAZANO Brand Yes No NESINA Brand Yes No OSENI Brand Yes No Tykerb and Xeloda (ST), metformin ER (ST), metformin ER (ST), metformin ER

5 GHP Family Member Updates May GHP Family Results GHP Family Tier Detailed Limits POMALYST Yes Yes VASCEPA Non Non ZORTRESS Brand Yes No 21 per 28 days Revlimid fenofibrate, gemfibrozil, lovastatin, mycophenolate, Gengraf, Rapamune

6 GOLD Member Updates May Part D (Gold) Updates $0 Deductible Standard 2013 y Limit AUVI-Q Brand Preferred 25% coinsurance No Yes 2 devices (1 box) per fill Epipen BOTOX/BOTOX COSMETIC *NEW INDICATION* ELIQUIS JETREA JUXTAPID Non Non Medical Non warfarin, Pradaxa, Xarelto atorvastatin, simvastatin, Zetia, Crestor KADCYLA Speciality KAZANO Non 25% coinsurance Yes No TYKERB METFORMIN, METFORMIN XR, PIOGLITAZONE, JANUVIA, JANUMET, JANUMET XR

7 $0 Deductible Standard 2013 y Limit VASCEPA Brand Non Preferred 25% coinsurance No Yes 120 capsules every 30 days atorvastatin, fenofibrate, fluvastatin, gemfibrozil, lovastatin, pravastatin, simvastatin, Lovaza, Niaspan, Trilipix

8 EDURANT $0 Deductible Standard y Limit 30 tablets every 30 days TAMIFLU - EXPANDED INDICATION 5 days supply every 6 months EXJADE *NEW INDICATION* ZORTRESS move to Speciality Tier for STIVARGA *NEW INDICATION* ABILIFY MAINTENA move to Speciality Tier for