CENTERLIGHT PACE FORMULARY GUIDE

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "CENTERLIGHT PACE FORMULARY GUIDE"

Transcription

1 As an alternative to a (left column) choose a Formulary medication (right column) ACTONEL (risedronate) ALPHAGAN (brimonidine) ALTABAX (retapamulin) ALVESCO (ciclesonide) ARICEPT 23 (donepezil) ASTEPRO (azelastine) BRIMONIDINE, APRCLONIDINE, DIPIVEFRIN GENTAMICIN, MUPIROCIN PULMICORT FLEXHALER, ASMANEX DONEPEZIL, GALANTAMINE, RIVASTIGMINE AZELASTINE ATELVIA (risedronate 35mg) AZILECT (rasagiline mesylate) AZOR (amlodipine/olmesartan) BECONASE AQ (beclomethasone) ALENDRONATE, IBANDRONATE, EVISTA SELEGILINE AMLODIPINE BESYLATE/BENAZEPRIL HYDROCHLORIDE, LISINOPRIL/HCTZ, LOSARTAN/HCTZ, QUINAPRIL/HCTZ FLUNISOLIDE, FLUTICASONE, TRIAMCINOLONE BENICAR (olmesartan) BENICAR HCT (olmesartan HCT) BONIVA INJ (ibandronate) BROMDAY (bromfenac) BROVANA (arformoterol neb) BUTRANS (buprenorphine patch) LOSARTAN, EPROSARTAN, IRBESARTAN, VALSARTAN LOSARTAN/ HCTZ, EPROSARTAN /HCTZ, VALSARTAN/HCTZ BROMFENAC, DICLOFENAC, FLURBIPROFEN ALBUTEROL NEB BUPRENORPHINE SL TAB, BUPRENEX INJ

2 As an alternative to a (left column) choose a Formulary medication (right column) BYSTOLIC (nebivolol) CARAFATE SUSP (sucralfate) METOPROLOL,, BETAXOLOL, BISOPROLOL SUCRALFATE CARISOPRODOL CYCLOBENZAPRINE CLOBEX (clobetasol) CLOBETASOL COREG CR (carvedilol) CARVEDILOL, LABETOLOL CYPROHEPTADINE HCL LEVOCETIRIZINE, CLEMASTINE DOVONEX CR (calcipotriene) CALCIPOTRIENE ERTACZO CR (sertaconazole ) ESTRACE CR (estradiol) EXFORGE (amlodipine/valsartan) EXFORGE HCT (amlodipine/valsartan/hct) FINACEA (azelaic acid) ECONAZOLE NITRATE ESTRADIOL(TAB, PATCH, VALERATE INJ.), PREMARIN CR AMLODIPINE BES/BENAZEPRIL HCL, TEKAMLO (amlodipine/aliskeran) AMLODIPINE BES/BENAZEPRIL HCL, TEKAMLO (amlodipine/aliskeran), LISINOPRIL/HCT, QUINAPRIL/HCT, LOSARTAN/HCT TRETINOIN, AVITA FLOVENT DISKUS (fluticasone) PULMICORT FLEXHALER (budesonide), ASMANEX (mometasone)

3 As an alternative to a (left column) choose a Formulary medication (right column) FLOVENT HFA (fluticasone) PULMICORT FLEXHALER (budesonide), ASMANEX (mometasone) FOSAMAX PLUS D (alendronate plus D) GRALISE TAB (gabapentin) GABAPENTIN 300mg CAP, 600mg TAB HYDROXYZINE PAMOATE JALYN (dutasteride/tamsulosin) LEVOCETIRIZINE, CLEMASTINE TAMSULOSIN HCL, DUTASTERIDE, FINASTERIDE, UROXATRAL(alfuzosin) KOMBIGLYZE XR (metformin/saxagliptan) LASTACAFT (alcaftadine) LEVEMIR (insulin detemir) JANUMET, JANUVIA, TRADJENTA, METFORMIN PATADAY(olopatadine 0.2%), PATANOL (olopatadine o.1%) LANTUS (insulin glargine) LIALDA (mesalamine) ASACOL (mesalamine), CANASA (mesalamine) LIVALO (pitavastatin) ATORVASTATIN, SIMVASTATIN, PRAVASTATIN LUMIGAN (bimatoprost ) DORZOLAMIDE HCL, AZOPT, COMBIGAN LUNESTA (eszopiclone) ZOLPIDEM TARTRATE

4 As an alternative to a (left column) choose a Formulary medication (right column) MICARDIS (telmisartan) LOSARTAN, EPROSARTAN, IRBESARTAN, VALSARTAN MICARDIS HCT (telmisartan hct) LOSARTAN/ HCTZ, EPROSARTAN /HCTZ, VALSARTAN/HCT NAFTIN (naftifine) CLOTRIMAZOLE, NYSTATIN, KETOCONAZOLE,CICLOPIROX,ECONAZOLE NAPRELAN (naproxen) NASONEX (mometasone furoate) NAPROXEN, IBUPROFEN FLUTICASONE, TRIAMCINOLONE NEXIUM (esomeprazole) OMEPRAZOLE, PANTOPRAZOLE, LANSOPRAZOLE NOVOLIN (insulin isophane NPH/insulin regular) NOVOLIN N (insulin isophane NPH) HUMULIN HUMULIN N NOVOLIN R (insulin regular) HUMULIN R NUCYNTA (tapentadol) TRAMADOL ONGLYZA (saxagliptan) JANUVIA (sitagliptan), TRADJENTA (linagliptan) PANCREAZE (pancrelipase) CREON, ZENPEP

5 As an alternative to a (left column) choose a Formulary medication (right column) PATANASE (olopatadine 0.6% nasal) AZELASTINE PERFOROMIST (formoterol for neb) FORADIL (formoterol aerolizer dry powder caps) PROLIA (denosumab) PROVENTIL HFA (albuterol) PROAIR (albuterol), VENTOLIN HFA (albuterol) QVAR (beclomethasone diproprionate) PULMICORT FLEXHALER (budesonide), ASMANEX (mometasone) RAPAFLO (silodosin) TAMSULOSIN HCL,, UROXATRAL (alfuzosin) SANCTURA XR (trospium) OXYBUTYNIN, TROSPIUM CHLORIDE, DETROL LA (tolterodine), Enablex (darifenacin),toviaz (fesoterodine) SYMBICORT (budesonide/formoterol) ADVAIR (fluticasone/salmeterol), DULERA (mometasone/formoterol) TACLONEX (calcipotriene/ betamethasone diprop) TRICOR (fenofibrate 45mg, 145mg) CALCIPOTRIENE, SELENIUM SULFIDE FENOFIBRATE (67mg,134mg,200mg cap,54mg 160mg tab), GEMFIBROZIL TRILIPIX (fenofibric acid 45mg, 135mg) FENOFIBRATE (67mg,134mg,200mg cap,54mg 160mg tab), GEMFIBROZIL TWYNSTA (amlodipine/telmisartan) AMLODIPINE BESYLATE/BENAZEPRIL HYDROCHLORIDE, TEKAMLO (amlodipine/aliskeran)

6 As an alternative to a (left column) choose a Formulary medication (right column) VANOS CR (fluocinonide) FLUOCINONIDE VERAMYST (fluticasone) FLUTICASONE, TRIAMCINOLONE VYTORIN (simvastatin/ezetimibe) ZETIA, ATORVASTATIN, SIMVASTATIN, PRAVASTATIN, LOVASTATIN XOPENEX NEB (levalbuterol) LEVALBUTEROL, ALBUTEROL Generic drugs are medications with the same active ingredients as their brand-name counterparts. The FDA requires generics to be identical to a brand-name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use. Generic drugs are chemically identical to their branded counterparts and are typically sold at substantial discounts from the branded price. According to the Congressional Budget Office, generic drugs save consumers an estimated $8 to $10 billion a year. In some cases, the same manufacturer makes both a brand-name and generic version of the same medication and half of all generic drugs are manufactured by the same facilities that make the equivalent branded products.

WV Public Employees Insurance Agency (PEIA)

WV Public Employees Insurance Agency (PEIA) Approved Changes for Plan Year 2013 (July 1, 2012 June 30, 2013) The WV PEIA Finance Board recommended several changes to the PEIA PPB Plan structure for the upcoming fiscal year, effective July 1, 2012,

More information

2014 Valley Baptist Medicare D Formulary Step Therapy Criteria

2014 Valley Baptist Medicare D Formulary Step Therapy Criteria 2014 Valley Baptist Medicare D Formulary Step Therapy Products Affected ACTONEL TAB Last Updated 11/1/2014 Requires a trial of alendronate. 1 APLENZIN TAB Patient must have tried bupropion SR or bupropion

More information

Medications Requiring Prior Authorization for Medical Necessity

Medications Requiring Prior Authorization for Medical Necessity January 2015 Medications Requiring Medical Necessity Below is a list of medicines by drug class that will not be covered without a prior authorization for medical necessity, effective January 1, 2015.

More information

Formulary Drug Removals

Formulary Drug Removals January 2015 Below is a list of medicines by drug class that have been removed from your plan s formulary. This list is effective January 1, 2015. If you continue using one of the drugs listed below and

More information

Plan Year Allegian Advantage (HMO) Step Therapy Criteria (ST)

Plan Year Allegian Advantage (HMO) Step Therapy Criteria (ST) Plan Year 2015 Allegian Advantage (HMO) Step Therapy (ST) Step Therapy: In some cases, Allegian Advantage requires you to first try certain drugs to treat your medical condition before we will cover another

More information

UnitedHealthcare Group Medicare Advantage (PPO)

UnitedHealthcare Group Medicare Advantage (PPO) Your Plan Explained UnitedHealthcare Group Medicare Advantage (PPO) UHEX11MP3230855_001 Y0066_100616_09113 Your Medicare. This brochure explains your Medicare Advantage plan, a type of health plan also

More information

Price Increases for Brand Name Prescription Drugs Since October 2012

Price Increases for Brand Name Prescription Drugs Since October 2012 Price Increases for Brand Name Prescription Drugs Since October 2012 Medication and Dose * * ABILIFY 1 MG/ML SOLUTION $4.15 $6.32 52.32% ABILIFY 10 MG TABLET $18.76 $29.12 55.25% ABILIFY 15 MG TABLET $18.70

More information

GEORGIA MEDICAID FEE-FOR-SERVICE ASTHMA and COPD AGENTS PA SUMMARY

GEORGIA MEDICAID FEE-FOR-SERVICE ASTHMA and COPD AGENTS PA SUMMARY GEORGIA MEDICAID FEE-FOR-SERVICE ASTHMA and COPD AGENTS PA SUMMARY Preferred Anticholinergics and Combinations Atrovent HFA (ipratropium) Combivent Respimat (ipratropium/albuterol) Ipratropium neb inhalation

More information

612 Program Midtown Express Pharmacy

612 Program Midtown Express Pharmacy ALENDRONATE SOD TAB 35MG (max 1 per week) $37.00 $70.00 ALENDRONATE SOD TAB 70MG (max 1 per week) $37.00 $70.00 ALLOPURINOL TAB 100MG $20.00 $38.00 ALLOPURINOL TAB 300MG $20.00 $38.00 AMITRIPTYLINE TAB

More information

Avoid paying too much for your prescriptions 2015 Aetna Rx Step Program Medicine List

Avoid paying too much for your prescriptions 2015 Aetna Rx Step Program Medicine List Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Avoid paying too much for your prescriptions 2015 Aetna Rx Step Program Medicine List 05.03.392.1 C (10/14) It

More information

Avoid paying too much for your prescriptions

Avoid paying too much for your prescriptions Quality health plans & benefits Healthier living Financial well-being Intelligent solutions 2016 Aetna Rx Step Program Medicine List Avoid paying too much for your prescriptions It s important to try to

More information

2015 Medicare Part D Step Therapy Requirements. Effective: November 01, 2015

2015 Medicare Part D Step Therapy Requirements. Effective: November 01, 2015 2015 Medicare Part D Step Therapy Requirements Effective: November 01, 2015 Formulary ID 15293, Version 17 Last Updated: 10/27/2015 BISPHOSPHONATE THERAPY ACTONEL 30 MG TABLET ACTONEL 35 MG TABLET ACTONEL

More information

AETNA BETTER HEALTH Prior Authorization guidelines for Step Therapy

AETNA BETTER HEALTH Prior Authorization guidelines for Step Therapy AETNA BETTER HEALTH Prior Authorization guidelines for Step Therapy Definition A form of automated Prior Authorization whereby one or more prerequisite medications, which may or may not be in the same

More information

Wadley Regional Medical Center Automatic Therapeutic Substitutions, Updated 4/15/2015

Wadley Regional Medical Center Automatic Therapeutic Substitutions, Updated 4/15/2015 Albuterol HFA Proair/Proventil/Ventolin Albuterol 2.5 mg/3 ml nebulized Albuterol Tablets Albuterol Liquid, same dose Almotriptan 6.25-12.5 mg Axert Sumatriptan 50 mg Alosetron PO Lotronex Ondansetron

More information

How to use your pharmacy benefits for better health

How to use your pharmacy benefits for better health cholestyramine fenofibrate gemfibrozil lovastatin pravastatin sodium simvastatin Crestor Niaspan Simcor Tricor Vytorin Frequently Asked Questions about Preventive Care Drugs High Cholesterol alendronate

More information

MEDICATION(S) SUBJECT TO STEP THERAPY

MEDICATION(S) SUBJECT TO STEP THERAPY ACE/ARB COMBO AZOR 5-20 MG TABLET, AZOR 5-40 MG TABLET, BENICAR HCT, MICARDIS HCT, TARKA, TEKTURNA HCT, TELMISARTAN-HYDROCHLOROTHIAZID, TRIBENZOR Claims for formulary step 2 ACE Inhibitor combination products

More information

Members enjoy more Pharmacy savings *

Members enjoy more Pharmacy savings * Sam s Plus Members enjoy more Pharmacy savings 5 prescription drugs available for FREE Generic medications: Donepezil, Pioglitazone, Escitalopram, Finasteride and Vitamin D2 50,000IU are $ 0 for a 30-day

More information

Formulary Drug Removals

Formulary Drug Removals January 2016 Below is a list of medicines by drug class that have been removed from your plan s formulary. This list is effective January 1, 2016. If you continue using one of the drugs listed below and

More information

2016 Step Therapy Criteria

2016 Step Therapy Criteria 2016 Step Therapy Criteria ANGIOTENSIN RECEPTOR BLOCKERS... 8 benazepril... 8 benazepril/amlodipine besylate... 8 benazepril/hctz... 8 captopril... 8 captopril/hctz... 8 enalapril... 8 enalapril maleate/hctz...

More information

Trinity Clinic Whitehouse Automatic Refill Policy April, 2007

Trinity Clinic Whitehouse Automatic Refill Policy April, 2007 Trinity Clinic Whitehouse Automatic Refill Policy April, 2007 Overview The following pages contain details on how to administer our automatic refill policy. Our intent is to streamline, standardize and

More information

PEBTF Drug List. July 2013 PLAN MEMBER HEALTH CARE PROVIDER

PEBTF Drug List. July 2013 PLAN MEMBER HEALTH CARE PROVIDER July 2013 PEBTF Drug List The PEBTF Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered the first line of prescribing.

More information

The 365-day period begins with the first dispensing transaction for each Ontario Drug Benefit (ODB) recipient on or after October 1, 2015.

The 365-day period begins with the first dispensing transaction for each Ontario Drug Benefit (ODB) recipient on or after October 1, 2015. Ontario Public Drug Programs, Ministry of Health and Long-Term Care Chronic-use Medications List by In accordance with subsection 18 (11.1) of Ontario Regulation 201/96 made under the Ontario Drug Benefit

More information

QUANTITY LIMITS TABLE

QUANTITY LIMITS TABLE S TABLE / TABLA DE ABILIFY ARIPIPRAZOLE ORAL SOLUTION 900 ML IN 30 DAYS ABILIFY DISCMELT 10 MG ARIPIPRAZOLE TAB RAPDIS 30 TABS IN 30 DAYS ABILIFY DISCMELT 15 MG ARIPIPRAZOLE TAB RAPDIS 60 TABS IN 30 DAYS

More information

Pharmacy and Therapeutics Committee-approved Therapeutic Interchange

Pharmacy and Therapeutics Committee-approved Therapeutic Interchange Therapeutic Interchanges Therapeutic Interchange Revision Date Alpha Blockers 08/11 Alpha Reductase Inhibitors 05/16 ACE Inhibitors 08/11 Angiotensin Receptor Blockers 08/11 Buprenorphine 09/11 Calcium

More information

SAVE ON MEDICAL SERVICES and PRESCRIPTION DRUGS for ongoing conditions

SAVE ON MEDICAL SERVICES and PRESCRIPTION DRUGS for ongoing conditions SAVE ON MEDICAL SERVICES and PRESCRIPTION DRUGS for ongoing conditions With Dickinson College s Value Based Insurance Design (VBID) If you have an ongoing condition, you can live well. You will need to

More information

Formulary Drug Removals

Formulary Drug Removals July 2016 Below is a list of medicines by drug class that have been removed from your plan s formulary. If you continue using one of the drugs listed below and identified as a Removal, you may be required

More information

Medications Requiring Prior Authorization for Medical Necessity

Medications Requiring Prior Authorization for Medical Necessity Medications Requiring Prior Medical Necessity July 2016 Below is a list of medicines by drug class that will not be covered without a prior authorization for medical necessity. If you continue using one

More information

Preferred Drug List. January 2014 PLAN MEMBER HEALTH CARE PROVIDER

Preferred Drug List. January 2014 PLAN MEMBER HEALTH CARE PROVIDER January 2014 Preferred Drug List The Preferred Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered the first line

More information

Performance Drug List

Performance Drug List January 2014 Performance Drug List The CVS Caremark Performance Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered

More information

Pharmacy Management Drug Policy

Pharmacy Management Drug Policy PAGE: Page 1 of 9 DESCRIPTION: Step Therapy encourages use of safe, cost-effective medications within different therapeutic drug categories. The entry of new generics and cost-effective therapeutic alternatives

More information

NALC Health Benefit Plan Formulary Drug List

NALC Health Benefit Plan Formulary Drug List NALC Health Benefit Plan Formulary Drug List January 2014 The NALC Health Benefit Plan Formulary Drug List is a guide within select therapeutic categories for clients, plan members and health care providers.

More information

Contraceptives Available at no Cost to HealthChoice Members. HealthChoice Basic and Basic Alternative Plan Changes for 2015. Ambulance Services

Contraceptives Available at no Cost to HealthChoice Members. HealthChoice Basic and Basic Alternative Plan Changes for 2015. Ambulance Services FALL 2014 Contraceptives Available at no Cost to HealthChoice Members Effective immediately, medroxyprogesterone acetate (J1050) and Skyla (J7301) are available at no cost to HealthChoice members. The

More information

Drug Cost Estimates Generics

Drug Cost Estimates Generics Cost Estimates Generics Note: The retail pharmacy prices displayed below are estimates only. The actual price of your prescription W/ CODEINE TAB 300-30 MG ACYCLOVIR TAB 400 MG ALBUTEROL INHAL AEROSOL

More information

Members enjoy more Pharmacy savings *

Members enjoy more Pharmacy savings * Sam s Plus Members enjoy more Pharmacy savings 5 prescription drugs available for FREE Generic medications: Donepezil, Pioglitazone, Escitalopram, Finasteride and Vitamin D2 50,000IU are $ 0 for a 30-day

More information

Monthly Copays. Medications must be tried for 30 days before ordering through Aspire Indiana CanaRx.

Monthly Copays. Medications must be tried for 30 days before ordering through Aspire Indiana CanaRx. Introduction: Aspire Indiana CanaRx is an international mail order option for eligible Employees and their Dependents of Aspire Indiana, Inc. For your convenience, a list of eligible medications is located

More information

Aetna 2015 Formulary updates for self insured and custom fully insured commercial plans

Aetna 2015 Formulary updates for self insured and custom fully insured commercial plans Key: #- ; $0^-Health Care Reform Zero-Dollar; OTC-Over-the-Counter abacavir PB SPB Moved to Specialty abacavir/lamivudine/ PB SPB Moved to Specialty zidovudine ABILIFY (PA, ST) 3 3 olanzapine, quetiapine,

More information

Members enjoy more Pharmacy savings *

Members enjoy more Pharmacy savings * Sam s Plus Members enjoy more Pharmacy savings 5 prescription drugs available for FREE Generic medications: Donepezil, Pioglitazone, Escitalopram, Finasteride and Vitamin D2 50,000IU are $ 0 for a 30-day

More information

Performance Drug List

Performance Drug List October 2015 Performance Drug List The CVS/caremark Performance Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered

More information

Attached is updated information for HEDIS 2015 specifications relating to Respiratory Conditions:

Attached is updated information for HEDIS 2015 specifications relating to Respiratory Conditions: TO: Providers to FHCP Members FROM: FHCP Quality Management RE: Update on HEDIS Quality Measures for 2015 FHCP follows current clinical practice guidelines and we are monitored by HEDIS (Healthcare Effectiveness

More information

Performance Drug List

Performance Drug List January 2016 Performance Drug List The CVS/caremark Performance Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered

More information

Excluded Drug List. Drug Class Excluded Product Clinical Alternative(s) ABSORICA ONEXTON GEL ANDRODERM FORTESTA VOGELXO BRINTELLIX DESVENLAFAXINE ER

Excluded Drug List. Drug Class Excluded Product Clinical Alternative(s) ABSORICA ONEXTON GEL ANDRODERM FORTESTA VOGELXO BRINTELLIX DESVENLAFAXINE ER Value Formulary Excluded Drug List Catamaran offers diverse formulary alternatives that help our clients select what works best for them. The Value Formulary is a partially-closed formulary that excludes

More information

FEATURED GENERIC DRUG LIST

FEATURED GENERIC DRUG LIST FREE 30 DAY SUPPLY ON SELECT PRENATALS AND FLUORIDE SUPPLEMENTS Annual enrollment fee of $10 per family applies. SM *** -- A -- ACYCLOVIR 400 MG TABLET 60 180 ALBUTEROL SULFATE 2 MG/5 ML SYRUP 90 270 ALBUTEROL

More information

Effective January 1, 2016

Effective January 1, 2016 Effective January 1, 2016 CONTENTS Prescription Benefit Changes...2 2016 Prescription Drug Benefit Highlights...3 Comparing Your Options...4 Filling Your Prescriptions...4 Benefit Coverage Tiers...5 Prescription

More information

If your drug is not on the list just give us a call for a price. Ask us for details on how to avoid the higher deductible generic price.

If your drug is not on the list just give us a call for a price. Ask us for details on how to avoid the higher deductible generic price. If your drug is not on the list just give us a call for a price. Ask us for details on how to avoid the higher deductible generic price. FREE SHIPPING TO AL, CT, DE, FL, GA, IN, KS, MA, MO, MS, NC, NH,

More information

2015 EMPIRE PLAN FLEXIBLE FORMULARY DRUG LIST Administered by CVS/caremark

2015 EMPIRE PLAN FLEXIBLE FORMULARY DRUG LIST Administered by CVS/caremark January 2015 2015 EMPIRE PLAN FLEXIBLE FORMULARY DRUG LIST Administered by CVS/caremark The Empire Plan Flexible Formulary is a guide within select therapeutic categories for enrollees and health care

More information

UMP Classic 2015 High Cost Generic Tier 2 Drug Program

UMP Classic 2015 High Cost Generic Tier 2 Drug Program UMP Classic 2015 High Cost Generic Tier 2 Program The listing below identifies select generic medications that are covered under Tier 2 coinsurance level and possible cost effective alternatives. For additional

More information

Extra Value Drug List. *

Extra Value Drug List. * List. * Brand Diabetes Levemir 100 units/ml Vial 10mL $122.29 Levemir FlexPen 100 units/ml 15mL $203.03 NovoLog 100 units/ml Vial 10mL $116.84 NovoLog FlexPen Syringe 15mL $222.41 NovoLog 100 units/ml

More information

Performance Drug List Change Summary Report Effective 01-01-2015 (Standard Drug List Reflects Removals)

Performance Drug List Change Summary Report Effective 01-01-2015 (Standard Drug List Reflects Removals) This report highlights all changes (additions, deletions and removals) to the CVS/caremark Performance Drug List. ADDITIONS: Brand Agents: Aranesp (darbepoetin alfa) Hematologic/ Hematopoietic Growth Factors

More information

Performance Drug List

Performance Drug List January 2015 Performance Drug List The CVS/caremark Performance Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered

More information

Medicare Part D. Take Control of Your Prescription Drug Costs. Inside: information you need to enroll.

Medicare Part D. Take Control of Your Prescription Drug Costs. Inside: information you need to enroll. 2010 Take Control of Your Prescription Drug Costs Medicare Part D Inside: information you need to enroll. IBPDP3179522_XACE000 C0009_PDP3179522_000 When you are ready to enroll: Call 1-866-804-3860, TTY

More information

BayCare Health System Drug List

BayCare Health System Drug List July 2016 BayCare Health System Drug List The BayCare Health System Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered

More information

PREFERRED GENERIC DRUG LIST

PREFERRED GENERIC DRUG LIST These discount programs are NOT health insurance policies and are not intended as a substitute for insurance. The programs do not qualify as a minimum creditable coverage under Massachusetts law or where

More information

2016 BlueChoice HealthPlan Prescription Drug List

2016 BlueChoice HealthPlan Prescription Drug List 2016 BlueChoice Healthlan rescription Drug List Important Information About This List This is not a comprehensive list of all drugs covered under your prescription drug benefit. Not all benefit plans cover

More information

PROJECT LIST GENERIC PRODUCTS

PROJECT LIST GENERIC PRODUCTS PROJECT LIST GENERIC PRODUCTS Acetylcysteine, Effervescent tablets 200 mg, 600 mg Alendronate sodium, Tablets 10, 70 mg Alfuzosin,Tablets 2.5mg Alfuzosin, ER Tablets 10 mg Ambroxol, Effervescent tablets

More information

Directory of Generic Medications Eligible for Rx Savings Program Flat Fees

Directory of Generic Medications Eligible for Rx Savings Program Flat Fees Directory of Generic Medications Eligible for Rx Savings Program Flat Fees CONNECTICUT VERSION If you re already enrolled in the FREE* Rx Savings Program, use this guide to find your best choices. And,

More information

ALTACE 5 MG CAPSULE $3.88 RAMIPRIL 5 MG CAPSULE $ $23.94 DILTIAZEM 24HR CD 120 MG CAP $29.35 DILTIAZEM 24HR CD 180 MG CAP

ALTACE 5 MG CAPSULE $3.88 RAMIPRIL 5 MG CAPSULE $ $23.94 DILTIAZEM 24HR CD 120 MG CAP $29.35 DILTIAZEM 24HR CD 180 MG CAP National (NADAC) Retail Pharmacies in the US Paid for Brand Name and Generic Medications in Based on the NADAC list for 9, Brand Name Medication ACTOS 15 MG $11.03 PIOGLITAZONE HCL 15 MG ACTOS 30 MG $16.80

More information

Your Choice Pharmacy Benefit Guide. Effective January 1, 2015. www.upmchealthplan.com

Your Choice Pharmacy Benefit Guide. Effective January 1, 2015. www.upmchealthplan.com Your Choice Pharmacy Benefit Guide Effective January, 205 www.upmchealthplan.com TABLE OF CONTENTS Your Choice Overview... Your Choice Contact Numbers... Understanding Coverage and Cost-Sharing... 2 About

More information

Asthma, COPD and Diabetes Preferred Drug List Medications

Asthma, COPD and Diabetes Preferred Drug List Medications GPI Name Dexamethasone Tab 0.5 MG Dexamethasone Tab 0.75 MG Dexamethasone Tab 1 MG Dexamethasone Tab 1.5 MG Dexamethasone Tab 2 MG Dexamethasone Tab 4 MG Dexamethasone Tab 6 MG Dexamethasone Elixir 0.5

More information

Monthly Copays. Union Copays Crestor 20MG - Tier 2,10% Eliquis 5mg - Tier 3, 20% Non-Union Copays Crestor 20MG - Tier 2, $25

Monthly Copays. Union Copays Crestor 20MG - Tier 2,10% Eliquis 5mg - Tier 3, 20% Non-Union Copays Crestor 20MG - Tier 2, $25 Introduction: MCSMeds is an international mail order option for eligible Employees, Retirees and Dependents of Muncie Community Schools. Your list of qualified maintenance medications is on the reverse.

More information

GEHA Drug List. July 2015 PLAN MEMBER HEALTH CARE PROVIDER

GEHA Drug List. July 2015 PLAN MEMBER HEALTH CARE PROVIDER July 2015 GEHA Drug List The GEHA Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered the first line of prescribing.

More information

DEPARTMENT OF ANESTHESIOLOGY Preoperative Medication Management Guidelines

DEPARTMENT OF ANESTHESIOLOGY Preoperative Medication Management Guidelines FMLH Preoperative Medication Management Guidelines DEPARTMENT OF ANESTHESIOLOGY Preoperative Medication Management Guidelines Purpose: To provide recommendations regarding medication management for patients

More information

2015 EMPIRE PLAN FLEXIBLE FORMULARY DRUG LIST Administered by CVS/caremark

2015 EMPIRE PLAN FLEXIBLE FORMULARY DRUG LIST Administered by CVS/caremark January 2015 2015 EMPIRE PLAN FLEXIBLE FORMULARY DRUG LIST Administered by CVS/caremark The Empire Plan Flexible Formulary is a guide within select therapeutic categories for enrollees and health care

More information

Burlington Scripts Vs. Current local purchase plan. Current Copays

Burlington Scripts Vs. Current local purchase plan. Current Copays Introduction: Burlington Scripts is a voluntary prescription drug program that is available to eligible Employees, Retirees and their Dependents of the Town of Burlington, MA. For your convenience, a list

More information

May 31, 2013. Ms. Debra Lansey American College of Physicians 190 North Independence Mall West Philadelphia, PA 19106

May 31, 2013. Ms. Debra Lansey American College of Physicians 190 North Independence Mall West Philadelphia, PA 19106 P.O. Box 30449 Salt Lake City, UT 84130-0449 May 31, 2013 Ms. Debra Lansey American College of Physicians 190 North Independence Mall West Philadelphia, PA 19106 Re: Pharmacy Benefit Coverage Changes Effective

More information

CalPERS Basic Plan Drug List

CalPERS Basic Plan Drug List July 2016 CalPERS Basic Plan Drug List The CalPERS Basic Plan Drug List contains non-specialty generic and preferred brand drugs for the outpatient prescription drug benefit program administered by CVS

More information

$10.00 PRESCRIPTION PROGRAM DETAILS

$10.00 PRESCRIPTION PROGRAM DETAILS $10.00 PRESCRIPTION PROGRAM DETAILS 1. The $10.00 program applies only to certain generic drugs at commonly prescribed 90 day usage dosages. (See list). 2. The Program may change without notification and

More information

Listing Updated: December 2007 ANALGESIC ANTI-INFECTIVE CARDIOVASCULAR

Listing Updated: December 2007 ANALGESIC ANTI-INFECTIVE CARDIOVASCULAR ANALGESIC NSAIDs Diclofenac Potassium Diclofenac Sodium Diflunisal Etodolac Fenoprofen Flurbiprofen Ibuprofen Indomethacin Indomethacin SR Ketoprofen Ketoprofen ER Ketorolac Meclofenamate Sod. Nabumetone

More information

Club Members save even more with the $4 Plus Plan!

Club Members save even more with the $4 Plus Plan! Club Members save even more with the $4 Plus Plan! ITEM DESCRIPTION Acephen Supp 650MG 12 Acetam Tab 325MG 30 90 Acyclovir Cap 200MG 30 90 Albuterol Syr 2MG/5ML 120 360 Albuterol Sulfate Nebulizer Ud Sol

More information

2015 new member prescription benefits program guide. putting your family first. MagnaCare Rx. we rise above. MagnaCareRx.com

2015 new member prescription benefits program guide. putting your family first. MagnaCare Rx. we rise above. MagnaCareRx.com 2015 new member prescription benefits program guide putting your family first. MagnaCare Rx 410 Peachtree Parkway Suite 4225 Cumming, Georgia 30041 member services: 888.975.0988 MagnaCareRx.com RxGRP 3381

More information

Drug Formulary Update, July 2014 Commercial and State Programs

Drug Formulary Update, July 2014 Commercial and State Programs Drug ormulary Update, July 2014 Commercial and State Programs Updates to the HealthPartners Drug ormularies are listed below. Changes start July 1 unless noted otherwise. Updates apply to all Commercial

More information

NEW MEMBERS GUIDE TO HEALTH NET HMO Important 2009 plan information for the Los Angeles Unified School District

NEW MEMBERS GUIDE TO HEALTH NET HMO Important 2009 plan information for the Los Angeles Unified School District NEW MEMBERS GUIDE TO HEALTH NET HMO Important 2009 plan information for the Los Angeles Unified School District WELCOME TO HEALTH NET! This guide is specifically geared to new HMO members. We know you

More information

Anthem Blue Cross and Blue Shield Medicaid: Pharmacy and Therapeutics Advisory Committee meeting

Anthem Blue Cross and Blue Shield Medicaid: Pharmacy and Therapeutics Advisory Committee meeting Anthem Blue Cross and Blue Shield Medicaid: Pharmacy and Therapeutics Advisory Committee meeting 1. Inhaled corticosteroids (ICS) VAC 4q14 Inhaled corticosteroids for asthma Reason for review: Category

More information

HMO and PPO Updates May 2013- Commercial Results

HMO and PPO Updates May 2013- Commercial Results HMO and PPO Updates May 2013- 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

More information

2015 Catamaran National Formulary Reference Guide. List of covered drugs

2015 Catamaran National Formulary Reference Guide. List of covered drugs 2015 Catamaran National Formulary Reference Guide List of covered drugs SHIP Drug Benefit If you have any questions about your SHIP drug benefit please contact: AIG Student Health Pharmacy Help Desk: 1-888-722-1668

More information

A Comparison of the Costs of Dispensing Prescriptions through Retail and Mail Order Pharmacies. Final Report to the NCPA Foundation

A Comparison of the Costs of Dispensing Prescriptions through Retail and Mail Order Pharmacies. Final Report to the NCPA Foundation A Comparison of the Costs of Dispensing Prescriptions through Retail and Mail Order Pharmacies Final Report to the NCPA Foundation February 2013 Norman V. Carroll, R.Ph., Ph.D. Professor of Pharmacoeconomics

More information

Network Health Insurance Corporation Upcoming Negative Changes to the Medicare Part D Formulary

Network Health Insurance Corporation Upcoming Negative Changes to the Medicare Part D Formulary Requesting an Exception to the Formulary You can ask Network Health Insurance Corporation to make an exception to our coverage rules. Generally, we will only approve your request for an exception if alternative

More information

United States. 2013 Land Line And Cell Phone Codebook Report. CHILD Asthma Call-Back Survey

United States. 2013 Land Line And Cell Phone Codebook Report. CHILD Asthma Call-Back Survey ACBS_2013_CHILD_PUBLIC_LLCP United States 2013 Land Line And Cell Phone Codebook Report CHILD Asthma Call-Back Survey April 29, 2015 STATE FIPS CODE Column: 1-2 Description: STATE FIPS CODE. SAS Variable

More information

VIVA Health Custom Drug List

VIVA Health Custom Drug List April 2016 VIVA Health Custom Drug List The VIVA Health Custom Drug List is a guide within select therapeutic categories for clients, plan members and health care providers. Generics should be considered

More information

NSAIDs* OPIOIDS, EXTENDED RELEASE SHORT ACTING NARCOTIC ANALGESICS NEUROPATHIC PAIN ANTI-INFECTIVE TETRACYCLINES CEPHALOSPORINS, 3RD GENERATION

NSAIDs* OPIOIDS, EXTENDED RELEASE SHORT ACTING NARCOTIC ANALGESICS NEUROPATHIC PAIN ANTI-INFECTIVE TETRACYCLINES CEPHALOSPORINS, 3RD GENERATION Diclofenac Potassium Diclofenac Sodium Diflunisal Etodolac Flurbiprofen Ibuprofen Indomethacin Indomethacin SR Ketoprofen * COX-2 specific NSAIDs require PA. *Generic for MS Contin and Kadian TOPICAL NSAIDs

More information

Retail Prescription Program Drug List

Retail Prescription Program Drug List Retail Prescription Program Drug List Price Matters New Men s Health Category Convenience Free Home Delivery Our 4 prescriptions have saved our customers over 3 billion The program is available to everyone,

More information

Glucocorticoids, Inhaled Therapeutic Class Review (TCR) February 7, 2012

Glucocorticoids, Inhaled Therapeutic Class Review (TCR) February 7, 2012 Glucocorticoids, Inhaled Therapeutic Class Review (TCR) February 7, 2012 No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying,

More information

Pharmacy Savings Program

Pharmacy Savings Program Pharmacy Savings Program SELECT GENERICS DRUG LIST The Pharmacy Savings Program provides you with savings on select generic medications included on this list. The prices for these select generic medications

More information

BlueSaver Generic Preventive Care Drug Program List

BlueSaver Generic Preventive Care Drug Program List An independent licensee of the Blue Cross and Blue Shield Association. BlueSaver Generic Preventive Care Drug Program List Preventive care drugs are drugs that can help keep you from developing a health

More information

First Choice Pharmacy Benefit Guide. Effective January 1, 2015. www.upmchealthplan.com

First Choice Pharmacy Benefit Guide. Effective January 1, 2015. www.upmchealthplan.com First Choice Pharmacy Benefit Guide Effective January, 205 www.upmchealthplan.com TABLE OF CONTENTS First Choice Overview... First Choice Contact Numbers... Understanding Coverage and Cost-sharing...

More information

CareATC Generic Formulary Medications Available (2015)

CareATC Generic Formulary Medications Available (2015) Allergic Reactions EPINEPHRINE** Ephinephrine, EpiPen CETIRIZINE 10MG Zyrtec FEXOFENADINE180MG TABS 100ct Allegra Allergies LORATADINE 10MG Claritin MONTELUKAST 4MG 30CT Singulair PROMETHAZINE 25MG AMP

More information

Stacie L. Penkova, PharmD, MHSA, BCPS Clinical Pharmacy Manager Critical Care Pharmacy Specialist Drug Information Coordinator Pharmacology Summit

Stacie L. Penkova, PharmD, MHSA, BCPS Clinical Pharmacy Manager Critical Care Pharmacy Specialist Drug Information Coordinator Pharmacology Summit Stacie L. Penkova, PharmD, MHSA, BCPS Clinical Pharmacy Manager Critical Care Pharmacy Specialist Drug Information Coordinator Pharmacology Summit July 26, 2014 Objectives Classify asthma by severity Prescribe

More information

MEDICATION INFORMATION: CONTROLLER MEDICATIONS

MEDICATION INFORMATION: CONTROLLER MEDICATIONS FRANK J. TWAROG, M.D., Ph.D. CURTIS T. MOODY, M.D. ADULT AND PEDIATRIC ASTHMA AND ALLERGIES Brookline Concord (617) 735-8750 (978) 369-3567 MEDICATION INFORMATION: CONTROLLER MEDICATIONS Asthma medications

More information

$4, 30-day $10, 90-day

$4, 30-day $10, 90-day $4 Prescriptions - Choose from hundreds of generic drugs and over the counter medications. Free Home Delivery Mailed right to your home Free shipping Prescription Program includes up to a 30-day supply

More information

Effective January 1,

Effective January 1, nafcillin sodium Cimzia Starter Kit oxacillin sodium Humira penicillin v potassium Humira Pen penicillin G potassium Humira Pen-crohns Diseasestarter January 2014 piperacillin sodium/ tazobactam Humira

More information

Your Guide to Saving Money on Prescriptions

Your Guide to Saving Money on Prescriptions Your Guide to Saving Money on Prescriptions Low-cost prescriptions make a difference At Walmart, we don t think you should have to choose between groceries and the medicines you need. Our $4 prescriptions

More information

ADULT PATIENTS: Drug ordered Drug Supplied Exceptions. aluminum hydroxide + magnesium

ADULT PATIENTS: Drug ordered Drug Supplied Exceptions. aluminum hydroxide + magnesium The following interchanges have been implemented to ensure rational use of select drugs, to decrease drug expenditures, and to allow interpretation of orders when the strength or dosage form is not indicated

More information

Home Delivery Prescription Program Drug List

Home Delivery Prescription Program Drug List Home Delivery Prescription Program Drug List Low-cost prescriptions, right in your mailbox. Now you can have your generic prescriptions mailed right to your home, no matter where you live. Because we think

More information

2016 EMPIRE PLAN FLEXIBLE FORMULARY DRUG LIST Administered by CVS Caremark

2016 EMPIRE PLAN FLEXIBLE FORMULARY DRUG LIST Administered by CVS Caremark July 2016 2016 EMPIRE PLAN FLEXIBLE FORMULARY DRUG LIST Administered by CVS Caremark The Empire Plan Flexible Formulary is a guide within select therapeutic categories for enrollees and health care providers.

More information

Pharmacy Handbook For non-grandfathered members

Pharmacy Handbook For non-grandfathered members Pharmacy Handbook For non-grandfathered members Table of Contents Formulary... 2 Pharmacy Programs... 2 Mail Order Programs... 2 Injectable and High Cost Medications Program... 2 Step Therapy Program...

More information

Medications for Managing COPD in Hospice Patients. Jim Joyner, PharmD, CGP Director of Clinical Operations Outcome Resources

Medications for Managing COPD in Hospice Patients. Jim Joyner, PharmD, CGP Director of Clinical Operations Outcome Resources Medications for Managing COPD in Hospice Patients Jim Joyner, PharmD, CGP Director of Clinical Operations Outcome Resources Goal of medications in COPD Decrease symptoms and/or complications Reduce frequency

More information

Breath of Fresh Air. In Case of Emergency. Information, news and advice for improving asthma well-being

Breath of Fresh Air. In Case of Emergency. Information, news and advice for improving asthma well-being Information, news and advice for improving asthma well-being Volume 11, No. 2 Winter 2009 In Case of Emergency Have a plan. A plan to deal with an asthma attack is the best defense against the severe,

More information

The Weekly Mortar & Pestle

The Weekly Mortar & Pestle The Weekly Mortar & Pestle A Publication of Walgreens Health Initiatives March 6, 2008 A publication created especially for our clients and associates, delivering up-to-date information about brand-name

More information

Molina Healthcare of Ohio Prior Authorization (PA) List

Molina Healthcare of Ohio Prior Authorization (PA) List Molina Healthcare of Ohio Prior Authorization (PA) List Effective October 1, 2013 DRUG NAME PA CODE ALTERNATIVE DRUG / CRITERIA 8-MOP 10 MG CAPSULE CUTANEOUS T CELL LYMPHOMA ABSTRAL TAB SUBLING REQUEST

More information

PREFERRED GENERIC DRUG LIST

PREFERRED GENERIC DRUG LIST ALLERGIES & COLD AND FLU Preferred generic drugs MARCH 2013 supply* for $5 supply* for $10 and $15 * The day supply is based upon the average dispensing patterns for the specific drug and strength. 90-

More information