Pending changes to the PriorityMedicare approved drug list
From time to time, we add drugs to or remove them from the
PriorityMedicare
SM approved drug list (formulary). We also may change their tier, which determines how much you pay for them. We make these changes based on the scientific evidence we have of their value in helping people get well and stay healthy.
If you are taking a drug that is being removed
If we remove drugs from the approved drug list during the year, we'll notify you of the change at least [60 days] before the date that the change becomes effective. The exceptions to this 60-day notice are when the FDA decides a drug is not safe, or if a drug manufacturer removes the drug from the market.
You may ask
PriorityMedicare to make an exception for you. We must make a decision within 72 hours of your request.
Contact us to make these requests at our regular member Customer Service numbers.
Current and pending changes to the approved drug list
KEY:
- PA = Prior authorization needed
- QL = Quantity limits apply
- ST = Step therapy (trying other drugs first) is required
Additions to the approved drug list:
| Drug Name |
Effective Date |
Tier |
Category |
| albuterol sulfate er |
02/01/2008
|
1
|
Respiratory tract agents |
albuterol sulfate/ipratropium bromide
|
02/01/2008 |
1/PA
|
Respiratory tract agents |
| amlodipine besylate |
02/01/2008 |
1
|
Cardiovascular agents
|
| AVINZA |
02/01/2008 |
3/ST
|
Analgesics |
| AZOR |
02/01/2008 |
3
|
Cardiovascular agents
|
| balsalazide sodium |
02/01/2008 |
1
|
Inflammatory bowel disease agents
|
| benzoyl peroxide gel |
02/01/2008 |
1
|
Dermatological agents |
chloral hydrate
|
02/01/2008
|
1
|
Sedatives/hypnotics
|
| ciclopirox nail lacquer |
02/01/2008 |
1/PA
|
Antifungals
|
| claravis |
02/01/2008 |
1
|
Dermatological agents |
| diclofenac sodium opht |
02/01/2008 |
1
|
Ophthalmic agents
|
estradiol valerate
|
02/01/2008 |
1
|
Hormonal agents, Stimulant/Replacement/Modifying (Sex hormones/modifiers)
|
| famciclovir |
02/01/2008
|
1
|
Antivirals |
FINACEA
|
02/01/2008 |
2/ST
|
Dermatological agents |
| glipizide/metformin hcl |
02/01/2008 |
1
|
Blood glucose regulators
|
granisetron hcl
|
02/01/2008 |
1/PA
|
Antiemetics |
| LANTUS FOR OPTICLIK |
02/01/2008 |
3
|
Blood glucose regulators
|
LANTUS SOLOSTAR
|
02/01/2008 |
3
|
Blood glucose regulators |
| MAXALT |
02/01/2008 |
2
|
Antimigraine agents
|
| metoprolol succinate er |
02/01/2008 |
1
|
Cardiovascular agents |
| moexepril hcl |
02/01/2008 |
1
|
Cardiovascular agents
|
| moexepril/hydrochlorothiazide |
02/01/2008 |
1
|
Cardiovascular agents
|
| nadolol-bendroflumethiazide |
02/01/2008 |
1
|
Cardiovascular agents
|
| nimodipine |
02/01/2008 |
1
|
Cardiovascular agents
|
oxcarbazepine
|
02/01/2008 |
1
|
Anticonvulsants
|
| pantoprazole sodium |
02/01/2008 |
1
|
Gastrointestinal agents
|
PERFOROMIST
|
02/01/2008
|
2/PA
|
Respiratory tract agents |
RECLAST
|
02/01/2008 |
3/ST
|
Metabolic bone disease agents |
| SELZENTRY |
02/01/2008 |
2/PA
|
Antivirals
|
| SEROSTIM |
02/01/2008 |
2/PA
|
Hormonal agents, Stimulant/Replacement/Modifying (Pituitary) |
| sotret |
02/01/2008 |
1
|
Dermatological agents
|
| SUPRAX |
02/01/2008
|
2
|
Antibacterials
|
| terbinafine |
02/01/2008
|
1/PA
|
Antifungals |
theophylline er
|
02/01/2008 |
1
|
Respiratory tract agents
|
| TRAVATAN Z |
02/01/2008 |
2
|
Ophthalmic agents
|
| tretinoin |
02/01/2008 |
1
|
Antineoplastics |
| COMBIGEN |
05/01/2008 |
2
|
Ophthalmic agents
|
| KUVAN |
05/01/2008 |
2
|
Miscellaneous therapeutic agents
|
| RENVELA |
05/01/2008 |
2/ST
|
Genitourinary agents
|
| EFFEXOR XR 150mg |
07/01/2008 |
3/ST, QL
|
Antidepressants
|
| ESTRING |
07/01/2008 |
2
|
Hormonal agents, Stimulant/Replacement/Modifying (Sex hormones/modifiers)
|
Changes to/removals from approved drug list:
| Drug Name |
Effective Date |
Tier |
Category |
Formulary Alternative |
Tier |
Removal Reason |
DIGITEK
|
IMMEDIATE
05/01/2008 |
2
|
Cardiovascular agents |
Contact your doctor |
N/A |
Recalled by manufacturer |
| ACIPHEX |
07/01/2008 |
2/ST |
Gastrointestinal agents |
n/a |
2/ST, QL |
Added quantity limits |
| ADDERALL XR |
07/01/2008 |
3 |
Central nervous system stimulants |
n/a |
3/QL |
Added quantity limits> |
| DUONEB |
07/01/2008 |
2/PA |
Respiratory tract agents |
albuterol sulfate/ipratropium bromide |
1/PA |
New generic available |
| LAMISIL |
07/01/2008 |
3/PA |
Antifungals |
terbinafine |
1/PA |
New generic available |
| MEDROL |
07/01/2008 |
2 |
Hormonal agents, Stimulant/Replacement/Modifying (Adrenal) |
methylprednisolone |
1 |
New generic available |
| NORVASC |
07/01/2008 |
2 |
Cardiovascular agents |
amlodipine besylate |
1 |
New generic available |
| PROAMATINE |
07/01/2008 |
2/PA |
Cardiovascular agents |
midodrine hcl |
1 |
New generic available |
TOPROL XL
|
07/01/2008 |
2 |
Cardiovascular agents
|
metoprolol succinate er
|
1
|
New generic available |
| AMBIEN |
07/01/2008 |
2 |
Sedative/hypnotics |
zolpidem |
1 |
New generic available |
| COREG |
07/01/2008 |
2 |
Cardiovascular agents |
carvedilol |
1 |
New generic available |
| UNIPHYL |
07/01/2008 |
3 |
Respiratory tract agents |
theophylline anhydrous |
1
|
New generic available |
| VOLTAREN |
07/01/2008 |
2 |
Ophthalmic agents |
diclofenac sodium opht |
1 |
New generic available |
| ACCUNEB |
07/01/2008 |
2/QL, PA |
Respiratory tract agents |
albuterol sulfate inhalant |
1/QL, PA |
New generic available |
| OMNICEF |
07/01/2008 |
2 |
Antibacterials |
cefdinir |
1 |
New generic available |
| NIMOTOP |
07/01/2008 |
3 |
Cardiovascular agents |
nimodipine |
1 |
New generic available |
| VESANOID |
07/01/2008 |
2 |
Antineoplastics |
tretinoin |
1 |
New generic available |
| PENLAC NAIL LACQUER |
07/01/2008 |
3/PA |
Antifungals |
cicloprox nail lacquer |
1/PA |
New generic available |
| VOSPIRE ER |
07/01/2008 |
2 |
Respiratory tract agents |
albuterol sulfate er |
1 |
New generic available |
| CORZIDE |
06/01/2008 |
2 |
Cardiovascular agents |
nadolol-bendroflumethiazide |
1 |
New generic available |
| DELESTROGEN |
06/01/2008 |
2 |
Hormonal agents, Stimulant/Replacement/Modifying (Sex hormones/modifiers) |
estradiol valerate |
1 |
New generic available |
| FAMVIR |
06/01/2008 |
2 |
Antiviral |
famciclovir |
1 |
New generic available |
| KYTRIL |
06/01/2008 |
2/PA |
Antiemetics |
granisetron |
1/PA |
New generic available |
| TERAZOL 3 |
06/01/2008 |
2
|
Antifungals |
terconazole |
1
|
New generic available |
| TRILEPTAL |
06/01/2008 |
2 |
Anticonvulsants |
oxcarbazepine |
1 |
New generic available |
| COLAZAL |
06/01/2008 |
3 |
Inflammatory bowel disease agents |
balsalazide sodium |
1 |
New generic available |
| PROTONIX |
06/01/2008 |
3/ST |
Gastrointestinal agents |
pantoprazole sodium |
1 |
New generic available |
| HUMIRA |
02/01/2008 |
3/QL, PA |
Immunological agents |
n/a |
2/QL, PA |
Changed from Tier 3 to Tier 2 |
| TYKERB |
02/01/2008 |
2 |
Antineoplastics |
n/a
|
2/PA |
Now requires prior authorization |
Last modified
07/01/08
