September 2009 formulary changes

Positive changes to more than 100 drugs

We're making changes to more than 100 drugs that will positively impact providers and members. These changes are in addition to the more than 50 positive changes we made in 2008.

Changes will be effective September 1, 2009. For your convenience we've provided a complete list of the changes below (alphabetically). Here are the main highlights:

• Positive changes have been made to approximately 48% of PA requests for the commercial (HMO, PPO, POS) formulary, 24% of requests for Medicaid and 10% of Medicare requests.

• These changes impact approximately 55 drugs on the commercial formulary, 80 drugs on the Medicaid formulary, and 30 drugs on the Medicare formulary.

• We've removed step therapy requirements for our number 1 requested drug, Crestor.  Members no longer need to try simvastatin first. We do encourage you to continue using simvastatin and other generic statins in members needing less than a 40% reduction in LDL. This saves members on average $30 per month with generics!

Therapeutic Class	Drug	Change applies to			What's Changing?
		Commercial	Medicaid	Medicare
Dermatology	Accutane		X		Add generic to formulary
Respiratory	Albuterol nebulizer solution	X	X	X	Increase QL to 3 boxes (up to 90 vials)/month
Anti-infective	Aldara		X		Add to formulary
Hematology	Amicar	X	X		Add generic to formulary
Gastrointestinal	Amitiza		X		Remove PA, automate ST (lactulose and Miralax first)
Endocrine	Androderm	X	X	X	Remove PA
Endocrine	AndroGel	X	X	X	Remove PA
Neurology	Apriso	X	X		Automate ST (Pentasa or Asacol first)
Respiratory	Aralast	X	X	X	Remove PA
Rheumatology	Arava		X	X	Add generic to formulary
Endocrine	Armour Thyroid		X	X	Add to formulary
Neurology	Azilect	X	X		Automate ST (selegiline first)
Cardiology	BiDil		X	X	Add to formulary
CNS	Butorphanol		X		Remove PA
Endocrine	Byetta			X	Modify ST (metformin 1500mg+ first)
Endocrine	Calcitonin/Fortical/Miacalcin	X	X		Add generics to formulary
Anti-infective	Cefuroxime axetil		X		Add to formulary
Dermatology	Claravis		X		Add to formulary
Anti-infective	Cleocin suspension		X		Add to formulary
Neurology	Copaxone		X		Remove PA
Cardiology	Coreg CR	X	X	X	Automate ST (generic Coreg first)
Cardiology	Crestor	X	X	X	Remove ST/PA
Endocrine	Cytomel		X		Add to formulary
Dermatology	Dapsone		X		Add to formulary
Anti-infective	Demeclocycline		X		Add to formulary
Neurology	Depakene		X		Remove QL
Neurology	Depakote ER		X		Remove QL
Dermatology	Dermatop	X			Add generic to formulary
Dermatology	Elidel		X		Add to formulary
Urology	Elmiron		X		Add to formulary
Oncology	Emend	X	X		Add to formulary
Gastrointestinal	Entocort EC		X		Add to formulary
Hematology	Epogen		X		Remove PA
Endocrine	Estratest		X		Add generic to formulary
Endocrine	Estring		X		Add to formulary
Pain Management	Euflexxa	X*	X*	X*	Remove PA
Endocrine	Evista Total		X		Add to formulary
Oncology	Femara Total		X		Add to formulary
Endocrine	Femring Total		X		Add to formulary
Pain Management	Fentanyl Total		X		Add to formulary
Urology	Flavoxate Total		X		Add to formulary
Pain Management	Flector	X	X	X	Add to formulary with ST (one generic oral NSAID first)
Anti-infective	Fortaz			X	Add generic to formulary
Anti-infective	Furadantin susp		X		Add to formulary
Respiratory	Gastrocrom	X			Add to formulary
Anti-infective	Grifulvin V		X		Add to formulary
Anti-infective	Gris-PEG		X		Add to formulary
Nephrology	Hectorol	X	X		Add to formulary
Gastrointestinal	Hepsera	X	X		Automate ST
Pain Management	Hydrocodone/Ibuprofen		X		Add to formulary
Respiratory	Intal		X		Add to formulary
Anti-infective	Intron A	X	X		Remove PA
Anti-infective	Itraconazole	X	X	X	Remove PA
Neurology	Keppra	X	X		Remove QL
Neurology	Keppra XR	X	X	X	Automate ST (generic Keppra first); remove QL
Anti-infective	Lamisil		X		Add generic to formulary with 12 week QL per year
Neurology	Lamotrigine	X	X		Remove QL
Hematology	Leukine		X		Remove PA for self-injecting
Gastrointestinal	Lialda	X	X	X	Automate ST (Pentasa or Asacol first)
Dermatology	Locoid Lipocream	X			Add generic to formulary
Ophthalmic	Lotemax		X	X	Add to formulary
Gastrointestinal	Lotronex		X	X	Remove PA
Cardiology	Lovenox		X		Remove PA for self-injecting
Anti-infective	Macrodantin		X		Add brand name 25mg to formulary
CNS	Marplan	X			Add to formulary
Oncology	Mesnex	X	X		Add to formulary
Anti-infective	Methenamine Hippurate	X	X		Add to formulary
Rheumatology	Methotrexate inj		X		Remove PA for self-injecting
Pain Management	Migranal		X		Add to formulary
Anti-infective	Monurol		X		Add to formulary
Anti-infective	Nebupent	X	X		Remove PA
Hematology	Neumega		X		Remove PA for self-injecting
Cardiology	Nitro-Bid			X	Add to formulary
Endocrine	Norditropin	X	X	X	Remove PA for pediatric endocrinology
Dermatology	Olux	X	X		Add generic to formulary
Gastrointestinal	Ondansetron	X	X	X	Increase QL to 90 per 30 days
CNS	Orap	X			Add to formulary
Endocrine	Ortho Evra	X	X		Add to formulary with ST (one generic contraceptive first)
Endocrine	Ovcon-50 (28)		X		Add to formulary with ST (one generic contraceptive first)
Gastrointestinal	Pamine		X		Add to formulary
Gastrointestinal	Pantoprazole	X	X	X	Increase QL to 2/day
CNS	Parcopa	X	X	X	Remove PA for generic
Gastrointestinal	Pegasys		X	X	Remove PA, implement QL (48 weeks/lifetime)
Endocrine	Pen Insulin (all brands)		X		Add to formulary
Dermatology	Penlac	X	X	X	Remove PA
Gastrointestinal	Pentasa		X		Add to formulary
Pain Management	Ponstel		X		Add to formulary
Dermatology	Pramosone	X	X		Add to formulary
Hematology	Procrit		X		Remove PA
Dermatology	Proctocort		X		Add to formulary
Respiratory	Prolastin	X	X	X	Remove PA
Dermatology	Protopic		X		Add to formulary
Neurology	Rebif		X		Remove PA for self-injecting
Respiratory	Rhinocort	X	X		Change ST (one generic nasal steroid first)
Oncology	Revlimid	X	X	X	Remove PA
Dermatology	Salicylic Acid		X		Add to formulary
Endocrine	Sandostatin		X		Add generic to formulary
Respiratory	Singulair		X	X	Remove PA
Dermatology	Soriatane CK	X	X		Add to formulary
Respiratory	Spiriva		X		Remove age edit
Neurology	Stalevo			X	Add to formulary (T3)
Hematology	Stimate		X		Add to formulary
Anti-infective	Stromectol	X	X		Add to formulary
Neurology	Trileptal		X		Remove QL
Pain Management	Ultram ER	X	X	X	Add to formulary with ST (tramadol first)
Gastrointestinal	Ultrase MT		X		Add to formulary
Nephrology	Urocit K		X	X	Add to formulary
Anti-infective	Valcyte		X		Add to formulary
Anti-infective	Vfend		X	X	Medicaid: Remove PA Medicare: Add to formulary (T4)
Ophthalmic	Vigamox		X	X	Remove PA/ST
Anti-infective	Vistide	X	X		Add to formulary
CNS	Vivactil	X			Add generic to formulary
Endocrine	Vivelle-Dot		X		Add to formulary
Pain Management	Voltaren Gel	X	X	X	Add to formulary with ST (one generic oral NSAID first)
Anti-infective	Xifaxan		X		Add to formulary with QL (30 per month)
Respiratory	Xopenex HFA	X	X	X	Medicaid: Automate ST (albuterol first) Commercial/Medicare: Remove ST
Respiratory	Xopenex nebulizer	X	X	X	Remove ST
Nephrology	Zemplar		X		Add to formulary
Anti-infective	Zosyn			X	Add to formulary (T3)
Ophthalmic	Zymar		X	X	Remove PA

PA= Prior Authorization
ST= Step Therapy
QL=Quantity Limit
X Indicates the change applies to this formulary
* indicates drug is covered under the medical benefit