Pharmacy & Therapeutics Committee formulary update

Jan. 19, 2010 P&T changes: At a glance

Alphabetized by drug name

Therapeutic Class	Drug	Change applies to			P&T recommendation	Effective Date
		Commercial	Medicaid	Medicare
Ophthalmic	Bepreve (bepotastine OP soln)	x NP	x	x T3	Add to formulary with ST (Zaditor OTC first)	3-1-2010
Pain Management	Colcrys (colchicine)	x NP		x T3	Add to formulary with ST (generic colchicines first)	3-1-2010
Cardiovascular	Cozaar (losartan)	x	x	x	Remove step therapy when generic available in April	5-1-2010
Neurology	Dysport (abobotulinum toxin)	x *	x *	x *	Add to formulary with PA	3-1-2010
Pain Management	Embeda (morphine/naltrexone)	x NP		x T3	Add to formulary with ST (generic morphine sulfate ER first)	3-1-2010
Cardiovascular	Hyzaar (losartan/HCTZ)	x	x	x	Remove ST when generic available in April	5-1-2010
CNS	Invega Sustenna (paliperidone)	x *		x *	Add to formulary	3-1-2010
Gastrointestinal	Metozolv ODT (metoclopramide)	x NP		x T3	Add to formulary with ST (generic metoclopramide first)	3-1-2010
Pain Management	Sumavel Dosepro (sumatriptan inj)	x NP		x T3	Add to formulary with ST (generic sumatriptan inj first)	3-1-2010
Cardiovascular	Valturna (aliskirin/valsartan)	x P	x	x T2	Add to formulary with ST (ARB first)	3-1-2010
Oncology	Votrient (pazopanib)	x T4	x	x T4	Add to formulary	3-1-2010
Gastrointestinal	Zenpep (pancrelipase)	x P	x	x T2	Add to formulary	3-1-2010

PA = Prior Authorization
ST = Step Therapy 
x Indicates the change applies to this formulary
* indicates drug is covered under the medical benefit
P = Preferred Brand
NP = Non-Preferred Brand
PS = Preferred Brand Specialty
NPS = Non-Preferred Brand Specialty
T1, T2, T3, T4 = Medicare Tier Designation

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