Notice of Mid-Year Changes to 2019 Paramount Enhanced Formulary
|
|
- Jordan Wright
- 5 years ago
- Views:
Transcription
1 Notice of Mid-Year s to 2019 Paramount Enhanced Formulary Paramount Elite (HMO) may immediately remove a brand name drug on our List if we are replacing it with a new generic drug that will appear on the same or lower cost sharing tier and with the same or fewer restrictions. Or, when adding the new generic drug, we may decide to keep the brand name drug on our List, but immediately move it to a different cost-sharing tier or add new restrictions. We may not tell you in advance before we make that change, but we will later provide you with information about the specific change(s) we have made. Also, if the Food and Administration deems a drug on our formulary to be unsafe or the drug s manufacturer removes the drug from the market, we may immediately remove the drug from our formulary and provide notice to members who take the drug. Before we make other changes during the year to our List that affect members currently taking a drug and that require us to provide advance notice, we will notify affected members of the change at least 30 days before the change becomes effective, or at the time the member requests a refill of the drug, at which time the member will receive a one-month supply of the drug. If you are affected by a change in drug coverage or restriction, you or your prescriber can ask us to make an exception and continue to cover the drug in the way you would like. The notice we provide you will also include information on the steps to request an exception. To learn more about coverage decisions and how to ask for an exception, see your Evidence of Coverage, or call Customer Care at (TTY: 711), 24 hours a day, 7 days a week. The table below outlines upcoming changes to our formulary that may impact you.
2 ACANYA GEL % ADCIRCA TAB 20MG ALBENZA TAB 200MG AMPYRA TAB 10MG ANDROGEL GEL 1.62% BILTRICIDE TAB 600MG CANASA SUPP 1000MG COSOPT PF SOLN FARESTON TAB 60MG FINACEA GEL 15% FORFIVO XL TAB 450MG INVANZ INJ 1GM LUZU CREAM 1% CLINDAMYCIN PHOSPHATE-BENZOYL PEROXIDE GEL % TADALAFIL TAB 20MG ALBENDAZOLE TAB 200 MG DALFAMPRIDINE TAB 10MG ER TESTOSTERONE GEL 1.62% PRAZIQUANTEL TAB 600MG MESALAMINE SUPP 1000 MG DORZOLAMIDE/TIMOLOL OPHTH SOL MG/ML PF TOREMIFENE CITRATE TAB 60 MG AZELAIC ACID GEL 15% BUPROPION TAB 450MG ER ERTAPENEM INJ 1GM LULICONAZOLE CREAM 1%
3 ONFI SUSP 2.5MG/ML ONFI TAB 10MG ONFI TAB 20MG PROAIR HFA RAPAFLO CAP 4MG RAPAFLO CAP 8MG SABRIL TAB 500MG SPORANOX SOLN 10MG/ML TOPICORT SPRAY 0.25% WELCHOL PACK 3.75GM ZYTIGA TAB 250MG ACETASOL HC SOLN OTIC AFEDITAB TAB 30MG CR CLINIMIX E INJ 5%/D25W CLOBAZAM SUSP 2.5 MG/ML CLOBAZAM TAB 10MG CLOBAZAM TAB 20MG ALBUTEROL AER HFA SILODOSIN CAP 4 MG SILODOSIN CAP 8 MG VIGABATRIN TAB 500 MG ITRACONAZOLE ORAL SOLN 10 MG/ML DESOXIMETASONE SPRAY 0.25% COLESEVELAM PAK 3.75 GM ABIRATERONE TAB 250MG HYDROCORTISONE W/ ACETIC ACID OTIC SOLN 1-2% NIFEDIPINE TAB 30MG ER CLINIMIX E INJ 5%/D20W Tier 4 03/01/2019
4 GRANISETRON INJ 0.1MG/ML INVANZ INJ 1GM ADD-VANTAGE VIAL INVIRASE CAP 200MG LYNPARZA CAP 50MG METIPRANOLOL SOLN 0.3% OPH MODERIBA PAK 800/DAY MODERIBA TAB 1000/DAY MODERIBA TAB 600/DAY POLYETHYLENE GLYCOL 3350 ORAL PACKET POLYETHYLENE GLYCOL 3350 ORAL POWDER ZENCHENT TAB ZERIT SOLN 1MG/ML AFEDITAB TAB 60MG CR GRANISETRON INJ 1MG/ML ERTAPENEM INJ 1GM INVIRASE TAB 500MG Tier 5 03/01/2019 LYNPARZA TAB Tier 5 03/01/2019 BETAXOLOL SOLN 0.5% OPHTH RIBASPHERE TAB 400MG Tier 5 03/01/2019 RIBAPAK TAB 1000/DAY Tier 5 03/01/2019 RIBAPAK TAB 600/DAY Tier 5 03/01/2019 LACTULOSE SOLN 10GM/15 ML LACTULOSE SOLUTION 10 GM/15ML VYFEMLA TAB STAVUDINE CAP NIFEDIPINE TAB 60MG ER
5 CEFOTAXIME INJ 2GM CLINIMIX INJ 2.75/D5W CLINIMIX INJ 4.25/D20 GIAZO TAB 1.1GM HEXALEN CAP 50MG KIMIDESS TAB NORVIR CAP 100MG PANLOR TAB MG ZOMETA INJ 4MG/100ML ACIPHEX SPR CAP 10MG ACIPHEX SPR CAP 5MG MEDICARE WILL NO LONGER COVER MEDICARE WILL NO LONGER COVER CEFOTAXIME INJ 500MG CLINIMIX INJ 4.25/D5W Tier 4 02/01/2019 CLINIMIX INJ 5%/D20W Tier 4 02/01/2019 BALSALAZIDE CAP 750MG CONSULT YOUR HEALTH CARE PROVIDER 02/01/2019 KARIVA TAB RITONAVIR TAB 100MG ACETAMINOPHEN- CAFFEINE- DIHYDROCODEINE TAB MG ZOLEDRONIC INJ 5/100ML OMEPRAZOLE CAP Tier 1 01/01/2019 OMEPRAZOLE CAP Tier 1 01/01/2019
6 AURYXIA TAB 210MG KETOPROFEN CAP 75MG LANOXIN TAB MG QVAR AER 40MCG QVAR AER 80MCG VESTURA TAB MG PRIOR AUTHORIZATION ADDED PA ADDED TO ENSURE USE IS FOR A PART D COVERED INDICATION CONSULT YOUR HEALTH CARE PROVIDER 01/01/2019 NAPROXEN TAB Tier 1 01/01/2019 DIGOXIN TAB 0.125MG Tier 2 01/01/2019 QVAR REDIHALER Tier 4 01/01/2019 QVAR REDIHALER Tier 4 01/01/2019 NIKKI TAB MG Tier 2 01/01/2019 * drugs are drugs in the same therapeutic category/class or cost sharing tier as the affected drug. Only your physician can determine if one of the alternatives listed here is appropriate for you given the individualized nature of drug therapy. Please consult your physician to confirm if this is an appropriate drug for you.
Memorial Hermann Advantage HMO February 2019 Formulary Addendum
Memorial Hermann Advantage HMO February 2019 Formulary Addendum Changes may have occurred since the printing of your current Memorial Hermann Advantage HMO Formulary. Medications that may have been added
More informationChanges to the 2018 BlueCross Secure SM (HMO) & BlueCross Total SM (PPO) Formularies
Changes to the 2018 BlueCross Secure SM (HMO) & BlueCross Total SM (PPO) Formularies BlueCross BlueShield of South Carolina may add or remove drugs from the formulary during the year. If we remove drugs
More informationHealth Partners Medicare Prime 2019 Formulary Changes
Health Partners Medicare Prime 2019 Formulary Changes Changes occur, for example, because new drugs come on the market, a drug is moved to a different cost-sharing level (tier), or a generic version becomes
More information2019 Drug List Negative Changes
2019 Drug List Negative Changes Updated 03/26/2019 If you are taking a drug that is removed from the formulary (also known as the Drug List), we will tell you. We will also tell you if we add any restrictions
More information2018 Formulary Notice of Change Prescription Drug Plans
2018 Formulary Notice of Change Prescription Drug Plans WellCare Prescription Insurance, Inc. Plans in all states: WellCare Classic (PDP) WellCare may add or remove drugs from our formulary during the
More information2019 Drug List Negative Changes
2019 Drug List Negative Changes Updated 03/26/2019 If you are taking a drug that is removed from the formulary (also known as the Drug List), we will tell you. We will also tell you if we add any restrictions
More information2019 Formulary Update
MEDICARE ADVANTAGE BlueShield of Northeastern New York Formulary Update BlueShield of Northeastern New York has updated its formulary (drug list) since its original publication in January. This document
More informationAetna Better Health of Illinois Medicaid Formulary Updates
October 2017 o DOXYLAMINE SUCCINATE 25mg-QL o DULOXETINE CAP 40MG DR-QL o GUANFACIN ER TABS (all strengths)-ql o TOBRAMYCIN NEBU SOLUTION- PA August 2017 Aetna Better Health of Illinois Medicaid 2017 Formulary
More informationPRESCRIPTION DRUG PROGRAM FORMULARY UPDATES Select Formulary April 1, 2018 Updates. Formulary Alternatives
PRESCRIPTION DRUG PROGRAM FORMULARY UPDATES Select April 1, 2018 Updates Drug Name adapalene-benzoyl-peroxide Gel 0.1-2.5% (Brand = Epiduo ) prasugrel hcl (Brand = Effient ) vigabatrin pak 500 mg (Brand
More informationHealth Partners Medicare Special 2018 Formulary Changes
Health Partners Medicare Special 2018 Changes Changes occur, for example, because new drugs come on the market, a drug is moved to a different cost-sharing level (tier), or a generic version becomes available.
More informationPRESCRIPTION DRUG PROGRAM FORMULARY UPDATES Select Formulary April 1, 2018 Updates. Formulary Alternatives
PRESCRIPTION DRUG PROGRAM FORMULARY UPDATES Select April 1, 2018 Updates Drug Name adapalene-benzoyl-peroxide Gel 0.1-2.5% (Brand = Epiduo ) prasugrel hcl (Brand = Effient ) vigabatrin pak 500 mg (Brand
More informationFORMULARY LIST OF COVERED DRUGS
FORMULARY LIST OF COVERED DRUGS 2018 PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. HPMS Approved Formulary File Submission ID 00018248, Version Number #3 This formulary
More informationBlueLink TPA FlexRx Updates
BlueLink TPA FlexRx Updates April 2018 TRADE NAME (generic name) or generic name abacavir sulfate soln 20 mg/ml (base equiv) Generic Addition, generic for ZIAGEN alclometasone dipropionate cream 0.05%
More informationEmblem Medicaid 3Q18 Formulary Updates
ALKERAN 2 MG TABLET Removed from Formulary 7/9/2018 AMITIZA 24 MCG CAPSULES Removed from Formulary 7/9/2018 AMITIZA 8 MCG CAPSULE Removed from Formulary 7/9/2018 avo cream topical emulsion Removed from
More informationYour prescription benefit updates Formulary Updates - Effective January 1, 2019
Your prescription benefit updates Formulary Updates - Effective January 1, 2019 Medications are grouped by the conditions they treat. Each medication is placed in a tier that shows the amount you will
More information3 Tier Formulary Additions
3 Tier Formulary Additions Drug Name Tier Category Management ACCU-CHECK GUIDE ME GLUCOSE METER 3 Diabetic Supplies Step Therapy applies pyridostigmine bromide 60mg/5ml syrup 1 Antimyasthenic Agents New
More informationWellCare Signature (PDP) and WellCare Classic (PDP) Formulary Addendum
WellCare Signature (PDP) and WellCare Classic (PDP) Formulary Addendum This is a listing of the changes that have occurred in our formulary. Please carefully review these changes and call WellCare if you
More informationBlue Cross and Blue Shield of Minnesota GenRx Formulary Updates
Blue Cross and Blue Shield of Minnesota GenRx Formulary Updates April 2018 TRADE NAME (generic name) or generic name Brand/Generic Description of Change abacavir sulfate soln 20 mg/ml (base equiv) Generic
More information2017 Formulary Changes Year to Date
2017 Formulary Changes Year to Date Health Choice Arizona may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, add prior authorization, quantity limits and/or
More information2017 Formulary Addendum Notice of Change (Medicare Advantage Plans)
207 Formulary Addendum Notice of Change (Medicare Advantage Plans) Easy Choice Health Plan Easy Choice Plus Plan (HMO) H5087-002, H5087-07 This is a listing of the changes that have occurred in our formulary.
More informationQuarterly pharmacy formulary change notice
Provider update Quarterly pharmacy formulary change notice Summary: The formulary changes listed in the table below were reviewed and approved at our first-quarter 2018, Pharmacy and Therapeutics Committee
More informationQuarterly pharmacy formulary change
Medi-Cal Managed Care L. A. Care Major Risk Medical Insurance Program Provider Bulletin The formulary changes listed in the table below were reviewed and approved at our first-quarter 2018 Pharmacy and
More informationQuarterly pharmacy formulary change notice
Quarterly pharmacy formulary change notice Provider update Summary: Effective August 1, 2018, the preferred formulary changes detailed in the table below will apply to District of Columbia Healthy Families
More information2017 Formulary Addendum Notice of Change (Medicare Advantage Plans)
2017 Formulary Addendum Notice of Change (Medicare Advantage Plans) Easy Choice Health Plan Easy Choice Best Plan (HMO) H5087-005 This is a listing of the changes that have occurred in our formulary. Please
More information2018 CareOregon Advantage Part D Formulary Changes
2018 CareOregon Advantage Part D Formulary Changes Abbreviations: AGE = Age Restriction; PA = Prior Authorization Required; QL = Quantity Limit; ST = Step Therapy Required; LD = Limited Distribution; BvD
More informationMedicare Part D 2017 Formulary Changes Service To Senior
Medicare Part D 2017 Formulary Changes Service To Senior Inter Valley Health Plan may add or remove drugs from our formulary during the year. If we remove a drug from our formulary, add prior authorization,
More informationQuarterly pharmacy formulary change notice
Quarterly pharmacy formulary change notice The formulary changes listed in the table below were reviewed and approved at our second quarter 2018 Pharmacy and Therapeutics Committee meeting. Effective October
More informationAcyclovir Ointment. Aetna Better Health Pennsylvania. Products Affected. acyclovir ointment 5 % external Details. Criteria
Medications that require Step Therapy (ST) require trial and failure of preferred formulary agents prior to their authorization. If the prerequisite medications have been filled within the specified time
More informationPlan Year CCHP Senior Program (HMO) Step Therapy Criteria (ST)
Plan Year 2016 CCHP Senior Program (HMO) Step Therapy Criteria (ST) Step Therapy: In some cases, CCHP Senior Program (HMO) requires you to first try certain drugs to treat your medical condition before
More information2017 Medicare Part D Formulary Change
2017 Medicare Part D Formulary Change We may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, or add prior authorizations, quantity limits and/or step therapy
More informationMedicare Part D 2017 Formulary Changes OC Preferred
Medicare Part D 017 Formulary s OC Preferred Inter Valley Health Plan may add or remove drugs from our formulary during the year. If we remove a drug from our formulary, add prior authorization, quantity
More informationWVCH Formulary Additions Effective 01/01/2016 Name Strength Dosage Form Route Formulary Restrictions
WVCH Formulary Additions Effective 01/01/2016 Name Strength Dosage Form Route Formulary Restrictions ANORO ELLIPTA 62.5-25MCG BLST W/DEV INHALATION ARCAPTA NEOHALER 75 MCG CAP W/DEV INHALATION CALCIPOTRIENE
More informationBlue Cross and Blue Shield of Minnesota GenRx Formulary Updates
Blue Cross and Blue Shield of Minnesota GenRx Formulary Updates July 2018 TRADE NAME (generic name) or generic name ADVAIR DISKUS (fluticasone-salmeterol aer powder ba 100-50 mcg/dose) Brand Addition ADVAIR
More informationMedicare Part D 2017 Formulary Changes Service To Senior
Medicare Part D 2017 Formulary s Service To Senior Inter Valley Health Plan may add or remove drugs from our formulary during the year. If we remove a drug from our formulary, add prior authorization,
More informationMedicare Part D 2017 Formulary Changes OC Preferred
Medicare Part D 2017 Formulary Changes OC Preferred Inter Valley Health Plan may add or remove drugs from our formulary during the year. If we remove a drug from our formulary, add prior authorization,
More informationQuarterly pharmacy formulary change notice
MEDICAID PROVIDER BULLETIN October 2018 The formulary changes listed in the table below were reviewed and approved at the second-quarter 2018 Pharmacy and Therapeutics Committee meeting. Effective October
More information2018 Medicare Part D Formulary Change
2018 Medicare Part D Formulary Change We may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, or add prior authorizations, quantity limits and/or step therapy
More informationAETNA BETTER HEALTH January 2017 Formulary Change(s)
AETNA BETTER HEALTH January 2017 Formulary Change(s) The following updates will be made to the Aetna Better Health of MI formulary on March 1, 2017 Drug Name, Strength, Dosage Form ALFUZOSIN HCL ER 10
More information2017 Formulary Addendum Notice of Change
017 Formulary Addendum Notice of Change (Medicare Advantage Plans) WellCare Health Plans WellCare Choice (HMO), WellCare Essential (HMO-POS), WellCare Value (HMO) This is a listing of the changes that
More informationMedicare Part D 2012 Formulary Changes Service To Senior and Total Fit
Medicare Part D 2012 Formulary s Service To Senior and Total Fit Inter Valley Health Plan may add or remove drugs from our formulary during the year. If we remove a drug from our formulary, add prior authorization,
More informationMedicare Part D 2017 Formulary Changes OC Preferred
Medicare Part D 2017 Formulary s OC Preferred Inter Valley Health Plan may add or remove drugs from our formulary during the year. If we remove a drug from our formulary, add prior authorization, quantity
More informationQuarterly pharmacy formulary change notice
Provider Bulletin October 2018 Quarterly pharmacy formulary change notice The formulary changes listed in the table below apply to all Anthem HealthKeepers Plus patients. The changes listed in the table
More informationFORMULARY LIST OF COVERED DRUGS
FORMULARY LIST OF COVERED DRUGS 2017 PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. HPMS Approved Formulary File Submission ID 00017274, Version Number 6 This formulary
More informationAETNA BETTER HEALTH January 2017 Formulary Change(s)
AETNA BETTER HEALTH January 2017 Formulary Change(s) The following updates will be made to the Aetna Better Health of MI formulary on February 1, 2017 Drug Name, Strength, Dosage Form IVERMECTIN 3 MG TABLET
More informationMedicare Part D 2016 Formulary Changes Service To Senior and OC Preferred
Medicare Part D 2016 Formulary s Service To Senior and OC Preferred Inter Valley Health Plan may add or remove drugs from our formulary during the year. If we remove a drug from our formulary, add prior
More information2015 Chinese Community Health Plan Senior Program (HMO) Step Therapy Criteria Last Updated 11/1/2015
2015 Chinese Community Health Plan Senior Program (HMO) Step Therapy Last Updated 11/1/2015 APLENZIN TAB 174MG, 348MG, 522MG Step Therapy requires trial of bupropion SR or bupropion XL in previous 180
More informationOffice of Medicaid Policy and Planning Over-the-Counter Drug Formulary ANALGESICS ANTACIDS ANTI-FLATULENTS
Acetaminophen 80mg/0.8mL Suspension Drops Acetaminophen 120mg Suppository Acetaminophen 160mg/5mL Suspension Acetaminophen 325mg Suppository Acetaminophen 325mg Tablet, Caplet, or Capsule Acetaminophen
More information2017 Formulary Addendum Notice of Change (Medicare Advantage Plans)
2017 Formulary Addendum Notice of Change (Medicare Advantage Plans) Easy Choice Health Plan Easy Choice Freedom Plan (HMO SNP) H5087-001 This is a listing of the changes that have occurred in our formulary.
More informationSeptember 2018 Pharmacy & Therapeutics Committee Decisions
UCare s Pharmacy and Therapeutics Committee (P&T) is a group of physicians and pharmacists that meet throughout the year to make changes to UCare (approved drug list). These changes are reviewed based
More information2017 Formulary Addendum Notice of Change (Prescription Drug Plans)
2017 Formulary Addendum Notice of Change (Prescription Drug Plans) WellCare Prescription Insurance, Inc. WellCare Classic (PDP) WellCare Extra (PDP) This is a listing of the changes that have occurred
More information2017 Formulary Addendum Notice of Change
2017 Formulary Addendum Notice of Change (Medicare Advantage Plans) WellCare Health Plans WellCare Access (HMO SNP), WellCare Liberty (HMO SNP), WellCare Reserve (HMO), WellCare Rx (HMO), WellCare Select
More informationFORMULARY UPDATES TO DENVER HEALTH MEDICAID CHOICE (DHMC) AND CHILD HEALTH PLAN PLUS (CHP+) PLANS
FORMULARY UPDATES TO DENVER HEALTH MEDICAID CHOICE (DHMC) AND CHILD HEALTH PLAN PLUS (CHP+) PLANS DHMC/CHP+ may add or remove drugs from the formulary or make changes to restrictions on formulary drugs
More informationHEALTH SHARE/PROVIDENCE (OHP)
HEALTH SHARE/PROVIDENCE (OHP) STEP THERAPY This is a complete list of drugs that have written coverage determination policies. Drugs on this list do not indicate that this particular drug will be covered
More informationPRESCRIPTION DRUG PROGRAM FORMULARY UPDATES Select Formulary October 1, 2018 Updates. Formulary. Alternatives
PRESCRIPTION DRUG PROGRAM FORMULARY UPDATES Select October 1, 2018 Updates Drug Name efavirenz 600mg (Brand = Sustiva ) trientine (Brand = Syprine ) hydrocortisone lot 0.1% (Brand = Locoid ) sumatriptan-naproxen
More information2019 Supplemental Drug List
2019 Supplemental Drug List This supplemental drug list was updated on August 2018. For more recent information or other questions, please contact Blue Cross Medicare Advantage Customer Service, at 1-877-299-1008
More informationPDP Classic Formulary Addendum
PDP Classic Formulary Addendum The following medications have been added to the WellCare formulary as of March 2009. Drug Name Therapeutic Class Drug Tier Requirements/Limits Changes Made acetazolamide
More informationESTIMATED LAUNCH DATE* Sensipar cinacalcet Amgen Mar 2018 Endocrine Disorders High. Altoprev lovastatin ER Andrx Mar 2018 High Blood Cholesterol Low
Topicort 0.25% Topical Spray desoximetasone topical spray Taro Mar 2018 Skin Sensipar cinacalcet Amgen Mar 2018 Endocrine Disorders High Altoprev lovastatin ER Andrx Mar 2018 High Blood Cholesterol Ketek
More information2014 FORMULARY LIST OF COVERED DRUGS
PLEASE READ: This formulary was updated on January 1, 2014. For more recent information or other questions, please contact Viva Medicare Member Services at 1-800-633-1542 or, for TTY users, 711, Monday
More informationFORMULARY CHANGE NOTICE 2008 JULY
FORMULARY CHANGE NOTICE 2008 JULY Drug Name Dosage Form Strength Alternative Medicine* Formulary Formulary Change and Reason Status of Alternative Medication Updated Status On Formulary STARLIX TABS 120MG
More information2014 Quantity Limits (QL) Criteria
2014 Quantity Limits (QL) Criteria Certain drugs covered through your EmblemHealth Medicare HMO/PPO Medicare Plan are covered for only a limited quantity. We do this to ensure compliance with the US Food
More informationQuarterly pharmacy formulary change notice
Quarterly pharmacy formulary change notice Summary of change: The Pharmacy and Therapeutics Committee (P&T) reviewed and approved the formulary changes listed in the table below on March 29, 2016. What
More information2018 Medicare Part D Formulary Change
2018 Medicare Part D Formulary Change We may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, or add prior authorizations, quantity limits and/or step therapy
More informationThe following list of recommended PDL changes were reviewed and approved by the MHS P&T Committee on December 14 th, 2016.
Q4 MHS PDL Changes Provider Notice The following list of recommended PDL changes were reviewed and approved by the MHS P&T Committee on December 14 th, 2016. Table 1: Summary of Medicaid PDL Additions
More information2018 Drug List Negative Changes Updated 10/25/2018 The table below shows changes made to our 2018 List of Covered Drugs (Formulary).
2018 Drug List Negative s Updated 10/25/2018 The table below shows changes made to our 2018 List of Covered Drugs (Formulary). Date of 1/1/2018 COLYTE-FLAVOR PACKS SOLR 227.1GM- 21.5GM-5.53GM- 2.82GM-6.36GM
More informationAlprazolam 0.25mg, 0.5mg, 1mg tablets
Presbyterian Senior Care (HMO) / Presbyterian MediCare PPO Quantity Limits Effective November 1, 2014 For the most recent list of drugs or other questions, please contact the Presbyterian Customer Service
More informationNotification of Product Changes (NOPC) forms, Containered Trade Product Pack (CTPP) codes and Pharmacodes
29 February 2016 TENDER RESULTS PHARMAC has resolved to award tenders for Sole Subsidised Supply Status and Status for some products included in the 2014/15 Invitation to Tender, d 6 November 2014, and
More informationQuarterly pharmacy formulary change notice
Quarterly pharmacy formulary change notice Provider update Summary: The formulary changes listed in the table below were reviewed and approved at our second quarter 2018, Pharmacy and Therapeutics Committee
More information2018 Step Therapy FID 18088
2018 Step Therapy FID 18088 Step Therapy ANTIDEPRESSANTS, SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS LEON 2018 Desvenlafaxine Er Fetzima Fetzima Titration Pack Khedezla Paxil SUSP Pristiq Trintellix
More informationCONTRACT UPDATE July 20, 2012
CONTRACT UP July 20, 2012 ADDS AMPHETAMINE SALT MIX ER CAPSULE 10MG 100 002-3059-11 $422.45 ACTAVIS ADDS AMPHETAMINE SALT MIX ER CAPSULE 20MG 100 002-3060-11 $422.45 ACTAVIS ADDS AMPHETAMINE SALT MIX ER
More informationNetwork 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 information2017 Formulary Addendum Notice of Change
2017 Formulary Addendum Notice of Change (Prescription Drug Plans) WellCare Prescription Insurance, Inc. WellCare Classic (PDP) WellCare Extra (PDP) This is a listing of the changes that have occurred
More informationLABEL NAME CHANGE EFFECTIVE DATE ARCALYST 220 MG INJECTION
LABEL NAME CHANGE EFFECTIVE DATE ARCALYST 220 MG INJECTION Added Prior Authorization 7/1/17 CORLANOR 5 MG TABLET Added Prior Authorization 7/1/17 CORLANOR 7.5 MG TABLET Added Prior Authorization 7/1/17
More informationALOGLIPTIN STEP. Details. Step Therapy Requirements Effective November 1, 2017
ALOGLIPTIN STEP alogliptin 12.5 mg tablet alogliptin 12.5 mg-metformin 1,000 mg tablet alogliptin 12.5 mg-metformin 500 mg tablet alogliptin 12.5 mg-pioglitazone 15 mg tablet alogliptin 12.5 mg-pioglitazone
More informationNOTIFICATION OF FORMULARY CHANGES
NOTIFICATION OF CHANGES The following summary describes changes to the 2018 Presbyterian Senior Care (HMO)/(HMO-POS), Presbyterian MediCare PPO and formularies. The formulary may change at any time. You
More informationAetna Better Health Illinois Premier Plan. November 2015 Formulary Updates. October 2015 Formulary Updates
Aetna Better Health Illinois Premier Plan November 2015 Formulary Updates desogestrel & ethinyl estradiol tab 0.15 mg-30 mcg RIVASTIGMINE DIS 13.3/24; QL (30 patches/30 days) RIVASTIGMINE DIS 4.6MG/24;
More informationFORMULARY UPDATES TO DENVER HEALTH MEDICAID CHOICE (DHMC) AND CHILD HEALTH PLAN PLUS (CHP+) PLANS
FORMULARY UPDATES TO DENVER HEALTH MEDICAID CHOICE (DHMC) AND CHILD HEALTH PLAN PLUS (CHP+) PLANS DHMC/CHP+ may add or remove drugs from the formulary or make changes to restrictions on formulary drugs
More informationDrug Formulary Update, April 2017 Commercial and State Programs
Drug Formulary Update, April 2017 Commercial and State Programs Updates to the HealthPartners Commercial and State Program Drug Formularies are listed below. Updates apply to all Commercial groups (PreferredRx,
More information1/1/2019 FORMULARY CHANGES CIGNA COMMERCIAL CUSTOMERS
1/1/2019 FORMULARY CHANGES CIGNA COMMERCIAL CUSTOMERS Effective 1/1/19, Cigna is making changes to our formularies that may impact medication coverage for customers at your pharmacy. We have included a
More informationWellCare s South Carolina Preferred Drug List Update
WellCare s South Carolina Preferred Drug List Update This is a list of changes to our preferred drug list. These are a result of the latest WellCare Pharmacy & Therapeutics meeting held on 09/03/2015.
More informationALOGLIPTIN STEP. Step Therapy Requirements Effective April 1, 2018
Step Therapy Requirements Effective April 1, 2018 ALOGLIPTIN STEP alogliptin 12.5 mg tablet alogliptin 12.5 mg-metformin 1,000 mg tablet alogliptin 12.5 mg-metformin 500 mg tablet alogliptin 12.5 mg-pioglitazone
More informationPharmacy Updates Summary
All of the following changes were reviewed and approved by the SFHP Pharmacy & Therapeutics (P&T) Committee on 04/15/2015 Effective date: 05/15/2015 Therapeutic Classes reviewed: Testosterone replacement
More informationALOGLIPTIN STEP. Step Therapy Requirements Effective June 1, 2018
Step Therapy Requirements Effective June 1, 2018 ALOGLIPTIN STEP alogliptin 12.5 mg tablet alogliptin 12.5 mg-metformin 1,000 mg tablet alogliptin 12.5 mg-metformin 500 mg tablet alogliptin 12.5 mg-pioglitazone
More informationFormulary Change Notice
Formulary Change Notice HealthPartners may remove drugs from our formulary (list of covered drugs) or add rules about whether and when certain drugs are covered during the year. The chart below contains
More informationQuarterly pharmacy formulary change notice
Provider Bulletin June 24, 2016 Summary of change The Pharmacy and Therapeutics Committee reviewed and approved the formulary changes listed in the table below on March 29, 2016. What this means to you
More informationFormulary. BlueMedicare SM Comprehensive
BlueMedicare SM Comprehensive Formulary BlueMedicare Classic (HMO) H1035-017,018 BlueMedicare Classic Plus (HMO) H1035-022 BlueMedicare Select (PPO) H5434-002 This formulary was updated on 12/31/2018.
More informationVIVA MEDICARE IMPORTANT T EXPANDED PERFORMANCE FORMULARY UPDATES
NORE/ETH/FER CHW 0.MG Added to the 07 //07 ALYACEN TAB / Added to the 07 //07 AMETHIA LO TAB Added to the 07 //07 ERGOT/CAFFEN TAB 00MG Added to the 07 //07 NORETH/ETHIN TAB /0 Added to the 07 //07 LORCET
More informationDrug Name Tier Drug Name Tier
Drug Name Tier Drug Name Tier ABELCET 100 MG/20 ML VIAL 4 ACETYLCYSTEINE 10% VIAL 2 ACETYLCYSTEINE 20% VIAL 2 ACYCLOVIR 1,000 MG/20 ML VIAL 2 ACYCLOVIR 500 MG/10 ML VIAL 2 ADRUCIL 500 MG/10 ML VIAL 2 ALBUTEROL
More informationKansas Health Advantage (HMO SNP) 2018 Formulary Quantity Limit Criteria
APREPITANT Kansas Health Advantage (HMO SNP) 2018 Formulary Aprepitant Oral Capsule 125, 40, 80 Aprepitant Oral Capsule 80 & 125 Quantity Limit: 8 EA Per 30 Days Quantity Limit: 12 EA Per 30 Days ARMODAFINIL
More informationVIVA Health, Inc. Part D Cumulative Formulary Changes for 2009
ulary ulary Effective ADDS 00472088282 ACETASOL HC 2%; 1% SOLN Pref(1) no 1/29/2009 3/1/2009 68382026101 ACETAZOLAMIDE 500MG CP12 Pref(1) yes 3/24/2009 5/1/2009 00078056651 AFINITOR 5MG TABS Pref (4);
More informationMedicare Part D 2016 Formulary Changes Desert Preferred Choice
Medicare Part D 2016 Formulary s Desert Preferred Choice Inter Valley Health Plan may add or remove drugs from our formulary during the year. If we remove a drug from our formulary, add prior authorization,
More informationPRESCRIPTION DRUG PROGRAM FORMULARY UPDATES
PRESCRIPTION DRUG PROGRAM FORMULARY UPDATES Generic Additions These generic drugs recently became available in the marketplace. When these generic drugs became available, we began covering them at the
More information2018 Step Therapy (ST) Criteria
2018 Step Therapy (ST) Criteria Some drugs require step therapy pre-approval. This means that your doctor must have you first try a different drug to treat your medical condition before we will cover a
More informationOntario Drug Benefit Formulary/Comparative Drug Index
Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 43 Summary of Changes December 2018 Effective December 21, 2018 Drug Programs Policy and Strategy Branch
More information2017 BlueMedicare Comprehensive Formulary
2017 BlueMedicare Comprehensive Formulary SM BlueMedicare Rx (PDP) BlueMedicare HMO BlueMedicare PPO BlueMedicare Regional PPO BlueMedicare Group Rx (Employer PDP) BlueMedicare Group PPO (Employer PPO)
More informationSTEP THERAPY CRITERIA
STEP THERAPY This is a complete list of drugs that have written coverage determination policies. Drugs on this list do not indicate that this particular drug will be covered under your medical or prescription
More informationYou ll find the most up-to-date comprehensive version of our formulary on our website, Click on Drug Finder.
3/1/2018 Medicare Part D Formulary Change In an effort to cover the most needed, cost-effective prescriptions, the AlohaCare Advantage Plus (HMO SNP) Formulary is updated monthly. The following are drugs
More information2017 Medicare Part D Formulary Change
2017 Medicare Part D Formulary Change We may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, or add prior authorizations, quantity limits and/or step therapy
More information