FORMULARY UPDATES TO DENVER HEALTH MEDICAID CHOICE (DHMC) AND CHILD HEALTH PLAN PLUS (CHP+) PLANS
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1 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 during the year. If DHMC/CHP+ removes drugs from the formulary, or adds a restriction to an existing formulary drug, such as prior authorization, quantity limits and/or step therapy, [and/or moves a drug to a higher cost-sharing tier], DHMC/CHP+ will notify you of the change at least 10 days before the date that the change becomes effective. If the Food and Administration (FDA) deems a drug on the formulary to be unsafe, or the drug s manufacturer removes the drug from the market, DHMC/CHP+ will immediately remove the drug from the formulary. The table below outlines previous and/or recent changes to the formulary. The newest updates are highlighted in yellow. For questions or if you would like more information related to these changes please call the DHMC/CHP+ Pharmacy Services Department at or FORMULARY ABBREVIATIONS (Explanations can be found on the website in the DHMC/CHP+ Formulary and Pharmaceutical Management Procedures) LA = Limited Access (must be filled at DH Pharmacy or PA Required); PA = ; QL = ; ST = Atomoxetine Fondaparinux Syringes Buprenorphine/ Naloxone Film 8 mg/ mg Film Praziquantel Atovaquone/ Proguanil Addition Addition Addition Addition Generic Generic for Suboxone 8 mg/ mg Film Generic for Generic Biltricide from to 1; Generic for Norvir Cost Ritonavir Generic Tacrolimus Addition Addition Tradjenta Addition Addition s 10/01/018 LA, QL 07/01/018 LA, QL 07/01/018 LA, QL 07/01/018 LA 07/01/018 1 QL 07/01/018 LA 0/01/018 LA 0/01/018 LA, QL 0/01/018
2 Jentadueto Narcan Nasal Spray Buprenorphine Sublingual Estradiol Vaginal Cream Efavirenz Tenofovir Disoproxil Fumarate Atazanavir Aripiprazole s LA, QL 0/01/018 Addition Addition Addition Addition QL 0/01/018 Addition Addition LA, QL 0/01/018 Addition Addition 1 QL 0/01/018 Generic for Sustiva Generic for Viread Generic Generic LA 0/01/018 LA 0/01/018 Generic for Reyataz Generic LA 0/01/018 LA, QL 01/01/018 Metformin Cost Metformin LA 01/01/018 Extended-Release from 1 to Extended- (Generic ; Release for Fortamet) Limited Access (Generic for Glucophage XR) Lyrica Addition Addition LA, QL, PA 01/01/018 Oxycodone Addition Addition One Formulary LA, QL, ST 01/01/018 Extended-Release Long-Acting Opioid Victoza Pens Addition Addition One Formulary Diabetic Medication Priftin Addition Addition Abacavir Oral Generic Generic Solution Ziagen Eletriptan Imiquimod Generic Relpax from to 1; Limited Access Generic Sumatriptan and zolmitriptan LA, QL, ST 01/01/018 LA 01/01/018 LA 10/01/017 LA, QL, ST 10/01/ /01/017
3 Enoxaparin from to ; Limited Access Mavyret Addition Addition Entresto Addition Addition Risperdal Consta Addition Addition Oral Syringes Risperidone Jardiance Addition Addition One Formulary Diabetic Medication Codeine Products Tramadol Ondansetron and Oral- Disintegrating Norvir Vivitrol Vials Age Updated to 1 Years and Older Age for 1 Years and Older Increased from 0 Per 0 Days to 90 Per 0 Days from to FDA Safety Warning Labeling FDA Safety Warning Labeling s QL 10/01/017 LA, QL, PA 10/01/017 LA, QL 07/01/017 LA, QL, ST 07/01/017 LA, QL, ST 07/01/017 Age, QL 07/01/017 Age, QL 07/01/017 QL 07/01/017 LA 07/01/017 LA, QL 07/01/017
4 Antipyrine/ Benzocaine Otic Solution Atropine Ophthalmic Solution Cytra-K Crystals and Oral Solution Donnatal Elixir and Esterified Estrogens/ Methyltestosterone Hydrocortisone/ Pramoxine Rectal Cream Phenazopyridine Tacrolimus Ointment from 1 to ; Limited Access Regulatory Requirement Vyvanse Addition Addition Amphetamine Salts and Xarelto 0 mg Venlafaxine Extended-Release Fenofibrate Doxycycline and Duloxetine Aranesp Syringes and Vials s LA 07/01/017 Addition Addition Topical Corticosteroids LA, QL, ST 0/01/017 LA, QL, ST 0/01/017 or Methylphenidate LA, QL 0/01/017 Increased Increased and from to 1 Cost QL 0/01/017 QL 0/01/017 QL 0/01/017 1 QL 0/01/017 LA 01/01/017
5 Leukine Syringes and Vials Neupogen Syringes and Vials Epinephrine Auto- Injectors Generic Epipen and Epipen Jr s LA 01/01/017 LA 01/01/017 Generic 1 QL 01/01/017 Descovy Addition Addition LA 01/01/017 Genvoya Addition Addition LA 01/01/017 Odefsey Addition Addition LA 01/01/017 Vemlidy Addition Addition LA 01/01/017 Vivitrol Vials Addition Addition LA, QL, PA 01/01/017 Oseltamivir Generic Tamiflu Generic 1 QL 01/01/017 Abacavir/ Lamivudine Aripiprazole Lidocaine 5% Ointment Generic Epzicom ; from 1 to and Limited Access and s Generic Cost Sovaldi Deletion Cost Clozapine, Olanzapine, Quetipaine, Risperidone, Ziprasidone Lidocaine % Cream Epclusa, Harvoni, Zepatier LA 01/01/017 LA, QL, PA 01/01/017 Epclusa Addition Addition LA, QL 01/01/017 01/01/017 LA, PA, QL 10/01/016
6 s LA, PA, QL 10/01/016 Zepatier Addition Addition Mesalamine Generic Generic 10/01/016 Delayed-Release Asacol HD Colchicine Addition Addition LA, QL, ST 10/01/016 Guanfacine Extended-Release LA, QL 10/01/016 Acitretin Rosuvastatin ; Generic Crestor Methotrexate LA, ST 10/01/016 Generic LA, QL 07/01/016 Modafinil Addition Addition QL 07/01/016 Complera Addition Addition LA 07/01/016 Celecoxib QL 07/01/016 Diclofenac Gel Generic Voltaren Gel Generic 1 QL 07/01/016 Levitra Age QL 07/01/016
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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
SUPPORTING OUR PROVIDER PARTNERS THROUGH COMMUNICATION AND COLLABORATION. DATE July 2016 ISSUE 3
SUPPORTING OUR PROVIDER PARTNERS THROUGH COMMUNICATION AND COLLABORATION. DATE July 2016 ISSUE 3 HELPFUL NUMBERS FOR PROVIDERS Magellan: 1-800-846-7971 Bin: 016523 Processor control: 747 HELPFUL NUMBERS
Step Therapy Requirements. Effective: 11/01/2018
Effective: 11/01/2018 Updated 10/2018 ANTIDEPRESSANTS Sharp Health Plan (HMO) TRINTELLIX 10 MG TABLET TRINTELLIX 20 MG TABLET TRINTELLIX 5 MG TABLET VIIBRYD 10 MG (7)-20 MG (23) TABLETS IN A DOSE PACK
Cynthia B. Jones, Director Department of Medical Assistance Services (DMAS)
Department of Medical Assistance Services 600 East Broad Street, Suite 1300 Richmond, Virginia 23219 MEDICAID MEMO http://www.dmas.state.va.us TO: All Prescribing Providers, Pharmacists, and Managed Care
VNSNY CHOICE FIDA Complete Step Therapy Requirements. Effective: 01/01/2017
Effective: 01/01/2017 Updated 11/2016 ANTI-INFLAMMATORY AGENTS - GI DIPENTUM PRIOR CLAIM FOR BALSALAZIDE OR APRISO WITHIN THE PAST 120 DAYS. ANTICONVULSANTS APTIOM BANZEL FYCOMPA GABITRIL OXTELLAR XR POTIGA
Quarterly 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 third quarter pharmacy and therapeutics committee meeting.
Calgary Long Term Care Formulary
Page 1 of 10 Calgary Long Term Care Formulary Pharmacy & Therapeutics November 2018 Highlights https://www.albertahealthservices.ca/info/page4071.aspx Page 2 of 10 Contents November 2018... 3 Formulary
2017 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
Quarterly pharmacy formulary change notice
Provider update Quarterly pharmacy formulary notice Summary: Effective February 1, 2018, the preferred formulary s detailed in the table below will apply to Amerigroup District of Columbia, Inc. members
TN Cover Rx Tennessee CoverRx MAC Price Change List As of: 04/26/2018
1 Tennessee CoverRx List Run : 04/26/18 Dosage Form amiodarone HCl 200 MG TABLET ORAL 04/25/2018 0.16102 0.14405 11.8 hydralazine HCl 100 MG TABLET ORAL 04/25/2015 0.11390 0.10854 4.9 hydralazine HCl 25
Appropriate Use & Safety Edits
Appropriate Use & Safety Edits Envolve Pharmacy Solutions provides a variety of safety edits to promote the use of the right medication, in the right patient, at the right time. These edits are routinely