2019 Drug List Negative Changes
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1 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 on a drug. We will tell you at least 60 days before we make these changes. This gives you time to talk to your doctor about what to do next. If the Food and Drug Administration (FDA) says a drug you are taking is not safe, we will take it off the formulary right away. We will also send you a letter telling you that. The table below shows changes made to our 2019 formulary. Your cost share depends on your coverage stage. Your formulary tells you the tier that applies to each covered drug. Date of Change Drug Name Type of Change Possible Alternative Drug(s) Comments 1/1/2019 GLEOSTINE CAPS 5 MG 1/1/2019 IPRIVASK SOLR 1/1/2019 ISTODAX SOLR This drug was removed from the market. 1/1/2019 METFORMIN HYDROCHLORIDE Removed non-medicaid and non-part D eligible drug. SOLN RIOMET 1/1/2019 PCE TBEC 333 MG 1/1/2019 PEG-INTRON REDIPEN PAK 4 KIT This drug was removed from the market. 1/1/2019 POTIGA TABS 300 MG 1/1/2019 VEXOL SUSP This drug was removed from the market. 2/1/2019 AMICAR TAB 1000MG 2/1/2019 FINACEA GEL 15% Y0020_DrugLstNegChngWebNtc17_NM aminocaproic acid tabs or 1000 mg azelaic acid gel 15%
2 Date of Change Drug Name Type of Change Possible Alternative Drug(s) 2/1/2019 GRASTEK SUBL 2/1/2019 MENOMUNE- A/C/Y/W-135 INJ 2/1/2019 TRELSTAR SUSR TRELSTAR MIXJECT 2/1/2019 ZYTIGA TAB 250MG abiraterone acetate tabs NORVIR NORVIR tabs PEGASYS PROCLICK PEGASYS triamcinolone mometasone furoate acetonide Nasal Susp 50 MCG/ACT CLINIMIX CLINIMIX 2.75%/DEXTROSE 5% 4.25%/DEXTROSE 5% pramoxine-hc crea Removal of non-part D eligible drug (DESI 5 LTE) amifostine SOLR This drug was removed from the market. TETANUS/DIPHTHERIA TOXOIDS-ADSORBED TDVAX SUSP SUSP This drug was removed from the market. ketoprofen CAPS 50 MG triamterene & hydrochlorothiazide CAPS 50MG-25MG This drug was removed from the market. Codeine Sulfate Tab 15 MG This drug was removed from the market. CANASA SUP Mesalamine Suppos MG MG RAPAFLO CAP 8MG silodosin Cap 8 MG Comments
3 Date of Change Drug Name Type of Change Possible Alternative Drug(s) RAPAFLO CAP 4MG silodosin Cap 4 MG Fluticasone-Salmeterol ADVAIR DISKU AER Aer Powder BA /50 4/1/2019 4/1/2019 ADVAIR DISKU AER 250/50 ADVAIR DISKU AER 500/50 ELIDEL CRE 1% INVIRASE CAPS 4/1/2019 MOEXIPRIL/HYDRO CHLOROTHIAZIDE TABS MCG/DOSE Fluticasone-Salmeterol Aer Powder BA MCG/DOSE Fluticasone-Salmeterol Aer Powder BA MCG/DOSE Pimecrolimus Cream 1% This drug was removed from the market. Comments 4/1/2019 NUTRESTORE PACK 4/1/2019 PRALUENT SOSY 75 MG/ML This drug was removed from the market. 4/1/2019 REMODULIN INJ Treprostinil Sodium Inj 10 10MG/ML MG/ML 4/1/2019 REMODULIN INJ Treprostinil Sodium Inj 1 1MG/ML MG/ML 4/1/2019 REMODULIN INJ Treprostinil Sodium Inj 2.5MG/ML 2.5 MG/ML 4/1/2019 REMODULIN INJ Treprostinil Sodium Inj 5 5MG/ML MG/ML If you or your doctor disagrees with the change to your drug, you may request an exception. To request an exception, call us at:
4 State Phone Number AR , TTY:711 AZ , TTY:711 Allwell CHF/Diabetes/Cardiac Medicare (HMO SNP) Allwell Medicare Essentials (HMO) FL , TTY:711 GA , TTY: 711 IL , TTY: 711 State Phone Number IN , TTY:711 KS , TTY:711 LA , TTY:711 MO , TTY:711 MS , TTY:711 OH , TTY:711 PA , TTY:711 SC , TTY:711 TX , TTY:711 From October 1 March 31, seven days a week, 8 a.m. to 8 p.m. From April 1 - September 30, Monday through Friday, 8 a.m. to 8 p.m. A messaging system is used after hours, weekend, and on federal holidays. Your doctor must provide a statement to support your request. For details on asking for an exception, check your Evidence of Coverage. If you don t agree with our decision, you may file a complaint with us. To file a complaint, call us at: State Phone Number AR , TTY:711 AZ , TTY:711 Allwell CHF/Diabetes/Cardiac Medicare (HMO SNP) Allwell Medicare Essentials (HMO) FL , TTY:711 GA , TTY:711 IL , TTY:711 State Phone Number IN KS LA MO MS OH PA SC TX , TTY: , TTY: , TTY: , TTY: , TTY: , TTY: , TTY: , TTY: , TTY:711 From October 1 March 31, seven days a week, 8 a.m. to 8 p.m. From April 1 - September 30, Monday through Friday, 8 a.m. to 8 p.m. A messaging system is used after hours, weekend, and on federal holidays. Your doctor must provide a statement to support your request. You may also send your complaint to us in writing at the following address. For all plans except Arizona: Allwell
5 Attn: Medicare Appeals & Grievances 7700 Forsyth Boulevard St. Louis, MO For Arizona ONLY: Allwell Attn: Appeals & Grievances Dept. P.O. Box Sacramento, CA The Formulary may change at any time. You will receive notice when necessary.
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