Relative Cost/Month. Less than $10. Loratadine Liquid* $10-$15 Cetirizine liquid 1mg/mL*
|
|
- Walter Watts
- 6 years ago
- Views:
Transcription
1 Allergy Chlorpheniramine Tablet* Diphenhydramine Tablet* Diphenhydramine Liquid* Loratadine Tablet* Cetirizine Tablet* Loratadine 10mg ODT* Less than $10 Loratadine Liquid* $10-$15 Cetirizine liquid 1mg/mL* Levocetirizine Tablet Fexofenadine 180 mg Tablet* Fluticasone nasal spray* Claritin 5 mg Reditabs (no generic available) Fexofenadine 60 mg Tablet Cetirizine chewables* Allegra ODT Azelastine nasal spray Allegra oral suspension Flunisolide nasal spray* Rhinoquart Aqua Nasal Spray Levocetirizine Liquid Nasonex Nasal Spray Patanase 0.6% Nasal Spray * formulary, step therapy $15-$25 $25 -$35 $45-$55 Greater than $125
2 Asthma Controllers Montelukast Tablets* Montelukast Chewables* Less than $20 Montelukast Granules* Flovent Diskus * Asmanex Twisthaler * $130 to $150 Pulmicort Flexhaler * Qvar Inhaler * Flovent HFA Inhaler* $150 to $200 Dulera Inhaler Symbicort Inhaler $200 to $250 Advair Diskus Advair HFA Inhaler $275 to $350 Budesonide Nebules Pulmicort Respules (1mg not available generically) >$700 * formulary, step therapy age limit Quantity Limit COPD Foradil Aerolizer $150 to $200 Serevent Diskus Atrovent HFA Inhaler Tudorza Pressair Inhaler $200 to $250 Symbicort Inhaler Combivent Respimat * Spiriva Handihaler * Advair Diskus $250 to $300 Advair HFA Inhaler * formulary, step therapy
3 ADHD Methylphenidate (Equivalent to Methylin )* Methylphenidate SR (Equivalent to Methylin ER )* Dexmethylphenidate IR (Equivalent to Focalin )* Dextroamphetamine IR (Equivalent to Dexedrine )* Amphetamine Salts IR (Equivalent to Adderall )* Methylphenidate ER (Equivalent to Ritalin LA ) Amphetamine Salts XR (Equivalent to Adderall XR )* Dextroamphetamine ER (Equivalent to Dexedrine Spanules )* Methylphenidate CD (Equivalent to Metadate CD ) Ritalin LA $20 to $30 $45 to $80 $125 to $155 Dexmethylphenidate XR (Equivalent to Focalin XR ) $160 to $200 Methylphenidate ER (Equivalent to Concerta ) Vyvanse Focalin XR Kapvay ER Intuniv ER Strattera $200 to $300 Daytrana Patch Quillivant XR Methylphenidate solution^ Nuvigil Modafinil (Equivalent to Provigil ) Greater than $400
4 * formulary, step therapy, ^Cost increases with higher doses 2014 Relative Cost for Select Drug Classes Neighborhood Health Plan of RI Second Generation Antipsychotics Olanzapine Tablets* Quetiapine Tablets* Risperidone Tablets* Risperidone Solution* $15 to $40 Ziprasidone Capsules*^ $85-$120 Abilify 1mg/ml Solution Abilify 15 mg Tablets Latuda Tablets Seroquel XR Tablets Invega ER <9 mg Tablets Saphris Tablets $400 to $450 $500 to $600 Abilify 20 mg Tablets $625 to $800 Invega ER 9 Mg Tablets Risperdal Consta Invega Sustenna * formulary, step therapy Quantity Limit Greater than $800 Quetiapine 25mg and 50 mg tablets require a prior authorization after 60 days of therapy. ^ Higher Strengths associated with higher costs for ziprasidone
5 Antidepressants Citalopram * Trazodone * Fluoxetine * Sertraline* Escitalopram* Paroxetine* Venlafaxine ER *^ Fluvoxamine* Buproprion SR* Venlafaxine IR*^ Buproprion XL* Buproprion IR* Duloxetine Viibryd Pristiq Fluvoxamine ER * formulary, step therapy Less than $10 $10 to $20 $25 to $35 Greater than $140 ^Note: Venlafaxine ER capsules are preferred. Tablets are non-formulary.
6 Proton Pump Inhibitors Omeprazole Capsules*^ Pantoprazole Tablets* Less than $15 Lansoprazole Capsules Prevacid 24HR Capsules Rabeprazole DR (generic Aciphex DR) $30 to $100 Omeprazole Reconstitution Dexilant Capsules Prevacid Solutab Prilosec Protonix Suspension $150 to $200 $200 to $300 Nexium Capsules Zegrid Packets Greater than $600 * formulary ^Note: Omeprazole Capsules are preferred. The OTC tablets are non-formulary.
Commissioner for the Department for Medicaid Services Selections for Preferred Products
Commissioner for the Department for Medicaid Services Selections for Preferred Products This is a summary of the final Preferred Drug List (PDL) selections made by the Commissioner for the Department for
More information2015 Step Therapy Prior Authorization Medical Necessity Guidelines
Tufts Health Unify 2015 Step Therapy Prior Authorization Medical Necessity Guidelines Effective: 01/01/2015 Updated: 10/01/2015 Tufts Health Plan P.O. Box 9194 Watertown, MA 02471-9194 Phone: 855-393-3154
More informationJudges Reference Table for the March 2016 Psychotropic Medication Utilization Parameters for Foster Children
Judges Reference Table for the Psychotropic Medication Utilization Parameters for Foster Children Stimulants for treatment of ADHD Preschool (Ages 3-5 years) Child (Ages 6-12 years) Adolescent (Ages 13-17
More informationAttention: Behavioral Health Providers, Pharmacists and Prescribers N.C. Medicaid and N.C. Health Choice Preferred Drug List Changes - UPDATE
Attention: Behavioral Health Providers, Pharmacists and Prescribers N.C. Medicaid and N.C. Health Choice Drug List Changes - UPDATE Note: This article was previously published in the December 2014 Medicaid
More informationU T I L I Z A T I O N E D I T S
I N D I A N A H E A L T H C O V E R A G E P R O G R A M S U T I L I Z A T I O N E D I T S A P R I L 1 9, 2 0 1 2 s for s Refer to Provider Bulletin BT200709 for additional information regarding the Mental
More informationStep Therapy Medications
Step Therapy Medications Step Therapy (ST PA ) is an automated form of prior authorization. It encourages the use of therapies that should be tried first, before other treatments are covered, based on
More informationSmithRx Standard Formulary Step Therapy List
SmithRx Standard Formulary Step Therapy List Revised: January 27, 2017 The following medications require prior use of at least one other medication for coverage. Please note that any plan-specific customizations
More informationOHIO MEDICAID PHARMACY COVERAGE
OHIO MEDICAID PHARMACY COVERAGE This information is intended for use by providers to help select the most appropriate cost-effective medication and formulation for their patients. Prescribers should utilize
More informationAvoid paying too much for your prescriptions
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions 2017 Aetna Rx Step Program Medicine List Avoid paying too much for your prescriptions It s important to try to
More informationCRITERIA Trial of two generic formulary products from the following: atomoxetine or ADHD stimulant medication.
ADHD STIMULANTS ATOMOXETINE HCL, DEXEDRINE 10 MG TABLET, DEXEDRINE 5 MG TABLET, DEXMETHYLPHENIDATE HCL, DEXMETHYLPHENIDATE HCL ER, DEXTROAMPHETAMINE 10 MG TAB, DEXTROAMPHETAMINE 5 MG TAB, DEXTROAMPHETAMINE
More informationA Brief Overview of Psychiatric Pharmacotherapy. Joel V. Oberstar, M.D. Chief Executive Officer
A Brief Overview of Psychiatric Pharmacotherapy Joel V. Oberstar, M.D. Chief Executive Officer Disclosures Some medications discussed are not approved by the FDA for use in the population discussed/described.
More informationSchedule FDA & literature based indications
Psychotropic Medication List Recommended dosages are intended to serve only as a guide for children. Recommended doses are literature based. Clinicians should consult package insert of medications for
More informationTABLE OF CONTENTS (Click on a link below to view the section.)
Follow the links below to access the complete formularies for Plans: Health Plan Acne Allergy Allergic Anaphylactic Reaction Allergic Conjunctivitis Allergic Rhinitis Asthma Atopic Dermatitis Behavioral
More informationADHD STIMULANTS-S(SHC)
Step Therapy Simply Health Care 2014 Formulary ID: 14406 Version: 14 Last Updated: 08/01/2014 ADHD STIMULANTS-S(SHC) Daytrana Focalin Xr Strattera Patient needs to have a paid claim for one Step 1 drug
More informationCONTRAINDICATIONS TABLE
CONTRAINDICATIONS TABLE Generic Name Brand Name Contraindications Amphetamine Salts Adderall, Adderall XR Hypersensitivity to amphetamine, dextroamphetamine, or other sympathomimetic amines Advanced arteriosclerosis
More informationTABLE OF CONTENTS (Click on a link below to view the section.)
Follow the links below to access the complete formularies for Plans: Buckeye Health Plan Acne Allergy Allergic Anaphylactic Reaction Allergic Conjunctivitis Allergic Rhinitis Asthma Atopic Dermatitis Behavioral
More informationLower your costs. Save money with preferred generic and preferred brand-name drugs 2018 Aetna Rx Step Program Medicine List
Call out bold Call out light Contact information, call X-XXX-XXX-XXXX or visit www.aetna.com Call to action small copy (especially related to mobile apps). Hendani adionse rferum faceatis incte voluptassi
More information2019 STEP THERAPY CRITERIA UCare Individual & Family Plans UCare Individual & Family Plans with Fairview
2019 STEP THERAPY CRITERIA UCare Individual & Family Plans UCare Individual & Family Plans with Fairview In some cases, UCare requires you to first try certain drugs to treat your medical condition before
More informationSouth Carolina Department of Health and Human Services Post Office Box 8206 Columbia, South Carolina
South Carolina Department of Health and Human Services Post Office Box 8206 Columbia, South Carolina 29202-8206 Pharmacy and Therapeutics (P&T) Committee Meeting MINUTES 1. Call to Order A meeting of the
More informationADHD Medications Table
Stimulants are the first line treatment of choice for ADHD followed by Non-Stimulants, then off-label medications. We are providing this list of medications so that you can be familiar with the common
More informationData Class: Internal. 1 inhaler (30 blisters OR 14 blisters institutional pack) per presciption
To help make the use of prescription drugs safer and more affordable, our plan is now using a Drug Quantity Management program. That is, for certain medications, you can receive an amount to last you a
More informationPharmacy Updates Summary
All of the following changes were reviewed and approved by the SFHP Pharmacy & Therapeutics (P&T) Committee on 4/16/2014 Effective date: 5/15/2014 Therapeutic Classes reviewed: ADHD Ophthalmic antihistamines
More informationMedications and Children Disorders
Mental Health Comprehensive Services Providing Family Stability and Developing Life Coping Skills Medications and Children Disorders Psychiatric medications can be an effective part of the treatment for
More informationABILIFY INJ. Products Affected Step 2: ABILIFY MAINTENA PREFILLED SYRINGE 300 MG INTRAMUSCULAR ABILIFY MAINTENA PREFILLED SYRINGE 400 MG INTRAMUSCULAR
ABILIFY INJ ABILIFY MAINTENA PREFILLED SYRINGE 300 MG ABILIFY MAINTENA PREFILLED SYRINGE 400 MG ABILIFY MAINTENA SUSPENSION RECONSTITUTED ER 300 MG Claim will pay automatically for ABILIFY MAINTENA if
More informationPharmacy Benefit Management (PBM) Program FORMULARY/PRODUCT RESTRICTIONS
Workforce Safety & Insurance Revised Document Date: 07/23/2015 1600 E Century Ave Ste 1 PO Box 5585 Bismarck, ND 58506-5585 701.328.3800 1.800.777.5033 www.workforcesafety.com Pharmacy Benefit Management
More informationStep Therapy Medications
Step Therapy Medications Step Therapy Group APTIOM Step-2: APTIOM 200 MG TABLET or APTIOM 400 MG TABLET or APTIOM 600 MG TABLET or APTIOM 800 MG TABLET Step 1 Drug(s): Oxcarbazepine immediate-release,
More informationGA KS KY LA MD NJ NV NY TN TX WA Applicable X N/A N/A X N/A X X X X X X N/A N/A X *FHK- Florida Healthy Kids. ADHD Narcolepsy
Override(s) Prior Authorization ADHD Narcolepsy Approval Duration 1 year *Louisiana, Washington and Maryland Medicaid See State Specific Information Below Medications Atomoxetine: Strattera generic Clonidine
More informationInhaled bronchodilators relax constricted airways and treat the noisy part of asthma: coughing, wheezing, choking and shortness of breath.
Inhaled bronchodilators relax constricted airways and treat the noisy part of asthma: coughing, wheezing, choking and shortness of breath. AccuNeb inhalation 0.021% solution: 0.63mg/3mL 3-4 times solution
More information35 mg NF -- Dextroamphetamine Sulfate IR Tablets: Zenzedi IR Ttablets: Dextroamphetamine Sulfate ER Capsules: 15 mg ProCentra Solution.
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: ADHD Medications P&T DATE 12/13/2017 CLASS: Psychiatric Disorders REVIEW HISTORY 12/16, 9/15, 5/12, 5/10, LOB: MCL (MONTH/YEAR)
More informationABILIFY ABILIFY DISCMELT ACTONEL ACTOPLUS MET ACTOPLUS MET XR ACTOS ADCIRCA ADVAIR DISKUS ADVAIR HFA
Quantity Limits Paramount Medicare Formulary 2012 Formulary ID 12112, Version 22. CMS Approved 10-23-2012. ABILIFY Abilify TABS ABILIFY DISCMELT Abilify Discmelt ACTONEL Actonel TABS 150MG Actonel TABS
More informationPain Oral-Intranasal Fentanyl (Abstral, Actiq, Fentora, Lazanda, Onsolis, Subsys)
Pennsylvania Employees Benefit Trust Fund (PEBTF) and n- Medicare Eligible Retired Employees Health Program (REHP), Step Therapy and Quantity Limit List Your doctor needs to get prior authorization for
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 informationFirstCarolinaCare Insurance Company Step Therapy Requirements
ANALGESICS, NARCOTICS KADIAN MORPHINE SULFATE ER PRIOR CLAIM FOR MORPHINE SULFATE SUSTAINED ACTION TABLET (MS CONTIN) WITHIN THE PAST 120 DAYS. ANTIBACTERIALS (EENT) BESIVANCE PRIOR CLAIM FOR CIPROFLOXACIN
More informationAMANTADINE ER. Products Affected Step 2: OSMOLEX ER 129 MG TABLET, EXTENDED RELEASE OSMOLEX ER 193 MG TABLET, Details
AMANTADINE ER OSMOLEX ER 129 MG TABLET, EXTENDED RELEASE OSMOLEX ER 193 MG TABLET, EXTENDED RELEASE OSMOLEX ER 258 MG TABLET, PRIOR CLAIM FOR AMANTADINE HCL IMMEDIATE RELEASE WITHIN THE PAST 120 DAYS.
More informationOregon Health Plan prescription benefit updates
Oregon Health Plan prescription benefit updates EOCCO s prescription program is a pharmacy benefit that offers members a choice of safe and effective medication treatments. The program also helps you save
More informationCigna Drug and Biologic Coverage Policy
Cigna Drug and Biologic Coverage Policy Subject Step Therapy Individual and Family Plan Table of Contents Coverage Policy... 1 General Background... 5 References... 5 Effective Date... 3/15/2018 Next Review
More informationTABLE OF CONTENTS (Click on a link below to view the section.)
Follow the links below to access the complete formularies for Plans: Health Plan Acne Allergy Allergic Anaphylactic Reaction Allergic Conjunctivitis Allergic Rhinitis Asthma Atopic Dermatitis Behavioral
More informationIMPORTANT NOTICE. Changes to dispensing of some Behavioral Health Medications for DC Healthcare Alliance members
IMPORTANT NOTICE Changes to dispensing of some Behavioral Health Medications for DC Healthcare Alliance members These changes apply only to members covered under the DC Healthcare Alliance program Alliance
More informationDose Range. Dose Schedule. Child: 5-60 mg Over 50 kg:5-100 mg Focalin, child: mg Over 50 kg: mg. Focalin: 4-5 hrs.
MEDICATIONS FOR ADHD Group Main Use Medication Brand/ Form Dose Schedule Dose Range Most Common Side Effects for Group Pros for Group Cautions for Group methylphenidate Methylin Focalin (dexmethylphenidate)
More informationUniversity System of Georgia Prior Authorization, Step Therapy and Quantity Limit List (Updated 1/1/2016)
University System of Georgia, Step Therapy and Quantity Limit List (Updated 1/1/2016) (PA) Your doctor will need to obtain a prior authorization for the drugs listed below, before your prescription drug
More informationAppendix: Psychotropic Medication Reference Tables
Appendix: Psychotropic Medication Reference Tables How to Use these Tables These reference tables are designed to provide clinic staff with specific medication related criteria for the Polypharmacy, Cardiometabolic
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 informationALPHA GLUCOSIDASE INHIBITOR THERAPY
ALPHA GLUCOSIDASE INHIBITOR THERAPY GLYSET Step 1: One generic formulary product containing one of the following ingredients: glimeperide, glipizide, metformin or pioglitazone. Step 2: Glyset PAGE 1 LAST
More informationStep Therapy Requirements. Effective: 05/01/2018
Step Therapy Requirements Effective: 05/01/2018 ANTIDEPRESSANTS TRINTELLIX 10 MG TABLET TRINTELLIX 20 MG TABLET TRINTELLIX 5 MG TABLET VIIBRYD 10 MG (7)-20 MG (23) TABLETS IN A DOSE PACK VIIBRYD 10 MG
More informationANTICONVULSANTS. Details. Step Therapy Criteria Date Effective: April 1, 2019
Step Therapy Date Effective: April 1, 2019 ANTICONVULSANTS APTIOM TABLET 200 MG ORAL APTIOM TABLET 400 MG ORAL APTIOM TABLET 600 MG ORAL APTIOM TABLET 800 MG ORAL BANZEL SUSPENSION 40 MG/ML ORAL BANZEL
More informationBLUE SHIELD OF CALIFORNIA JUNE 2016 PLUS DRUG FORMULARY CHANGES
BLUE SHIELD OF CALIFORNIA JUNE 2016 PLUS DRUG FORMULARY CHANGES Blue Shield is committed to covering safe, effective and affordable medications, so we regularly review and update our drug formularies.
More informationStep Therapy Requirements. Effective: 12/01/2016
Effective: 12/01/2016 H2986_PD_049 Updated 11/2016 ALPHA 1-PROTEINASE INHIBITOR GLASSIA PRIOR CLAIM FOR ARALAST NP OR ZEMAIRA WITHIN THE PAST 120 DAYS. ANALGESICS, NARCOTICS KADIAN MORPHINE SULFATE ER
More informationBig Lots Behavioral Health. Prescribing Guidelines for Behavioral Health
Big Lots Behavioral Health Prescribing Guidelines for Behavioral Health Prescribing for Behavioral Health This document was developed by Nationwide Children s Hospital in conjunction with Partners For
More informationPL CE LIVE February 2011 Forum
February 2011 PL CE LIVE Kristin W. Weitzel, Pharm.D., CDE, FAPhA Associate Editor and Director of Editorial Projects Pharmacist s Letter/Prescriber s Letter Atypical Antipsychotics Atypical Antipsychotics
More informationResponsible Quantity Program Effective 4/1/10. Abilify oral solution
Abilify Abilify Discmelt Abilify oral solution Aciphex Actiq Page 1 of 9 750 ml 120 units Actonel 5 mg, 30 mg Actonel 35 mg 4 tabs Actonel 75 mg 2 tabs Actonel 150 mg 1 tab Actonel with Calcium Adcirca
More informationTABLE OF CONTENTS (Click on a link below to view the section.)
Follow the links below to access the complete formularies for Plans: Health Plan Acne Allergy Allergic Anaphylactic Reaction Allergic Conjunctivitis Allergic Rhinitis Asthma Atopic Dermatitis Behavioral
More informationSTEP THERAPY ALGORITHMS PUP Select Formulary
The Step Therapy drug will be dispensed if the drug has been dispensed within 120 days of current fill or if alternative (Step 1) drugs have been used first. If the member s prescription claim fails the
More informationBig Lots Behavioral Health. Prescribing Guidelines for Behavioral Health
Big Lots Behavioral Health Prescribing Guidelines for Behavioral Health Prescribing for Behavioral Health This document was developed by Nationwide Children s Hospital in conjunction with Partners For
More informationAMANTADINE ER. Products Affected Step 2: OSMOLEX ER 129 MG TABLET, EXTENDED RELEASE OSMOLEX ER 193 MG TABLET, Details
AMANTADINE ER OSMOLEX ER 129 MG TABLET, EXTENDED RELEASE OSMOLEX ER 193 MG TABLET, EXTENDED RELEASE OSMOLEX ER 258 MG TABLET, PRIOR CLAIM FOR AMANTADINE HCL IMMEDIATE RELEASE WITHIN THE PAST 120 DAYS.
More informationALLERGIC CONJUNCTIVITIS AGENTS
2018 5 Tier Standard- Keystone First VIP Choice Document: 2018 Step Therapy Formulary ID: 18390 Last Updated: 04/2018 Effective Date: 05-01-2018 ALLERGIC CONJUNCTIVITIS AGENTS epinastine 0.05 % eye drops
More information2017 Step Therapy Criteria
FRESENIUS TOTAL HEALTH 2017 Step Therapy Updated 07/01/2017. For more recent information or other questions, please contact Fresenius Total Health Customer Service at 1-855-598-6774 / TTY 1-844-209-9094.
More informationAD/HD is a mental disorder, and it often lasts from
short version10 WHAT WE KNOW Managing Medication for Adults with AD/HD AD/HD is a mental disorder, and it often lasts from childhood into adulthood. Medication is the basic part of treatment for adults.
More informationCentral Nervous System Stimulants Drug Class Prior Authorization Protocol
Line of Business: Medi-Cal Effective Date: August 16, 2017 Revision Date: August 16, 2017 Central Nervous System Stimulants Drug Class Prior Authorization Protocol This policy has been developed through
More informationCAMPER APPLICATION PACKET
CAMPER APPLICATION PACKET Monday- Friday June 12-16, 2017 Rockport, Texas DEADLINE FOR SUBMITTING ALL FORMS: THE IMPORTANCE OF COMPLETING ALL CAMP FORMS Although it may seem like a lot of paperwork, the
More informationStep Therapy Group. Atypical Antipsychotic Agents
Atypical Antipsychotic Agents Any beneficiary newly enrolled into Community Care, Inc. currently receiving aripiprazole, aripiprazole ODT, risperidone, risperidone ODT, olanzapine, olanzapine ODT, quetiapine,
More informationManagement. Quantity. What Is Quantity Management? What Happens at the Pharmacy? Which Medications Are Included? January 2017
Quantity January 2017 Management What Is Quantity Management? It s a quality and safety program that promotes the safe use of medications. The program limits the amount of some medications that we cover.
More informationReview of Psychotrophic Medications. (An approved North Carolina Division of Health Services Regulation Continuing Education Course)
Review of Psychotrophic Medications (An approved North Carolina Division of Health Services Regulation Continuing Education Course) Common Psychiatric Disorders *Schizophrenia *Depression *Bipolar Disorder
More informationManagement. Quantity. What Is Quantity Management? What Happens at the Pharmacy? Which Medications Are Included? January 2016
January 2016 Quantity Management What Is Quantity Management? It s a quality and safety program that promotes the safe use of medications. The program limits the amount of some medications that we cover.
More informationARBS MEDICATION(S) SUBJECT TO STEP THERAPY DIOVAN HCT MG TAB, DIOVAN HCT MG TABLET
ARBS DIOVAN HCT 160-12.5 MG TAB, DIOVAN HCT 80-12.5 MG TABLET 30-day trial of a Step 1 drug in the previous 120 days is required. Step 1 Drugs: Losartan, Losartan/HCTZ PAGE 1 LAST UPDATED 05/2016 BILE
More informationBehavioral Health. Behavioral Health. Prescribing Guidelines
Behavioral Health Behavioral Health Prescribing Guidelines Attention Deficit/Hyperactivity Disorder (ADHD) Start with a first line medication, either from the methylphenidate or dextroamphetamine-amphetamine
More informationAttention Deficit Hyperactivity Disorder (ADHD) in Children under Age 6
in Children under Age 6 Level 0 Conduct comprehensive assessment and provide psychoeducation about ADHD, including clearly defined treatment expectations. Consider co-morbid developmental language disorder,
More informationStep Therapy Requirements. Effective: 1/1/2019
Effective: 1/1/2019 Updated 1/2019 AMANTADINE ER Sharp Health Plan (HMO) OSMOLEX ER 129 MG, EXTENDED RELEASE OSMOLEX ER 193 MG, EXTENDED RELEASE OSMOLEX ER 258 MG, EXTENDED RELEASE PRIOR CLAIM FOR AMANTADINE
More informationTourette Syndrome. Biological Basis, Clinical Symptoms, Treatment. Drake D. Duane, MS, MD
Tourette Syndrome Biological Basis, Clinical Symptoms, Treatment Drake D. Duane, MS, MD Director, Institute for Developmental Behavioral Neurology Adjunct Professor, Arizona State University Scottsdale/Tempe,
More informationNational Preferred Formulary Quantity Limits Drug List Helpful Tip: To search for a specific drug, use the find feature (Ctrl + F)
Page 1 of 6 Allergies Anaphylaxis Antifungal Anti-infective Anti-infective - Specialty Anti-Influenza Asthma - Specialty Asthma/COPD National Preferred Formulary Quantity Limits Drug List Helpful Tip:
More informationTRELEGY ELLIPTA (fluticasone-umeclidinium-vilanterol) aerosol powder
TRELEGY ELLIPTA (fluticasone-umeclidinium-vilanterol) aerosol powder Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific
More informationOhana Community Care Services (CCS) Comprehensive Preferred Drug List (List of Covered Drugs)
2015 Ohana Community Care Services (CCS) Comprehensive referred Drug List (List of Covered Drugs) Ohana Health lan 00 lease read: This document contains information about the drugs we cover in this plan.
More informationANTIDEPRESSANTS. Details. dose pack Viibryd 10 mg tablet Viibryd 20 mg tablet Viibryd 40 mg tablet. Criteria
ANTIDEPRESSANTS Trintellix 10 mg tablet Trintellix 20 mg tablet Trintellix 5 mg tablet Viibryd 10 mg (7)-20 mg (23) tablets in a dose pack Viibryd 10 mg tablet Viibryd 20 mg tablet Viibryd 40 mg tablet
More informationMethylphenidate Dexmethylphenidate
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.60.25 Yeah Subject: Methylphenidates Page: 1 of 6 Last Review Date: September 15, 2017 Methylphenidate
More informationALAMEDA COUNTY BEHAVIORAL HEALTH CARE SERVICES MEDICATION FORMULARY
ANTIDEPRESSANTS Serotonin Selective Reuptake Inhibitors citalopram 10, 20, 40 mg, 10 mg/5cc $ 0.40 No escitalopram 10, 20 mg $ 2.60 Yes fluoxetine 10, 20 mg, 20 mg/5 ml $ 0.40 Yes fluvoxamine 25, 50, 100
More informationSecretary for Health and Family Services Selections for Preferred Products
Secretary for Health and Family Services Selections for Preferred Products This is a summary of the final Preferred Drug List (PDL) selections made by the Secretary for Health and Family Services based
More information2018 PDP Premier Step Therapy Document September 2018 Y0114_18_33144_I_009
2018 PDP Premier Step Therapy Document September 2018 Aggrenox Y0114_18_33144_I_009 aspirin 25 mg-dipyridamole 200 mg capsule,ext.release 12 hr multiphase drug may be given. Step 1 Drug(s): clopidigrel.
More informationBlue Medicare HMO Essential 2015 Quantity Limit List Blue Medicare Rx Standard 2015 Quantity Limit List
Blue Medicare HMO Essential 2015 Quantity Limit List Blue Medicare Rx Standard 2015 Quantity Limit List Drug Name Monthly Limit (30 days unless otherwise noted) abacavir 300 mg abacavir/lamivudine/zidovudine
More informationANTICHOLINERGIC BRONCHODILATORS ANTICHOLINERGIC BETA-AGONIST COMBO'S CORTICOSTEROID / BRONCHODILATOR COMBO'S NASAL STEROIDS LEUKOTRIENE MODIFIERS
1 of 5 ALLERGY / ASTHMA THERAPIES ANTIHISTAMINES, MINIMALLY SEDATING cetirizine fexofenadine loratadine ANTIHISTAMINE/DECONGESTANT COMBINATIONS cetirizine/pseudoephedrine fexofenadine/pseudoephedrine loratadine/pseudoephedrine
More informationMethylphenidate also has an off-label indication for depression, although published trials are limited in size and duration (14).
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.60.25 Yeah Subject: Methylphenidates Page: 1 of 5 Last Review Date: December 2, 2016 Methylphenidate
More informationANTINEOPLASTIC DRUGS CHAPTER 21. Antineoplastic drugs - designed to treat malignancies, now also used to treat diseases with inflammatory component
ANTINEOPLASTIC DRUGS CHAPTER 21 Antineoplastic drugs - designed to treat malignancies, now also used to treat diseases with inflammatory component Tx of malignancies Antineoplastic drugs: methotrexate
More informationANTIDIABETIC AGENTS - MISCELLANEOUS
ANTIDIABETIC AGENTS - MISCELLANEOUS Glyxambi 10 mg-5 mg tablet Glyxambi 25 mg-5 mg tablet Invokamet 150 mg-1,000 mg tablet Invokamet 150 mg-500 mg tablet Invokamet 50 mg-1,000 mg tablet Invokamet 50 mg-500
More informationMethylphenidate Dexmethylphenidate
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Methylphenidates Page: 1 of 7 Last Review Date: November 30, 2018 Methylphenidate Dexmethylphenidate
More informationProton Pump Inhibitors
Market DC Proton Pump Inhibitors Override(s) Prior Authorization Quantity Limit** Approval Duration Preferred PPI: No Prior Authorization required Preferred PPI quantity override: Lifetime Non-Preferred
More informationStep 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
More informationFocalin compared to concerta
Focalin compared to concerta Search FREE SHIPPING how does focalin compared to concerta. Free shipping, quality, privacy, secure. how does focalin compared to concerta. Compare Ritalin vs. Focalin. Focalin
More informationPharmacy Medical Necessity Guidelines: ADHD CNS Stimulant Medications
Pharmacy Medical Necessity Guidelines: ADHD CNS Stimulant Medications Effective: November 13, 2018 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review
More informationADHD Medications: Basics. David Benhayon MD, PhD
ADHD Medications: Basics David Benhayon MD, PhD Goals & Objectives Understand basic classes of stimulants and equivalents Be exposed to role of nonstimulant alternatives Discuss the role of therapy in
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 informationAlameda Alliance for Health Pharmacy & Therapeutics (P&T) Committee Decisions
Alameda Alliance for Health FORMULARY UPDATE Effective: October 27, 2017. Drugs notated with an * have an undetermined implementation date Alameda Alliance for Health Pharmacy & Therapeutics (P&T) Committee
More informationMDI Bonanza. Dwayne Griffin, DO
MDI Bonanza Dwayne Griffin, DO Bonanza 3. A MDI costing $200 - $500 per month SISYPHUS MDI Griffin Mountain Evolution of Deliver Systems for COPD in the US 2003 2009 2011 2013 2004 2012 2014 Prescribing
More informationSimply Step Therapy Document September 2018 Y0114_18_33074_I_009
2018 2018 Simply Step Therapy Document September 2018 Aptiom APTIOM 200 MG TABLET APTIOM 400 MG TABLET Y0114_18_33074_I_009 APTIOM 600 MG TABLET APTIOM 800 MG TABLET Criteria If the patient has tried a
More informationCENPATICO INTEGRATED CARE BEHAVIORAL HEALTH DRUG LIST BY DRUG NAME. Use Brand Only
ACAMPROSATE TABLET DELAYED RELEASE ALPHA-TOCOPHEROL CAPSULES ALPRAZOLAM CONCENTRATE 1 MG/ML ALPRAZOLAM ODT TABLET 0.25MG, 0.5MG, 1MG ALPRAZOLAM ODT TABLET 2MG ALPRAZOLAM SR TABLET 24-HOUR ALPRAZOLAM TABLET
More informationDrug Class Monograph
Drug Class Monograph Class: Inhaled Corticosteroids Drugs: Aerospan (flunisolide), Advair Diskus, Advair HFA (fluticasone/salmeterol), Alvesco (ciclesonide), Arnuity Ellipta (fluticasone furoate), Asmanex
More informationANTIDIABETIC AGENTS - MISCELLANEOUS
ANTIDIABETIC AGENTS - MISCELLANEOUS GLYXAMBI 10 MG-5 MG GLYXAMBI 25 MG-5 MG INVOKAMET 150 MG-1,000 MG INVOKAMET 150 MG-500 MG INVOKAMET 50 MG-1,000 MG INVOKAMET 50 MG-500 MG INVOKAMET XR 150 MG-1,000 MG,
More informationADHD Stimulant Step Therapy Program
ADHD Stimulant Step Therapy Program Policy Number: 5.01.592 Last Review: 7/2018 Origination: 7/2017 Next Review: 7/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage
More informationQuantity Management. October 2017
Quantity Management October 2017 What Is Quantity Management? It s a quality and safety program that promotes the safe use of medications. The program limits the amount of some medications we cover. We
More informationDrug Class Review. Pharmacologic Treatments for Attention Deficit Hyperactivity Disorder
Drug Class Review Pharmacologic Treatments for Attention Deficit Hyperactivity Disorder Final Update 5 Report July 2015 The purpose of reports is to make available information regarding the comparative
More information