ADDITIONAL 2017 FORMULARY CHANGES CIGNA COMMERCIAL CUSTOMERS

Size: px
Start display at page:

Download "ADDITIONAL 2017 FORMULARY CHANGES CIGNA COMMERCIAL CUSTOMERS"

Transcription

1 ADDITIONAL 2017 FORMULARY CHANGES CIGNA COMMERCIAL CUSTOMERS Cigna will be making additional formulary changes that may impact customers at your pharmacy. We have included a list of drugs by drug class that will be considered non-covered, non-preferred brand or require approval from Cigna for coverage, as well as the covered alternatives. We sent letters to the customers explaining the changes to their current medications. However, if a customer with Cigna pharmacy benefits does come in and attempts to refill a medication that is not covered, when appropriate, we ask that you assist him or her in the following ways: Mention the alternative covered drugs available in the chart below Urge the customer to meet with the prescriber to discuss these alternatives or please call the prescriber to facilitate the new prescription Help the customer fill out the simple form below to bring to his or her prescriber If you have questions, please see below: Question: Point of Service and Processing Phone Number: Issue Type: Refill too Soon Drug Coverage Issues Copay Issues You will need the following information for the phone prompts: Customer ID Customer DOB Prescription Information Pharmacy Contract Provider.Relations@optum.com Contract inquiries Reimbursement Optum.com/pharmacycareservices Select Pharmacists Reimbursement All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Cigna Health and Life Insurance Company, Connecticut General Life Insurance Company, Tel-Drug, Inc., Tel- Drug of Pennsylvania, L.L.C., and HMO or service company subsidiaries of Cigna Health Corporation. The Cigna name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc Cigna. 01/17

2 Drug Coverage Changes by Class Please note that this list only applies to our non-medicare Standard Prescription Drug List and does not reflect the entire list of covered and not-covered drugs for this or any other Cigna drug list. Drug class Non-preferred Generic and/or preferred brand** medication** brand alternatives Infections Daklinza + Epclusa +, Harvoni +, Sovaldi + Generic and/or preferred Drug class Medication not covered^ brand alternatives Cardizem diltiazem Blood Pressure/ Heart Isordil Titradose isosorbide dinitrate Medications Lanoxin digitek, digox, digoxin Cholesterol Medications Antara, Fenoglide fenofibrate Cough/Cold Medications Tussicaps hydrocodone-chlorpheniramne ER, promethazine-codeine Diuretics Edecrin, ethacrynic acid bumetanide,furosemide, torsemide anucort-hc, Grx Hicort 25, hemmorex- Anusol-HC suppository Gastrointestinal/ HC, hydrocortisone, rectacort HC Heartburn lansoprazole-amoxicilin-clarithromycin Omeclamox- pak, Prevpac, Pylera (combo pak) Hormonal Agents Dexpak dexamethasone Infections Onmel itraconazole, terbinafine Conzip tramadol, tramadol ER acetaminophen-codeine, hydrocodone acetaminophen, hydromorphone ER, Levorphanol tartate hydromorphone, lorcet, lorcet HD, lorcet plus, oxycodone, oxycodone ER, tramadol, verdrocet, vicodin, vicodin Skin Conditions Naprelan, naproxen CR, naproxen ER, Zipsor Zomig ZMT Aldara Anusol-HC cream Clobex Ertaczo Extina Halog Locoid lipocream Loprox Oxistat ES, vicodin HP diclofenac, diclofenac ER, etodolac, etodolac ER, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamate, mefenamic acid, meloxicam, nabumetone, naproxen, naproxen DS, oxaprozin, piroxicam, sulindac, tolmentin zolmitriptan ODT imiquimod hydrocortisone, protco-med HC proctosol-hc, proctozone-hc clobetasol, clodan shampoo ketoconazole ketoconazole, ketodan clobetasol propionate, halobetasol propionate hydrocortisone butyrate ciclodan, ciclopriox clotrimazole econazole nitrate, ketoconazole, oxiconazole nitrate

3 Penlac Ciclodan, ciclopirox Plexion sulfacetamide-sulfur, SS 10-2, Zencia Prudoxin doxepin Salex salicylic acid Trianex Triamcinolone acetonide, triderm Ala-cort, alclometasone dipropionate, aminonide, apexicon, betamethasone dipropinate, betamethasone valerate, clobetasol emollient, clobetaslon emulsion, clobetasol propionate, clocortonlone pivalate, clodan, cormax, desonide, desoximetasone, diflorasone Ultravate diacetate, fluocinolene acetonide, fluocinonide, fluocinonide-e, flurandrenolide, fluticasone propionate, halobetasol propionate, hydrocortisone, hydrocortisone butyrate, hydrocortisone valerate, micort-hc, mometasone furoate, prednicarbate, psorcon, scalacort, tacrolimus, triamcinolone acetonide, trianex, triderm Ultravate X clobetasol propionate, halobetasol propionate Verdeso desonide Vusion ketoconazole Zonalon doxepin, prudoxin Sleep Disorders/ Ambien zolpidem Sedatives Ambien CR zolpidem ER Drug class Medication requiring prior authorization Additional information Miscellaneous Syprine acetaminophen-codeine, butalbitalacetaminophencaffeinecodeine, butalbital-caffeineacetaminophencodeine, Dilaudid, Duragesic, Embeda, Endocet, fentanyl patch, hydrocodone-acetaminophen, hydrocodoneibuprofen, hydromorphone, hydromorphone ER, Hysingla ER, Ibudone, Kadian ER, levorphanol tartrate, Lorcet, Lorcet HD, Ask your doctor to call us. Your plan will Lorcet Plus, Lortab, morphine sulfate, morphine only cover your medication if your sulfate ER, doctor requests and receives approval Nucynta, Nucynta ER, Opana, Opana ER, from Cigna. Oxaydo, oxycodoneacetaminophen, oxycodone, oxycodone ER, oxymorphone ER, oxymorphone, Oxycontin, Percocet, Primlev, Reprexain, Roxicodone, Verdrocet, Vicodin, Vicodin ES, Vicodin HP, Xartemis XR, Xtampza ER, Xylon 10, Zohydro ER Cuprimine, Depen Titratab

4 Drug class Cough/ Cold Medications Gastrointestinal/ Heartburn Miscellaneous Medication with quantity limits Flowtuss, hycofenix, Hydrocod-cpmpseudoephedrine, Hydrocodone BT-homatropine, Hydrocodone-chlorpheniramne ER, Hydrocodonehomatropine, hydromet, obredon, Promethazine VC-codeine, Promethazine-codeine, Promethazine-phenyleph-codeine, Rezira, Tussicaps, Tussigon, Tussionex, Tuzistra XR, Vituz, Zutripro Opium Tincture Evzio, Naltrexone Abstral, acetaminophen-codeine, actiq, alfentanil, asa-butalb-caffeine-codeine, ascomp with codeine, aspirin- caffeine- dihydocodein, astramorph-pf belladonna- opium, butalbitalacetaminophen-caffeine- codeine, butalbitalcaffeine-acetaminophen-codeine, butalbital compound-codeine, butalbital-acetaminophencaffeine, butalbital-aspirin-caffeine, butorphanol, capacet, carisoprodol compound-codeine, carisoprodol-aspirin-codeine, codeine, Demerol, dihydrocodein-acetaminoph-caffeine, Dilaudid, diskets, Duragesic, dolophine, duramorph, Endocet, esgic, fentanyl patch, fentanylbupivacacaine, fentora, fioricet, fioricet with codeine, fiorinal, finorinal with codeine, hycet, hydrocodone-acetaminophen, hydrocodoneibuprofen, hydromorphone, Ibudone, infumorph, ionsys, lazanda, levorphanol, Lorcet, Lorcet HD, Lorcet Plus, Lortab, meperidine, methadone intensol, methadose, morphine,, nalbuphine, norco, Opana, Oxaydo, oxycodone- aspirin, oxycodone- ibuprofen, oxycodoneacetaminophen, oxymorphone, Oxycontin, pentazocine- naloxone, Percocet, Primlev, Reprexain, Roxicodone, subsys, sufentanil,synalgos- dc, talwin, trezix, Tylenol-codeine, ultiva, Verdrocet, Vicodin, Vicodin ES, Vicodin HP, Xodol,10-300, xodol 5-300, xodol , zamicet, zebutal Additional information Your plan only covers a certain amount of this medication. If your doctor writes a prescription for an amount more than what s allowed, it will only be covered in that amount if your doctor requests and receives approval from Cigna. * Drug is not covered unless approved through a medical necessity review. Customers should speak with their provider about switching to a covered alternative drugs. ^ In Step Therapy, customers must try the most cost-effective, appropriate drugs available before their plan approves more expensive brand name drugs.

5 I am currently taking: I am currently taking: I am currently taking:

ADDITIONAL 2017 FORMULARY CHANGES CIGNA COMMERCIAL CUSTOMERS

ADDITIONAL 2017 FORMULARY CHANGES CIGNA COMMERCIAL CUSTOMERS ADDITIONAL 2017 FORMULARY CHANGES CIGNA COMMERCIAL CUSTOMERS Effective 7/1/2017, Cigna will be making additional formulary changes that may impact customers at your pharmacy. We have included a list of

More information

CHANGES TO YOUR DRUG LIST

CHANGES TO YOUR DRUG LIST CHANGES TO YOUR DRUG LIST More generics and lower-cost brands to help you stay healthy and save money At Cigna, it s our goal to offer you access to coverage for safe, effective and affordable medications.

More information

PRESCRIPTION DRUG LIST CHANGES

PRESCRIPTION DRUG LIST CHANGES PRESCRIPTION DRUG LIST CHANGES Cigna Pharmacy Management The medications listed below are changing coverage (or cost levels) on Cigna s Prescription Drug List. Changes are listed by drug list and by the

More information

Cigna Drug and Biologic Coverage Policy

Cigna Drug and Biologic Coverage Policy Cigna Drug and Biologic Coverage Policy Subject Controlled Substance Analgesic and Narcotic Antagonist Quantity Limitations Table of Contents Coverage Policy... 1 General Background... 6 Coding/Billing

More information

Capital BlueCross Open/Closed Formulary Update (1 st Quarter 2017)

Capital BlueCross Open/Closed Formulary Update (1 st Quarter 2017) Capital BlueCross Open/Closed Formulary Update (1 st Quarter 2017) The Capital BlueCross formulary is a reference list of prescription drugs that contains a wide range of generic and brand drugs that have

More information

Generic Label Name Drug Strength Dosage Form Example Product (s) MME/Unit ACETAMINOPHEN WITH CODEINE

Generic Label Name Drug Strength Dosage Form Example Product (s) MME/Unit ACETAMINOPHEN WITH CODEINE STATE OF TENNESSEE DEPARTMENT OF FINANCE AND ADMINISTRATION DIVISION OF HEALTH CARE FINANCE AND ADMINISTRATION BUREAU OF TENNCARE 3 Great Circle Road NASHVILLE, TENNESSEE 37243 This notice is to advise

More information

Xyrem (Sodium Oxybate)

Xyrem (Sodium Oxybate) Texas Prior Authorization Program Clinical Criteria Drug/Drug Class Clinical Criteria Information Included in this Document Drugs requiring prior authorization: the list of drugs requiring prior authorization

More information

Opiate/Benzodiazepine/Muscle Relaxant Combinations

Opiate/Benzodiazepine/Muscle Relaxant Combinations Texas Prior Authorization Program Clinical Edit Criteria Drug/Drug Class Opiate/Benzodiazepine/Muscle Relaxant Combinations Clinical Edit Information Included in this Document Drugs requiring prior authorization:

More information

Texas Prior Authorization Program Clinical Edit Criteria

Texas Prior Authorization Program Clinical Edit Criteria Texas Prior Authorization Program Clinical Edit Criteria Drug/Drug Class Clinical Edit Information Included in this Document Drugs requiring prior authorization: the list of drugs requiring prior authorization

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association Opioid Immediate Release Page 1 of 13 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Opioid Immediate Release Prime Therapeutics will review Prior Authorization

More information

Opioid Analgesic/Opioid Combination Products

Opioid Analgesic/Opioid Combination Products Market DC Opioid Analgesic/Opioid Combination Products Override(s) Quantity Limit Approval Duration 1 year Generic Name Brand Name Quantity Limit APAP/Caf/Dihydrocodeine 320.5mg/30mg/16mg APAP/Caf/Dihydrocodeine

More information

Opioid Management Program May 2018

Opioid Management Program May 2018 Opioid Management Program May 2018 What Is the Opioid Management Program? This program is based on guidelines developed by the U.S. Centers for Disease Control and Prevention (CDC). It consists of daily

More information

Opioid Management Program October 2018

Opioid Management Program October 2018 Opioid Management Program October 2018 What Is the Opioid Management Program? This program is based on guidelines developed by the U.S. Centers for Disease Control and Prevention (CDC). It consists of

More information

Opioid Analgesic/Opioid Combination Products

Opioid Analgesic/Opioid Combination Products Opioid Analgesic/Opioid Combination Products Override(s) Quantity Limit Approval Duration 1 year Generic Name Brand Name Quantity Limit 320.5mg/30mg/16mg 356.4mg/30mg/16mg 325mg/30mg/16mg Trezix (new formulation)

More information

New Hampshire Healthy Families CLINICAL POLICY

New Hampshire Healthy Families CLINICAL POLICY New Hampshire Healthy Families CLINICAL POLICY DEPARTMENT: Pharmacy DOCUMENT NAME: Opioid Analgesics PAGE: 1 o f 6 REFERENCE NUMBER: NH.PPA.13 EFFECTIVE DATE: 6/1/2016 REPLACES DOCUMENT: N/A RETIRED: REVIEWED:

More information

APPROVED PA CRITERIA. Initial Approval: January 10, 2018 Revised Dates: April 11, 2018 CRITERIA FOR PRIOR AUTHORIZATION

APPROVED PA CRITERIA. Initial Approval: January 10, 2018 Revised Dates: April 11, 2018 CRITERIA FOR PRIOR AUTHORIZATION Initial Approval: January 10, 2018 Revised Dates: April 11, 2018 CRITERIA FOR PRIOR AUTHORIZATION PROVIDER GROUP Pharmacy Opioid Products Indicated for Pain Management MANUAL GUIDELINES All dosage forms

More information

Prior Authorization Opioid Overutilization 2017

Prior Authorization Opioid Overutilization 2017 Drugs Requiring Prior Authorization Label Name ACETAMINOPHEN/CAFFEINE/DIHYDROCODEINE CAPSULE ACETAMINOPHEN/CODEINE SOLUTION ACETAMINOPHEN/CODEINE TABLET ASCOMP/CODEINE CAPSULE BUTALBITAL/CAFFEINE/ACETAMINOPHEN/CODEINE

More information

Pequot Health Care Opioid Analgesic Quantity Program*

Pequot Health Care Opioid Analgesic Quantity Program* Pequot Health Care 1 Annie George Drive Mashantucket, CT 06338 Phone: 1-888-779-6638 Fax: 1-860-396-6494 Pequot Health Care Opioid Analgesic Quantity Program* Effective January 2018 *Quantity Program limits

More information

** Fee-For-Service Pharmacy Provider Notice #229 May 2018 PDL Changes **

** Fee-For-Service Pharmacy Provider Notice #229 May 2018 PDL Changes ** ** Fee-For-Service Pharmacy Provider Notice #229 May 2018 PDL Changes ** August 03, 2018 Please be advised that the Department for Medicaid Services (DMS) is making changes to the Kentucky Medicaid Fee-For-Service

More information

PRESCRIPTION DRUG PROGRAM FORMULARY UPDATES Select Formulary October 1, 2018 Updates. Formulary. Alternatives

PRESCRIPTION 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 information

AN ACTIVE, DISCIPLINED APPROACH TO FORMULARY MANAGEMENT TO DRIVE BETTER PLAN AFFORDABILITY

AN ACTIVE, DISCIPLINED APPROACH TO FORMULARY MANAGEMENT TO DRIVE BETTER PLAN AFFORDABILITY Cigna Pharmacy Management AN ACTIVE, DISCIPLINED APPROACH TO FORMULARY MANAGEMENT TO DRIVE BETTER PLAN AFFORDABILITY Changes begin 1/1/17 As part of the effort to position our pharmacy plans for long-term

More information

Cigna Drug and Biologic Coverage Policy

Cigna Drug and Biologic Coverage Policy Cigna Drug and Biologic Coverage Policy Subject Opioid Therapy Table of Contents Coverage Policy... 1 General Background... 4 Coding/Billing Information... 7 References... 7 Effective Date..1/1/2018 Next

More information

1/1/2019 FORMULARY CHANGES CIGNA COMMERCIAL CUSTOMERS

1/1/2019 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 information

Beneficiary Advisory Panel Handout Uniform Formulary Decisions 24 June 2010

Beneficiary Advisory Panel Handout Uniform Formulary Decisions 24 June 2010 Beneficiary Advisory Panel Handout Uniform Formulary Decisions 24 June 2010 PURPOSE: The purpose of this handout is to provide BAP Committee members with a reference document for the relative clinical

More information

: Opioid Quantity Limits

: Opioid Quantity Limits March 7, 2017 2017-09: Opioid Quantity Limits The Louisiana Department of Health (LDH), in conjunction with the Louisiana Medicaid Drug Utilization Review (DUR) Board, has revised quantity limits for selected

More information

Future Formulary Changes

Future Formulary Changes Future Formulary Changes Upd 09/11/2018 Applies to: Employer group plan 2018 open formularies KEY: =prior authorization; ST=step therapy; QL=quantity limit Generic name Brand name Change Effective Hydroxyprogesterone

More information

Future Formulary Changes

Future Formulary Changes Future Formulary Changes Upd 11/21/2018 Applies to: Employer group plan 2018 2019 open formularies KEY: PA=prior authorization; ST=step therapy; QL=quantity limit Generic name Brand name Change Effective

More information

MEDICARE Program Policies & Procedures POLICY NUMBER: Medicare D-111

MEDICARE Program Policies & Procedures POLICY NUMBER: Medicare D-111 POLICY: Medicare Part D Formulary-Level Cumulative Opioid and Opioid/Buprenorphine POS Edits MEDICARE Program Policies & Procedures POLICY NUMBER: Medicare D-111 Policy for contracts H3351, S3521 and H3335

More information

The Medical Letter. on Drugs and Therapeutics

The Medical Letter. on Drugs and Therapeutics The Medical Letter publications are protected by US and international copyright laws. Forwarding, copying or any other distribution of this material is strictly prohibited. For further information call:

More information

comprehensive formulary (list of covered drugs) January 1st - December 31st leon cares medicare

comprehensive formulary (list of covered drugs) January 1st - December 31st leon cares medicare comprehensive formulary (list of covered drugs) leon cares 2019 medicare January 1st - December 31st PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. Formulary ID

More information

Pharmacy Medical Necessity Guidelines: Opioid Analgesics

Pharmacy Medical Necessity Guidelines: Opioid Analgesics Pharmacy Medical Necessity Guidelines: Effective: January 1, 2019 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review Pharmacy (RX) or Medical (MED) Benefit

More information

2014 FORMULARY LIST OF COVERED DRUGS

2014 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 information

Medication Policy Manual. Topic: Immediate-release (IR) Opioid Medication Products for Pain. Date of Origin: January 1, 2018

Medication Policy Manual. Topic: Immediate-release (IR) Opioid Medication Products for Pain. Date of Origin: January 1, 2018 Independent licensees of the Blue Cross and Blue Shield Association Medication Policy Manual Topic: Immediate-release (IR) Opioid Medication Products for Pain Policy No: dru516 Date of Origin: January

More information

Medication Policy Manual. Topic: Dupixent, dupilumab Date of Origin: March 10, Committee Approval: March 10, 2017 Next Review Date: May 2018

Medication Policy Manual. Topic: Dupixent, dupilumab Date of Origin: March 10, Committee Approval: March 10, 2017 Next Review Date: May 2018 Independent licensees of the Blue Cross and Blue Shield Association Medication Policy Manual Policy No: dru493 Topic: Dupixent, dupilumab Date of Origin: March 10, 2017 Committee Approval: March 10, 2017

More information

Opioid Capture in the AHSQC Can we reduce use by measuring it? Michael Reinhorn MD, MBA, FACS Dept of Surgery, Newton Wellesley Hospital

Opioid Capture in the AHSQC Can we reduce use by measuring it? Michael Reinhorn MD, MBA, FACS Dept of Surgery, Newton Wellesley Hospital Opioid Capture in the AHSQC Can we reduce use by measuring it? Michael Reinhorn MD, MBA, FACS Dept of Surgery, Newton Wellesley Hospital Disclosure Davol/Bard Consultant Medtronic Physician Advisory Honorarium

More information

Quarterly pharmacy formulary change notice

Quarterly pharmacy formulary change notice Provider Bulletin June 2017 The formulary changes listed in the table below apply to all Anthem HealthKeepers Plus patients. These changes were reviewed and approved at the first quarter Pharmacy and Therapeutics

More information

ALLERGIC RHINITIS-NASAL

ALLERGIC RHINITIS-NASAL ALLERGIC RHINITIS-NASAL FLUNISOLIDE Patient needs to have paid claims for any one of the following Step 1 drugs: NasaCort OTC, fluticasone Rx, fluticasone OTC, Budesonide OTC. Prior to filling the Step

More information

High-Cost Drug Exclusions

High-Cost Drug Exclusions PHARMACY SERVICES High-Cost Exclusions The high cost medications listed below are excluded from coverage because lower cost similar alternatives are available. To help you get the best health benefit at

More information

Comparison of representative topical corticosteroid preparations (classified according to the US system)

Comparison of representative topical corticosteroid preparations (classified according to the US system) Comparison of representative topical corticosteroid preparations (classified according to the US system) Potency group* Corticosteroid Vehicle type/form Trade names (United States) Available strength(s),

More information

Future Formulary Changes

Future Formulary Changes Future Formulary Changes Applies to: Employer group plan 2019 open formularies with specialty tiers KEY: PA=prior authorization; ST=step therapy; QL=quantity limit Obeticholic acid Ocaliva Limited to Kaiser

More information

used for dealing with anxiety. Both of the drugs are also given to patients for dealing with pain activated by damaged or hypersensitive nerves that i

used for dealing with anxiety. Both of the drugs are also given to patients for dealing with pain activated by damaged or hypersensitive nerves that i Aspirin (also classified under NSAIDs or acetylsalicylic acid). Morphine and morphine sustained release (MS-Contin, Avinza, Kadian) Oxymorphone (Opana, Opana ER) Hydrocodone with acetaminophen (Lortab

More information

Morphine Equivalent Dosing

Morphine Equivalent Dosing Texas Prior Authorization Program Clinical Criteria Drug/Drug Class This criteria was recommended for review by the Texas Medicaid Vendor Drug Program to ensure appropriate and safe utilization. Clinical

More information

Step Therapy Criteria (Criteria for Step Therapy-2 [ST-2] Drugs)

Step Therapy Criteria (Criteria for Step Therapy-2 [ST-2] Drugs) CareAdvantage CMC 2018 Formulary Supplement II (List of Covered Drugs) Step Therapy Criteria (Criteria for Step Therapy-2 [ST-2] Drugs) Formulary ID: 00018157 Formulary Version:11 19 CMS Approved: 08/21/2018

More information

A Statewide Evaluation of Opioid Prescribing Patterns with an Emphasis on Drug Diversion and Substance Abuse

A Statewide Evaluation of Opioid Prescribing Patterns with an Emphasis on Drug Diversion and Substance Abuse A Statewide Evaluation of Opioid Prescribing Patterns with an Emphasis on Drug Diversion and Substance Abuse INVESTIGATIVE TEAM: STEERING COMMITTEE FOR THE TUFTS HEALTH CARE INSTITUTE ON OPIOID RISK MANAGEMENT

More information

2019 LIST OF COVERED DRUGS (FORMULARY)

2019 LIST OF COVERED DRUGS (FORMULARY) 2019 LIST OF COVERED DRUGS (FORMULARY) Prescription drug list information UnitedHealthcare Connected for MyCare Ohio (Medicare-Medicaid Plan) Toll-free 1-877-542-9236, TTY 711 8 a.m. - 8 p.m. local time,

More information

The safety and effectiveness of Dupixent in pediatric patients have not been established (1).

The safety and effectiveness of Dupixent in pediatric patients have not been established (1). Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.90.30 Subject: Dupixent Page: 1 of 6 Last Review Date: September 15, 2017 Dupixent Description Dupixent

More information

High-Cost Drug Exclusions

High-Cost Drug Exclusions Pharmacy Services High-Cost Exclusions The high cost medications listed below are excluded from coverage because lower cost similar alternatives are available. To help you get the best health benefit at

More information

The original MED criteria can be referenced at the Texas Vendor Drug Program website located at

The original MED criteria can be referenced at the Texas Vendor Drug Program website located at Morphine Equivalent Dosing (MED) Clinical Edit Criteria Drug/Drug Class Morphine Equivalent Dosing (MED) Superior HealthPlan follows the guidance of the Texas Vendor Drug Program (VDP) for all clinical

More information

PRESCRIPTION DRUG BENEFITS. open/closed formulary. Capital BlueCross is an Independent Licensee of the BlueCross BlueShield Association

PRESCRIPTION DRUG BENEFITS. open/closed formulary. Capital BlueCross is an Independent Licensee of the BlueCross BlueShield Association GUIDE TO PRESCRIPTION DRUG BENEFITS open/closed formulary Capital BlueCross is an Independent Licensee of the BlueCross BlueShield Association TABLE OF CONTENTS 2 Contact Us Phone Number Website 3 Using

More information

10 mg hydrocodone equals how much oxycodone

10 mg hydrocodone equals how much oxycodone Cari untuk: Cari Cari 10 mg hydrocodone equals how much oxycodone Posts about dilaudid 8 vs oxycodone 30 written by buyprescriptionmedication. Can you help me with the conversion of Oxycodone IR (5mg tab)

More information

Prior Authorization for Opioid Products Indicated for Pain Management

Prior Authorization for Opioid Products Indicated for Pain Management Kansas Medical Assistance Program PA Phone 800-933-6593 PA Fax 800-913-2229 Amerigroup PA Pharmacy Phone 855-201-7170 PA Pharmacy Fax 800-601-4829 Sunflower PA Pharmacy Phone 877-397-9526 PA Pharmacy Fax

More information

FORMULARY LIST OF COVERED DRUGS

FORMULARY 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 information

Prior Authorization Guideline

Prior Authorization Guideline Guideline GL-35952 Opioid Quantity Limit Overrides Formulary OptumRx Formulary Note: Approval Date 7/10/2017 Revision Date 7/10/2017 Technician Note: P&T Approval Date: 2/16/2010; P&T Revision Date: 7/12/2011

More information

Effective for all members on August 1, 2017

Effective for all members on August 1, 2017 August 2017 Pharmacy Formulary Change Notice BlueChoice HealthPlan Medicaid is here to help you stay on top of your health care. We want to tell you about some upcoming changes to your Preferred Drug List

More information

AETNA BETTER HEALTH Prior Authorization guideline for Narcotic Analgesic Utilization

AETNA BETTER HEALTH Prior Authorization guideline for Narcotic Analgesic Utilization AETNA BETTER HEALTH Prior Authorization guideline for Narcotic Analgesic Utilization Policy applies to all formulary and non-formulary schedules II V opioid narcotics, including tramadol and codeine, as

More information

LABEL NAME CHANGE EFFECTIVE DATE ARCALYST 220 MG INJECTION

LABEL 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 information

20/0.8mg, 30/1.2mg, Films 90 MME/day Belbuca (buprenorphine) 75mcg, 150mcg, 300mcg, 450mcg 60 units per 90 days

20/0.8mg, 30/1.2mg, Films 90 MME/day Belbuca (buprenorphine) 75mcg, 150mcg, 300mcg, 450mcg 60 units per 90 days Pre - PA Allowance Quantity Extended Release Tablets or Capsules 90 MME/day Medication Strength Avinza (morphine) 60mg, 75mg, 90mg Embeda (morphine /naltrexone) 50/2mg, 60/2.4mg, 80/3.2mg Exalgo (hydromorphone)

More information

Eucrisa. Eucrisa (crisaborole) Description

Eucrisa. Eucrisa (crisaborole) Description Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.90.25 Subject: Eucrisa Page: 1 of 6 Last Review Date: September 15, 2017 Eucrisa Description Eucrisa

More information

High-Cost Drug Exclusions

High-Cost Drug Exclusions PHARMACY SERVICES High-Cost Exclusions The high cost medications listed below are excluded from coverage because lower cost similar alternatives are available. To help you get the best health benefit at

More information

Embeda. Embeda (morphine sulfate and naltrexone hydrochloride) Description

Embeda. Embeda (morphine sulfate and naltrexone hydrochloride) Description Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.39 Subject: Embeda Page: 1 of 6 Last Review Date: March 18, 2016 Embeda Description Embeda (morphine

More information

2019 PacificSource Health Plans Step Therapy Criteria. Last Modified: 02/22/2019 (All criteria reviewed at least once per year)

2019 PacificSource Health Plans Step Therapy Criteria. Last Modified: 02/22/2019 (All criteria reviewed at least once per year) 2019 PacificSource Health Plans Step Therapy Criteria Last Modified: 02/22/2019 (All criteria reviewed at least once per year) Table of Contents ACTICLATE... 3 AMITIZA/LINZESS... 4 ANTIDIABETICS Farxiga,

More information

Eucrisa. Eucrisa (crisaborole) Description

Eucrisa. Eucrisa (crisaborole) Description Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Eucrisa Page: 1 of 7 Last Review Date: June 22, 2018 Eucrisa Description Eucrisa (crisaborole)

More information

Drug Formulary Update, April 2017 Commercial and State Programs

Drug 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 information

UnitedHealthcare Pharmacy Clinical Pharmacy Programs

UnitedHealthcare Pharmacy Clinical Pharmacy Programs UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2017 P 2116-3 Program Prior Authorization/Medical Necessity Medications Dupixent (dupilumab) P&T Approval Date 1/2017, 5/2017, 7/2017

More information

Drug Class Literature Scan: Topical Steroids

Drug Class Literature Scan: Topical Steroids Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119

More information

IS PERCOCET GOOD TATTOO PAIN RELIEVER FOR DOGS

IS PERCOCET GOOD TATTOO PAIN RELIEVER FOR DOGS IS PERCOCET GOOD TATTOO PAIN RELIEVER FOR DOGS Is Percocet Good Tattoo Pain Reliever For Dogs Can u mix percocet and suboxone Take suboxone with percocet How much does percocet prescription cost Oxycodone

More information

1/29/2013. Schedule II Controlled Substances: Basics and Beyond. Controlled Substances. Controlled Substances, Schedule I

1/29/2013. Schedule II Controlled Substances: Basics and Beyond. Controlled Substances. Controlled Substances, Schedule I chedule II Controlled ubstances: Basics and Beyond James L. Besier, Ph.D., R.Ph., FAHP Adjunct Associate Professor College of Nursing Adjunct Assistant Professor James L. Winkle College of Pharmacy University

More information

Drug Name (specify drug) Quantity Frequency Strength

Drug Name (specify drug) Quantity Frequency Strength Prior Authorization Form GEHA FEDERAL - STANDARD OPTION 1363-M Opioids IR MME Limit and Post Limit This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information,

More information

Morphine Sulfate Hydromorphone Oxymorphone

Morphine Sulfate Hydromorphone Oxymorphone Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.02.33 Subject: Morphine Drug Class Page: 1 of 8 Last Review Date: June 19, 2015 Morphine Sulfate Hydromorphone

More information

WellCare of South Carolina Preferred Drug List Update

WellCare of South Carolina Preferred Drug List Update WellCare of 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 August 21,

More information

Section 2 Class III, IV & V Pharmaceuticals Page 13

Section 2 Class III, IV & V Pharmaceuticals Page 13 Section 2 Class III, IV & V Pharmaceuticals Page 13 ACETAMINOPHEN W/ CODEINE #3 30MG TABS (GENERIC TYLENOL) #100 41.99 ACETAMINOPHEN W/ CODEINE #3 30MG TABS #1000 298.99 ACETAMINOPHEN W/ CODEINE #4 60MG

More information

Drug Name (specify drug) Quantity Frequency Strength

Drug Name (specify drug) Quantity Frequency Strength Prior Authorization Form MEDICA HEALTH PLAN IA EXCHANGE 1362-M Opioids IR Labeling Post Limit (HMF) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information,

More information

Demerol (meperidine oral tablet, oral solution), Meperitab (oral tablet)

Demerol (meperidine oral tablet, oral solution), Meperitab (oral tablet) Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subsection: Analgesics and Opioids Original Policy Date: May 8, 2015 Subject: Meperidine Page: 1 of 5 Last

More information

Methadone. Description

Methadone. Description Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.41 Subject: Methadone Page: 1 of 8 Last Review Date: March 18, 2016 Methadone Description Dolophine

More information

2017 Step Therapy (ST) Criteria

2017 Step Therapy (ST) Criteria 2017 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 information

FORMULARY LIST OF COVERED DRUGS

FORMULARY 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 information

Slide 1. Slide 2. Slide 3. Opioid (Narcotic) Analgesics and Antagonists. Lesson 6.1. Lesson 6.1. Opioid (Narcotic) Analgesics and Antagonists

Slide 1. Slide 2. Slide 3. Opioid (Narcotic) Analgesics and Antagonists. Lesson 6.1. Lesson 6.1. Opioid (Narcotic) Analgesics and Antagonists Slide 1 Opioid (Narcotic) Analgesics and Antagonists Chapter 6 1 Slide 2 Lesson 6.1 Opioid (Narcotic) Analgesics and Antagonists 1. Explain the classification, mechanism of action, and pharmacokinetics

More information

Opioid Analgesic Treatment Worksheet

Opioid Analgesic Treatment Worksheet Opioid Analgesic Treatment Worksheet Aetna Better Health of Louisiana Fax: 1 844 699 2889 www.aetnabetterhealth.com/louisiana/providers/pharmacy LA Legacy Fee for Service (FFS) Medicaid Fax: 1 866 797

More information

Commonwealth Care Alliance (Medicare-Medicaid Plan) One Care Plan

Commonwealth Care Alliance (Medicare-Medicaid Plan) One Care Plan 2018 List of Covered Drugs (Formulary) Commonwealth Care Alliance (Medicare-Medicaid Plan) One Care Plan 30 Winter Street Boston, MA 02108 PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS

More information

CNS DEPRESSANT OVERDOSE

CNS DEPRESSANT OVERDOSE Signs and symptoms of CNS depressant overdose include: altered mental status, respiratory depression, hypotension, bradycardia, pulmonary edema, coma, and constricted pupils (opioids only). The following

More information

UnitedHealthcare Pharmacy Clinical Pharmacy Programs

UnitedHealthcare Pharmacy Clinical Pharmacy Programs UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2018 P 3053-9 Program Step Therapy Long Acting Opioids Medication Includes both brand and generic versions of the listed products unless

More information

Drug List exclusions for Blue Cross commercial plans

Drug List exclusions for Blue Cross commercial plans Drug List exclusions for Blue Cross commercial plans The drugs shown below aren t covered on the commercial Blue Cross Blue Shield of Michigan drug lists. In most cases, if you fill a prescription for

More information

15 mg morphine 10 mg hydrocodone

15 mg morphine 10 mg hydrocodone Cari untuk: Cari Cari 15 mg morphine 10 mg hydrocodone 3-2-2013 Convert From CALCULATED MORPHINE EQUIVALENT BY RESOURCE: Average ( mg ) Range ( mg ) Standard Deviation of Sample ( mg ) Hydrocodone. I usually

More information

Drug Use Evaluation: Gabapentin Use in the FFS Population

Drug Use Evaluation: Gabapentin Use in the FFS Population Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119

More information

Carefirst. +.V Family of health care plans

Carefirst. +.V Family of health care plans Family of health care plans Prior Authorization Form 1361M Opioids ER MME Limit and Post Limit This fax machine is located in a secure location as required by HPAA regulations. Complete/review information,

More information

2015 Step Therapy Prior Authorization Medical Necessity Guidelines

2015 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 information

See Important Reminder at the end of this policy for important regulatory and legal information.

See Important Reminder at the end of this policy for important regulatory and legal information. Clinical Policy: Reference Number: CP.CPA.259 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Commercial Revision Log See Important Reminder at the end of this policy for important regulatory

More information

Allergic to hydrocodone can i take tramadol

Allergic to hydrocodone can i take tramadol Allergic to hydrocodone can i take tramadol The Borg System is 100 % Allergic to hydrocodone can i take tramadol Dec 7, 2017. Tramadol and hydrocodone/acetaminophen (Vicodin) are powerful pain relievers

More information

Hydrocodone 10mg vs oxycodone 10 mg. What is the difference between oxycontin and oxycodone hcl 1 acetaminophen with oxycodone and roxicodone 5mg

Hydrocodone 10mg vs oxycodone 10 mg. What is the difference between oxycontin and oxycodone hcl 1 acetaminophen with oxycodone and roxicodone 5mg TE Te Hydrocodone 10mg vs oxycodone 10 mg What is the difference between oxycontin and oxycodone hcl 1 acetaminophen with oxycodone and roxicodone 5mg Manufacturer of oxycodone hcl 15 mg tablet side effects

More information

``Considerations for using opioid drug therapy in workers compensation include patient safety, drug effectiveness and financial impacts

``Considerations for using opioid drug therapy in workers compensation include patient safety, drug effectiveness and financial impacts Opioids Effective Case Management Opioids RELEVANCE IN WORKERS COMP Opioids are a diverse group of drugs that represent the strongest pain medications available. They are frequently prescribed for pain

More information

Step Therapy Medications

Step 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 information

PRESCRIPTION DRUG PROGRAM FORMULARY UPDATES Select Formulary April 1, 2018 Updates. Formulary Alternatives

PRESCRIPTION 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 information

Fact Sheet 2. Patient Tool Kit Types of Pain Medications. Chronic pain is pain that lasts longer than it should and serves no useful purpose.

Fact Sheet 2. Patient Tool Kit Types of Pain Medications. Chronic pain is pain that lasts longer than it should and serves no useful purpose. Sheet 2 Fact Sheet 2 Types of Pain Medications Chronic pain is pain that lasts longer than it should and serves no useful purpose. You may have heard the familiar phrase no two people are exactly alike.

More information

Drug List Oregon (OR) This formulary was updated on April 22, 2018.

Drug List Oregon (OR) This formulary was updated on April 22, 2018. 8 Oregon (OR) Drug List This formulary was updated on April, 8. Please Read: This document contains information about the drugs we cover in this plan. For a complete, up-to-date list of covered drugs,

More information

Pharmacologic Management of Pain

Pharmacologic Management of Pain Pharmacologic Management of Pain Natalie Keil, Pharm.D. NMCSD PGY1 Pharmacy Practice Resident Palliative Care Nursing Symposium October 14, 2011 The views expressed in this presentation are those of the

More information

Commonwealth Care Alliance (Medicare-Medicaid Plan) One Care Plan

Commonwealth Care Alliance (Medicare-Medicaid Plan) One Care Plan 2018 List of Covered Drugs (Formulary) Commonwealth Care Alliance (Medicare-Medicaid Plan) One Care Plan 30 Winter Street Boston, MA 02108 PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS

More information