Drug Class Excluded Product Clinical Alternative(s) ABSORICA ONEXTON GEL ANDRODERM FORTESTA VOGELXO MENTHOCIN PAD LIDOCAINE SCAR PATCH
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1 Value Formulary Key Exclusions and Their Alternatives Catamaran offers diverse formulary alternatives that help our clients select what works best for them. The Value Formulary is a partially-closed formulary that excludes coverage of brand-name drugs that offer no clear clinical advantage over less-costly brand or generic alternatives. This list consists of some of the key Value exclusions along with their clinical alternatives and is not intended to be a comprehensive exclusion list. Please reference the full formulary to determine if your product is excluded. Drug Class Excluded Product Clinical Alternative(s) ACNE TREATMENTS ANDROGENS ANESTHETICS TOPICAL ABSORICA ONEXTON GEL VELTIN ANDRODERM AVEED FORTESTA NATESTO TESTIM VOGELXO LIDOVEX MENTHOCIN PAD LIDOCAINE SCAR PATCH PAIN RELIEF PAD PATCH AMNESTEEM, CLARAVIS, MYORISAN, ZENATANE clindamycin/benzoyl peroxide, tretinoin gel, ZIANA testosterone gel, ANDROGEL, AXIRON lidocaine ANTICONVULSANTS LAMICTAL ODT lamotrigine BRINTELLIX DESVENLAFAXINE ER FETZIMA duloxetine, venlafaxine, PRISTIQ ANTIDEPRESSANTS IRENKA KHEDEZLA FORFIVO XL VIIBRYD bupropion XL citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline
2 ANTI-FUNGALS ORAL ORAVIG clotrimazole troches ANTI-FUNGALS TOPICAL NAFTIN clotrimazole, econazole, ketoconazole, miconazole, nystatin ANTI-GOUT TREATMENTS MITIGARE COLCRYS ANTIHYPERLIPIDEMICS ANTIHYPERTENSIVES ADVICOR ALTOPREV LESCOL XL LIVALO EDARBI EDARBYCLOR TEVETEN HCT niacin ER AND lovastatin, SIMCOR lovastatin, fluvastatin, simvastatin, atorvastatin, CRESTOR irbesartan, losartan, BENICAR candesartan/hydrochlorothiazide, losartan/hydrochlorothiazide, valsartan/hydrochlorothiazide, BENICAR HCT ANTI-INFECTIVE AGENTS TOPICAL NUVESSA metronidazole gel ALSUMA AXERT ANTI-MIGRAINE AGENTS ANTI-NAUSEA AGENTS ANTI-PARASITIC AGENTS ANTIPARKINSONIAN AGENTS FROVA SUMAVEL DOSEPRO TREXIMET ZOMIG NASAL SPRAY AKYNZEO ZUPLENZ EURAX SOOLANTRA DUOPA RYTARY sumatriptan, naratriptan, rizatriptan, RELPAX ondansetron permethrin cream, malathion lotion carbidopa/levodopa ANTIVIRALS RAPIVAB TAMIFLU, RELENZA BENIGN PROSTATIC HYPERPLASIA TREATMENTS BETA-2 ADRENERGIC AGONISTS JALYN MAXAIR AUTOHALER PROVENTIL HFA XOPENEX HFA VENTOLIN HFA tamsulosin, finasteride, RAPAFLO PROAIR HFA CONTRACEPTIVES QUARTETTE levonorgestrel/ethinyl estradiol (91-day)
3 CORTICOSTEROIDS ORAL CORTICOSTEROIDS TOPICAL COUGH/COLD/ALLERGY RAYOS APEXICON E All single source brand cough and cold medications methylprednisolone; prednisolone; immediaterelease prednisone betamethasone dipropionate, diflorasone diacetate, fluocinonide Multiple generic cough and cold products DIABETES TESTING SUPPLIES MONITORS AND TEST STRIPS All manufacturers except Lifescan, Animas Diagnostics, and Liberty Medical ONETOUCH DIABETES TREATMENTS INJECTABLE DIABETES TREATMENTS ORAL APIDRA/APIDRA SOLOSTAR HUMALOG HUMULIN LEVEMIR/LEVEMIR FLEXPEN TOUJEO SOLO TANZEUM TRULICITY JENTADUETO KAZANO OSENI NESINA TRADJENTA GLYXAMBI GLUMETZA NOVOLOG NOVOLIN LANTUS BYDUREON, BYETTA, VICTOZA JANUMET, JANUMET XR, KOMBIGLYZE XR JANUVIA, ONGLYZA INVOKANA, FARXIGA, JARDIANCE, INVOKAMET, XIGDUO XR metformin DIABETES TREATMENTS - OTHER AFREZZA NOVOLIN PANCREAZE DIGESTIVE AIDS PERTZYE ULTRESA CREON, PANCRELIPASE EPINEPHRINE AUTO INJECTORS ADRENACLICK EPIPEN, EPIPEN JR, AUVI-Q
4 LEVITRA ERECTILE DYSFUNCTION TREATMENTS STENDRA STAXYN CIALIS, VIAGRA ESTROGENS DIVIGEL estradiol, VIVELLE-DOT, ALORA, EVAMIST FERTILITY TREATMENTS GROWTH HORMONES HEMATOPOIETICS HEPATITIS C TREATMENTS INFLAMMATORY BOWEL DISEASE TREATMENTS IMMUNOMODULATING AGENTS INHALED STEROID COMBOS INHALED STEROIDS GONAL-F MENOPUR GENOTROPIN HUMATROPE OMNITROPE SAIZEN TEV-TROPIN ZOMACTON ARANESP EPOGEN MIRCERA OLYSIO VICTRELIS VIEKIRA PAK GIAZO APRISO UCERIS FOAM ENTYVIO ZYCLARA ADVAIR DISKUS/HFA BREO ELLIPTA AEROSPAN ALVESCO ARNUITY ELLIPTA FLOVENT DISKUS/HFA FOLLISTIM AQ, BRAVELLE NUTROPIN, NUTROPIN AQ, NORDITROPIN PROCRIT HARVONI, SOVALDI balsalazide DELZICOL, PENTASA mesalamine, Pentasa, Lialda, Canasa, Cimzia imiquimod DULERA, SYMBICORT ASMANEX, PULMICORT FLEXHALER, QVAR LAXATIVES KRISTALOSE lactulose MULTIPLE SCLEROSIS TREATMENTS EXTAVIA GLATOPA BETASERON COPAXONE
5 BECONASE AQ NASAL STEROIDS/ STEROID COMBOS NONSTEROIDAL ANTI-INFLAMMATORY DRUGS ORAL NONSTEROIDAL ANTI-INFLAMMATORY DRUGS TOPICAL OPHTHALMIC/OTIC AGENTS OPIATE AGONISTS OMNARIS QNASL VERAMYST ZETONNA DUEXIS VIMOVO CAMBIA ZIPSOR FLECTOR REXAPHENAC BETOPTIC S RESCULA ZIOPTAN AZASITE DUREZOL LASTACAFT CETRAXAL ABSTRAL FENTORA SUBSYS EXALGO HYSINGLA ER KADIAN ZOHYDRO ER CONZIP flunisolide, fluticasone, triamcinolone acetonide, NASONEX ibuprofen AND famotidine omeprazole, pantoprazole, lansoprazole AND naproxen diclofenac diclofenac, VOLTAREN gel betaxolol latanoprost, TRAVATAN Z erythromycin oint dexamethasone, prednisolone, ALREX, LOTEMAX azelastine, PATADAY, PATANOL ofloxacin otic fentanyl patch, fentanyl citrate oral transmucosal morphine sulfate ext-release, oxymorphone ext-release, NUCYNTA ER, OPANA ER, OXYCONTIN tramadol ER OPIATE AGONIST-INDUCED CONSTIPATION MOVANTIK AMITIZA, RELISTOR OPIOID DEPENDENCE TREATMENTS BUNAVAIL buprenorphine/naloxone BINOSTO OSTEOPOROSIS TREATMENTS ACTONEL ATELVIA alendronate, ibandronate, FOSAMAX PLUS D
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