ALBUTEROL - SCORE. Products Affected. Details. Step Therapy Criteria Farm Bureau Health Plans Date Effective: November 1, 2018.
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1 ALBUTEROL - SCORE Ventolin Hfa Trial of ProAir Formulary ID 18351, Version 15 1
2 ANTIDEPRESSANTS - SCORE Desvenlafaxine Er TB24 100MG, 50MG Emsam Fetzima Fetzima Titration Pack Trial of two of the following formulary products: bupropion, mirtazapine, generic SSRI, or generic SNRI. Formulary ID 18351, Version 15 2
3 ANTIGOUT - SCORE Uloric Trial of allopurinol Formulary ID 18351, Version 15 3
4 ATYPICAL ANTIPSYCHOTICS - SCORE Fanapt Fanapt Titration Pack Vraylar Trial of two generic formulary atypical antipsychotic agents Formulary ID 18351, Version 15 4
5 DPP4 INHIBITORS - SCORE Janumet Janumet Xr Januvia Jentadueto Jentadueto Xr Kombiglyze Xr Onglyza Tradjenta Trial of one generic formulary metformin or metformin combination Formulary ID 18351, Version 15 5
6 EPINEPHRINE - SCORE Adrenaclick Epinephrine INJ 0.15MG/0.15ML Trial of one of the following: generic epinephrine (generic Epipen or generic EpiPen Jr, by manufacturer: Mylan, NDCs ** and **), brand Epipen, or brand Epipen Jr. Formulary ID 18351, Version 15 6
7 FILGRASTIM - SCORE Neupogen Nivestym Trial of Zarxio Formulary ID 18351, Version 15 7
8 GLP1 AGONIST - SCORE Bydureon Bydureon Bcise Bydureon Pen Trulicity Victoza Trial of one generic formulary metformin or metformin combination Formulary ID 18351, Version 15 8
9 LEUKOTRIENE MODIFIERS - SCORE Zileuton Er Zyflo Trial of generic montelukast or generic zafirlukast Formulary ID 18351, Version 15 9
10 LONG-ACTING OPIOID - SCORE Arymo Er Trial of Embeda Formulary ID 18351, Version 15 10
11 OPHTHALMIC NSAID - SCORE Bromsite Trial of one generic ophthalmic NSAID solution: diclofenac, flurbiprofen, ketorolac, AND one brand from: Nevanac, Prolensa, Ilevro. Formulary ID 18351, Version 15 11
12 PD AGENTS - SCORE Neupro Trial of one generic formulary dopamine agonist agent Formulary ID 18351, Version 15 12
13 RHOPRESSA - SCORE Rhopressa Trial of one of the following: generic latanoprost, generic bimatoprost, Lumigan, Travatan Z, Alphagan P, Azopt, Combigan, Simbrinza. Formulary ID 18351, Version 15 13
14 RYTARY - SCORE Rytary Trial of any generic antiparkinson agent Formulary ID 18351, Version 15 14
15 SGLT2 - SCORE Glyxambi Invokamet Invokamet Xr Invokana Jardiance Synjardy Synjardy Xr Trial of one generic formulary metformin or metformin combination Formulary ID 18351, Version 15 15
16 STATINS - SCORE Livalo Trial of any one generic formulary HMG-CoA reductase inhibitor (statin) Formulary ID 18351, Version 15 16
17 INDEX Step Therapy A Adrenaclick... 6 Albuterol - Score... 1 Antidepressants - Score... 2 Antigout - Score... 3 Arymo Er Atypical Antipsychotics - Score... 4 B Bromsite Bydureon... 8 Bydureon Bcise... 8 Bydureon Pen... 8 D Desvenlafaxine Er... 2 Dpp4 Inhibitors - Score... 5 E Emsam... 2 Epinephrine... 6 Epinephrine - Score... 6 F Fanapt... 4 Fanapt Titration Pack... 4 Fetzima... 2 Fetzima Titration Pack... 2 Filgrastim - Score... 7 G Glp1 Agonist - Score... 8 Glyxambi I Invokamet Invokamet Xr Invokana J Janumet... 5 Janumet Xr... 5 Januvia... 5 Jardiance Jentadueto... 5 Jentadueto Xr... 5 K Kombiglyze Xr... 5 L Leukotriene Modifiers - Score... 9 Livalo Long-acting Opioid - Score N Neupogen... 7 Neupro Nivestym... 7 O Onglyza... 5 Ophthalmic Nsaid - Score P Pd Agents - Score R Rhopressa Rhopressa - Score Rytary Rytary - Score S Sglt2 - Score Formulary ID 18351, Version 15 17
18 Statins - Score Synjardy Synjardy Xr T Tradjenta... 5 Trulicity... 8 U Uloric... 3 V Ventolin Hfa... 1 Victoza... 8 Vraylar... 4 Z Zileuton Er... 9 Zyflo... 9 Formulary ID 18351, Version 15 18
ALBUTEROL - SCORE. Products Affected. Details. Step Therapy Criteria Optima Tier Gold Formulary Date Effective: November 1, 2018.
ALBUTEROL - SCORE Ventolin Hfa Trial of ProAir Formulary ID 18354, Version 15 1 ANTIDEPRESSANTS - SCORE Aplenzin Desvenlafaxine Er TB24 100MG, 50MG Emsam Fetzima Fetzima Titration Pack Trial of two of
ALBUTEROL - SCORE. Products Affected. Details. Step Therapy Criteria Health Choice Generations 1 Tier Gold Effective Date: 11/01/2018.
ALBUTEROL - SCORE Ventolin Hfa Trial of ProAir Formulary ID: 18349, Ver.15 Last Updated 10/23/2018 Effective Date: 11/1/2018 1 ANTIDEPRESSANTS - SCORE Aplenzin Desvenlafaxine Er TB24 100MG, 50MG Emsam
ALBUTEROL - SCORE{XE "ALBUTEROL - SCORE"}
Step Therapy ALBUTEROL - SCORE{XE "ALBUTEROL - SCORE"} Ventolin Hfa{XE "Ventolin Hfa"} Trial of ProAir Formulary ID# 00018097 Last Updated: 04/01/2018 1 ANTIDEPRESSANTS - SCORE{XE "ANTIDEPRESSANTS - SCORE"}
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Step Therapy Golden State Medicare Health Plan, Golden (HMO) Last Updated: 09/01/2018 ALBUTEROL - SCORE Ventolin Hfa Trial of ProAir 1 ANTIDEPRESSANTS - SCORE Aplenzin Desvenlafaxine Er TB24 100MG, 50MG
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Y0133_StepTherapyCriteria _C 10/18/18 Y0133_StepTherapyCriteria _C es 10/18/18
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DPP4 INHIBITORS Janumet 50 mg-1,000 mg tablet Janumet 50 mg-500 mg tablet Januvia 100 mg tablet Januvia 25 mg tablet Januvia 50 mg tablet Onglyza 2.5 mg tablet Onglyza 5 mg tablet Tradjenta 5 mg tablet
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5-ASA Dipentum 250 mg capsule Lialda 1.2 gram tablet,delayed release You are required to have previous therapy with balsalazide, Delzicol, Apriso, or Asacol HD before we will cover Lialda or Dipentum.
Objectives. How Medicine Works to Control Blood Sugar Levels. What Happens When We Eat? What is diabetes? High Blood Glucose (Hyperglycemia)
How Medicine Works to Control Blood Sugar Levels Stacie Petersen, RN, CDE Objectives Define Diabetes List how medications work (ominous octet) Identify side effects of medications for diabetes What is
If you have questions about the Step Therapy Program, contact ClearScript Member Services at the number on the back of your ID Card.
Step Therapy The ClearScript Step Therapy program promotes the cost-effective use of clinically appropriate medications when more than one drug is available to treat a medical condition. What is Step Therapy?
HEALTH SHARE/PROVIDENCE (OHP)
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ALPHA BLOCKERS. Products Affected. Details. Step 2: RAPAFLO 4 MG CAPSULE. Step 1: alfuzosin extended release tablet doxazosin tablet
ALPHA BLOCKERS RAPAFLO 4 MG CAPSULE RAPAFLO 8 MG CAPSULE drug may be given. alfuzosin extended release tablet doxazosin tablet tamsulosin capsule terazosin capsule 1 ANTIDEPRESSANTS - SNRI FETZIMA 10 MG
Oregon 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