Chronic Medicine. Reduced out-of-pocket costs for the medicine you need Value and Value Plus plans
|
|
- Cody Bridges
- 5 years ago
- Views:
Transcription
1 Chronic Medicine Reduced out-of-pocket costs for the medicine you need Value and Value Plus plans
2 Forget your deductible just pay your copay or coinsurance when buying certain medication. January 1, 2019 Chronic Medicine List Value and Value Plus plans Drug Class ANTIANGINAL AGENTS isosorbide dinitrate isosorbide dinitrate er isosorbide mononitrate isosorbide mononitrate er ANTIASTHMATIC albuterol sulfate albuterol sulfate er ANORO ELLIPTA ASMANEX HFA ASMANEX TWISTHALER BREO ELLIPTA budesonide COMBIVENT RESPIMAT cromolyn difil-g forte DULERA fluticasone propionate/salmeterol INCRUSE ELLIPTA ipratropium bromide ipratropium bromide/albuterol sulfate levalbuterol metaproterenol sulfate montelukast minitran nitroglycerin RANEXA PROAIR HFA PROAIR RESPICLICK QVAR REDIHALER SEREVENT DISKUS SPIRIVA HANDIHALER SPIRIVA RESPIMAT STIOLTO RESPIMAT SYMBICORT terbutaline sulfate THEO-24 theochron theophylline theophylline cr theophylline er TRELEGY ELLIPTA VENTOLIN HFA zafirlukast Key UPPERCASE lowercase italics Brand-name medicine Generic medicine Health benefits and health insurance plans are offered, administered and/or underwritten by Aetna Health Inc., Aetna Health Insurance Company of New York, Aetna Health Assurance Pennsylvania Inc., Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). In Florida, by Aetna Health Inc. and/or Aetna Life Insurance Company. In Utah and Wyoming by Aetna Health of Utah Inc. and Aetna Life Insurance Company. In Maryland, by Aetna Health Inc., 151 Farmington Avenue, Hartford, CT Each insurer has sole financial responsibility for its own products. Aetna Pharmacy Management refers to an internal business unit of Aetna Health Management, LLC.
3 ANTIDEPRESSANTS amitriptyline hcl amoxapine bupropion hcl bupropion hcl er bupropion hcl sr bupropion hcl xl citalopram hydrobromide clomipramine hcl desipramine hcl desvenlafaxine er doxepin hcl duloxetine hcl escitalopram oxalate fluoxetine dr fluoxetine hcl ANTIDIABETIC acarbose ADMELOG products alogliptin alogliptin/metformin hcl alogliptin/pioglitazone BASAGLAR KWIKPEN chlorpropamide FARXIGA glimepiride glipizide glipizide er glipizide xl glipizide/metformin hcl GLUCAGEN HYPOKIT GLUCAGON EMERGENCY KIT glucose glyburide glyburide micronized glyburide/metformin hcl GLYXAMBI HUMALOG products HUMULIN products INVOKAMET INVOKAMET XR fluvoxamine fluvoxamine er imipramine hcl maprotiline hcl mirtazapine mirtazapine odt nortriptyline hcl paroxetine hcl paroxetine hcl er phenelzine sulfate protriptyline hcl sertraline hcl tranylcypromine sulfate trazodone hcl venlafaxine hcl venlafaxine hcl er INVOKANA JANUMET JANUMET XR JANUVIA JARDIANCE JENTADUETO JENTADUETO XR LEVEMIR products metformin hcl metformin hcl er miglitol pioglitazone hcl pioglitazone hcl/glimepiride pioglitazone hcl/metformin hcl SOLIQUA SYNJARDY SYNJARDY XR tolazamide TRADJENTA TRESIBA FLEXTOUCH TRULICITY VICTOZA XIGDUO XR XULTOPHY
4 ANTIHYPERLIPIDEMIC atorvastatin calcium cholestyramine cholestyramine light colesevelam hcl colestipol hcl ezetimibe ezetimibe/simvastatin fenofibrate fenofibrate micronized fenofibric acid fenofibric acid dr ANTIHYPERTENSIVE amlodipine/benazepril hcl amlodipine/valsartan amlodipine/valsartan/hctz atenolol/chlorthalidone benazepril hcl benazepril hcl/hctz bisoprolol fumarate/hctz candesartan cilexetil candesartan cilexetil/hctz captopril captopril/hctz clonidine hcl doxazosin doxazosin mesylate enalapril enalapril/hctz fosinopril fosinopril/hctz guanfacine hcl hydralazine hcl irbesartan irbesartan/hctz lisinopril lisinopril fluvastatin gemfibrozil lovastatin niacin er omega-3-acid ethyl esters pravastatin prevalite rosuvastatin calcium simvastatin VASCEPA lisinopril/hctz losartan potassium losartan potassium/hctz methyldopa methyldopa/hctz metoprolol/hctz minoxidil moexipril hcl moexipril/hctz olmesartan medoxomil olmesartan medoxomil/hctz prazosin hcl propranolol/hctz quinapril hcl quinapril/hctz ramipril telmisartan telmisartan/hctz terazosin hcl trandolapril trandolapril/verapamil hcl er valsartan valsartan/hctz
5 ANTIPSYCHOTICS aripiprazole aripiprazole odt chlorpromazine hcl clozapine clozapine odt compro fluphenazine hcl haloperidol lithium lithium carbonate lithium carbonate er loxapine loxapine succinate BETA BLOCKERS acebutolol hcl atenolol bisoprolol fumarate carvedilol labetalol hcl metoprolol succinate er metoprolol tartrate nadolol CALCIUM BLOCKERS afeditab cr amlodipine cartia xt dilt-xr diltiazem cd diltiazem hcl diltiazem hcl cd diltiazem hcl er felodipine er isradipine CARDIOTONICS digitek DIAGNOSTIC PRODUCTS FREESTYLE BLOOD GLUCOSE TEST STRIPS ketone urine test strips olanzapine olanzapine odt perphenazine prochlorperazine quetiapine fumarate risperidone risperidone m-tab risperidone odt thioridazine hcl thiothixene trifluoperazine hcl ziprasidone hcl pindolol propranolol hcl propranolol hcl er sorine sotalol hcl sotalol hcl (af) timolol nicardipine hcl nifedipine nifedipine er nimodipine nisoldipine er taztia xt verapamil hcl verapamil hcl er verapamil hcl sr digoxin ONETOUCH BLOOD GLUCOSE TEST STRIPS PRECISION BLOOD GLUCOSE TEST STRIPS
6 DIURETICS acetazolamide amiloride hcl amiloride/hctz bumetanide chlorothiazide chlorthalidone furosemide hydrochlorothiazide MEDICAL DEVICES BD INSULIN SYRINGES AND PEN NEEDLES MISCELLANEOUS PSYCHOTHERAPEUTIC AND NEUROLOGICAL AGENTS perphenazine/amitriptyline MISCELLANEOUS CARDIOVASCULAR ENTRESTO indapamide methazolamide metolazone spironolactone pironolactone/hctz torsemide triamterene/hctz lancets
7 Please remember that this is not a complete list of medications covered under your plan. Because there are thousands of medications included in your pharmacy benefit, we only list the most common ones. Certain drugs such as those for smoking cessation or vitamins may not be covered by your particular pharmacy plan. Diabetic supplies may be covered under your medical plan. If you have any questions about your pharmacy benefits, log in to your member website. If you don t have access to our website, call the toll-free number on your member ID card. To check coverage and copay information for a specific medicine, log in to your member website. For more details, please call the toll-free number on your member ID card. This is not an inclusive list. Products that are not represented on this list may be subject to plan-specific copayment or coinsurance. Void where prohibited by law. Void in the State of Connecticut. Specific prescription benefits plan design may not cover certain categories or may be subject to additional charges or restrictions, regardless of their appearance in this document. Aetna may receive rebates, discounts and service fees from pharmaceutical manufacturers for certain listed products. Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. Information is believed to be accurate as of the production date; however, it is subject to change. For questions, please call the toll-free number on your member ID card. Policy forms issued in Oklahoma include: HMO OK COC-5 09/07, HMO/OK GA-3 11/01, HMO OK POS RIDER 08/07, GR-23, GR-29N. Policy form issued in Missouri include: AL HGrpPol 01R5, HI HGrpAg 01, HO HGrpPol 01. ta Aetna Inc (06/18)
Preventive Medicine. Reducing your out-of-pocket costs for the medicine you need Value and Value Plus plans
Preventive Medicine Reducing your out-of-pocket costs for the medicine you need Value and Value Plus plans Forget your deductible just pay your copay or coinsurance when buying certain medication. January
More informationPreventive Medicine. Reduced out-of-pocket costs for the medicine you need Premier and Premier Plus plans
Preventive Medicine Reduced out-of-pocket costs for the medicine you need Premier and Premier Plus plans Forget your deductible just pay your copay or coinsurance when buying certain medication. January
More informationIntroducing exciting new Rx benefits 2019
Introducing exciting new x benefits 2019 In 2019, the Middlesex prescription plan is aligning with best-in-class evidence-based practices. Two new tiers will be added that evaluate drugs on the basis of
More information2019 Preventive Drug List
2019 Preventive Drug List Managing your health with preventive medications Your pharmacy benefit plan includes special coverage for generic preventive medications. These medications help protect against
More informationTHERAPEUTIC AREA NAME STRENGTH DOSAGE FORM
Value Based Tier Drugs are selected for the management of Asthma, Diabetes, Hypertension and Hyperlipidemia. These drugs are covered at no charge or at a reduced cost share. Medications are under continual
More informationTHERAPEUTIC AREA NAME STRENGTH DOSAGE FORM
Value Based Tier Drugs are selected for the management of Asthma, Diabetes, Hypertension and Hyperlipidemia. These drugs are covered at no charge or at a reduced cost share. Medications are under continual
More informationMedication Therapy Management
Medication Therapy Management Drug & COPD & COPD, Other ATROVENT HFA cromolyn inhalation DALIRESP ORAL TABLET ipratropium bromide inhalation montelukast oral granules in packet montelukast oral tablet
More informationSave on your drugs with HealthyRx
Save on your drugs with HealthyRx HealthyRx is a savings program offered through the UVa Hoo s Well program. It helps lower your costs on drugs for certain health conditions. Effective 4/1/17, you are
More information2019 Preventive medications and your plan
2019 Preventive medications and your plan Managing your health with preventive medications Your pharmacy benefit plan includes special coverage for generic preventive medications. These medications help
More informationAmbetter 90-Day-Supply Maintenance Drug List
Ambetter 90-Day-Supply Maintenance Drug List What is the Ambetter 90-Day-Supply Maintenance Drug List? Ambetter 90-Day-Supply Maintenance Drug List is a list of maintenance medications that are available
More informationAlaska Medicaid 90 Day** Generic Prescription Medication List
1 ACYCLOVIR 200 MG CAPSULE BUPROPION HCL 150 MG TAB ER 24H ACYCLOVIR 200 MG/5ML BUPROPION HCL 150 MG TABLET ER ACYCLOVIR 400 MG TABLET BUPROPION HCL 150 MG TABLET ER ACYCLOVIR 800 MG TABLET BUPROPION HCL
More informationDRUG CLASSIFICATION. Prevention of Cardiovascular Disease
Generic Preventive Care/ Safe Harbor Drug Program List Preventive care/safe harbor drugs are drugs that can help keep you from developing a health condition or related complications of a health condition.
More informationDrug Regimen Optimization
Texas Prior Authorization Program Clinical Criteria Drug/Drug Class Clinical Criteria Information Included in this Document Excluding Valsartan / Ramipril Prior authorization criteria logic: a description
More informationGeneric Preventive Care/ Safe Harbor Drug Program List
Preventive care/safe harbor drugs are drugs that can help keep you from developing a health condition or related complications of a health condition. The Generic Preventive Care/Safe Harbor Drug Program
More informationValue-Based Drug List for ABCs of Diabetes
Effective January 1, 2019 Value-Based Drug List for ABCs of Diabetes PCPS provides a Value-Based Benefit Design (VBD) to qualified participants in the ABCs of Diabetes. This means you will have lower out-of-pocket
More informationQTY LIMIT COPAY (30 DAY/90 DAY) BENIGN PROSTATIC HYPERPLASIA FINASTERIDE $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8 $4/$8
2019 LiveWELL Health Plan PREVENTIVE DRUG LIST - GENERIC Names ( Copay) - ALPHABETICAL by DRUG CATEGORY You should always check with your prescriber and/or pharmacist to determine if these alternatives
More information2018 Step Therapy Criteria
2018 Step Therapy Criteria ANGIOTENSIN RECEPTOR BLOCKERS... 2 ANTIDEPRESSANTS... 3 ANTIDEPRESSANTS, MISCELLANEOUS... 4 ANTIDEPRESSANTS, OTHER... 5 ANTIDIABETIC AGENTS... 6 ANTIGOUT AGENTS... 7 ANTIHYPERTENSIVE
More information$0 Preferred Generics List
2017 HMO/POS/Select $0 Preferred Generics List Members enrolled in one of the listed HMO/POS/Select plans beginning on or after January 1, 2016 will have a zero-dollar copayment for the following Preferred
More informationACCOUNT HEALTH SAVINGS. Preventive Medication List (by Therapy Class)
HEALTH SAVINGS ACCOUNT Preventive Medication List (by Therapy Class) Capital BlueCross is an Independent Licensee of the BlueCross BlueShield Association Preventive medications are an important element
More informationIntel Connected Care with Providence 2015 Preventive Drug List
Intel Connected Care with Providence 2015 Preventive Drug List Formulary drugs listed below are covered at 100%, not subject to the deductible for the High Deductible Health Plan (HDHP) and Primary Care
More informationValue-Based Benefits MEDICATION LIST. by Therapy Class
Value-Based Benefits MEDICATION LIST by Therapy Class The prescription drug coverage under your Healthy Rewards value-based benefits program is designed to increase adherence to medications used to treat
More informationEffective January 2018
Effective January 2018 MultiCare Health System employee medical plan members can receive preventive medications covered at 100%, not subject to deductible, when dispensed at MultiCare Pharmacies. Drugs
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 informationProfessionalism & Service with Great Prices
Acyclovir Capsules 200mg Viruses 30 90 Albuterol Syrup 2mg/5ml Asthma 120 360 Albuterol Sulfate Solution 0.05% * Asthma ----- ----- 20 60 Albuterol Sulfate Solution 0.083% Asthma ----- ----- 75 225 Alendronate
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 information90-Day Generic Drug Discount List Treatment Medication Strength Dose Quantity Price Allergy/Cold&Flu Benzonatate 100mg Tablet 42 $15.
90-Day Generic Drug Discount List Treatment Medication Strength Dose Quantity Price Allergy/Cold&Flu Benzonatate 100mg Tablet 42 $15.00 Allergy/Cold&Flu C-Phen Drops n/a Drops 90 $15.00 Allergy/Cold&Flu
More informationCash Wise Pharmacy $4 GENERIC MEDICATION FORMULARY. Cash Wise Pharmacy s $4 generic medication formulary is sorted by medical condition.
Cash Wise Pharmacy $4 GENERIC MEDICATION FORMULARY Cash Wise Pharmacy s $4 generic medication formulary is sorted by medical condition. 30- day 90- day 30- day 90- day quantity quantity quantity quantity
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 informationFruth Pharmacy Prescription Savings Club Prescription Club October 2010 Generics item list 30 Day Qty
Fruth Pharmacy Prescription Savings Club Prescription Club October 2010 Generics item list Antihistamine Drugs Cyproheptadine HCl Tab 4 mg Anti-Infective Agents Diphenhydramine HCl Cap mg Promethazine
More informationFormulary for the JHM Outpatient Medication Assistance Program (OMAP)
Note: The JHM Outpatient is a clinic-based program and may only be used by outpatient clinics and JHCP sites approved to participate in the program. To be eligible for OMAP, the patient must not have any
More informationASEBP and ARTA TARP Drugs and Reference Price by Categories
ASEBP Pantoprazole Sodium 40 mg (generic) $0.2016 ASEBP Dexlansoprazole 30 mg Dexlansoprazole 60 mg Esomeprazole 10 mg Esomeprazole 20 mg Esomeprazole 40 mg Lansoprazole 15 mg Lansoprazole 30 mg Omeprazole
More informationSelect Preventive Prescription Drugs Jan. 1, 2018
Select Preventive Prescription Drugs Jan. 1, 2018 In addition to a healthy lifestyle, preventive medications can help you avoid some illnesses and conditions. Zimmer Biomet's medical options Value HSA,
More informationAdditional Standard Generics HSA Preventive Drug List Effective January 1, 2019
Additional Standard Generics HSA Preventive Drug List Effective January 1, 2019 Employers can elect to include an additional generic HSA Preventive Drug coverage feature with your prescription benefit
More informationGeneric Drug List - Alphabetical
Generic Drug List - Alphabetical *** Individual pages can be printed by entering the page number in the Print Range field of the Print menu (Ctrl+P)*** Medication Name Category 30-Day 90-Day ACYCLOVIR
More informationPharmacy Savings Program
Pharmacy Savings Program SELECT GENERICS DRUG LIST The Pharmacy Savings Program provides you with savings on select generic medications included on this list. The prices for these select generic medications
More informationRiesbeck's Pharmacy Reward Club Generic Medication List October 2017
Allergy, Cold & Flu Antibiotic Treatments Arthritis & Pain Benzonatate 100mg cap 14 42 Diphenhydramine HCl Cap 50 MG 30 90 Diphenhydramine HCl Inj 50MG/ML 1 3 Diphenhydramine HCl Liquid 12.5 MG/5ML 720ml
More informationSelectHealth Advantage 2018 Step Therapy Criteria. Previous trial on at least ONE: Generic topical acne treatment. Previous trial on: alendronate
ACNE ACZONE ADAPAL/BEN P AZELEX DAPSONE EPIDUO EPIDUO FORTE TRETINOIN ACTONEL RISEDRON SOD RISEDRONATE SelectHealth Advantage Previous trial on at least ONE: Generic topical acne treatment alendronate
More informationClub Members save even more with the $4 Plus Plan!
Club Members save even more with the $4 Plus Plan! ITEM DESCRIPTION Acephen Supp 650MG 12 Acetam Tab 325MG 30 90 Acyclovir Cap 200MG 30 90 Albuterol Syr 2MG/5ML 120 360 Albuterol Sulfate Nebulizer Ud Sol
More informationRiesbeck's Pharmacy Reward Club Generic Medication List February 2018 $4 30 Day Supply
Allergy, Cold & Flu Antibiotic Treatments Arthritis & Pain Benzonatate 100mg cap 14 42 Diphenhydramine HCl Cap 50 MG 30 90 Diphenhydramine HCl Inj 50MG/ML 1 3 Diphenhydramine HCl Liquid 12.5 MG/5ML 720ml
More informationACEBUTOLOL HCL 100MG TABLET GENERIC BETA BLOCKERS ALISKIREN 150MG TABLET RASILAZ RENIN INHIBITOR
S/N ME OF MEDICATIONS BRANDED/GENERIC DRUG CLASS * UNIT PRICE RANGE (SGD$) 1 ACEBUTOLOL HCL 100MG CAPSULE SECTRAL BETA BLOCKERS 0.50 2 ACEBUTOLOL HCL 100MG TABLET GENERIC BETA BLOCKERS 0.33 3 ALISKIREN
More informationSelectHealth Advantage 2019 Step Therapy Criteria Previous trial on at least ONE: Generic topical acne treatment
ACNE ADAPAL/BEN P AZELEX DAPSONE TRETINOIN ACTONEL ANTICONVULSANT ANTIDEPRESSION ANTIPSYCHOTIC ASTHMA RISEDRON SOD RISEDRONATE APTIOM OXTELLAR XR SPRITAM FETZIMA KHEDEZLA TRINTELLIX ARISTADA FANAPT LATUDA
More informationAllergy, Cough and Cold. Analgesic. Anti-Anxiety. Antibiotic
For your convenience, this list is sorted by drug category. Drugs are categorized based on their most common use and may be included in more than one category. Drugs are not categorized by all of their
More informationOakwood Healthcare Low Cost Drug List for OHSCare & BCN
Oakwood Healthcare Low Cost Drug List for OHSCare & BCN ACETAMINOPHEN-CODEINE ELIXIR Analgesic 240 720 ACYCLOVIR CAP 200MG Antiviral 30 90 AKTOB 0.3% EYE DROPS Miscellaneous 5 15 ALBUTEROL INH SOL 0.083%
More information$4 Prescription Program October 23, 2007
Allergies & Cold and Flu Benzonatate 100mg 14 Ceron DM syrup Ceron drops Dec-Chlorphen drops Dec-Chlorphen DM syrup 118ml* Loratadine 10mg Promethazine DM syrup Trivent DPC syrup * Antibiotic Treatments
More informationRiesbeck's Pharmacy Reward Club Generic Medication List September 2017
Drug Category Allergy, Cold & Flu Antibiotic Treatments Arthritis & Pain Riesbeck's Benzonatate 100mg cap 14 42 Diphenhydramine HCl Cap 50 MG 30 90 Diphenhydramine HCl Liquid 12.5 MG/5ML 720ml 2160ml Hydroxyzine
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 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 informationRETAIL PRESCRIPTION PROGRAM DRUG LIST -- WALMART Revised 8/24/11
Allergies & Cold and Flu $4, 30-day $10, 90-day Benzonatate 100mg cap 14 42 Loratadine 10mg tab 30 90 Promethazine DM syrup 120ml 360ml Antibiotic Treatments Amoxicillin 125mg/5ml susp (80ml bottle) 1
More informationMaintenance Drug List
Maintenance Drug List December 2017 Maintenance drugs are medications prescribed for chronic, long term conditions and are taken on a regular, recurring basis. Examples of chronic conditions that may require
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 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 informationATYPICAL ANTIPSYCHOTICS
Step Therapy CareOregon 2018 Last Updated: 07/27/2018 ATYPICAL ANTIPSYCHOTICS Fanapt Fanapt Titration Pack Paliperidone Er Vraylar The following criteria applies to members who newly start on the drug:
More informationPRESCRIPTION SAVINGS CLUB FLAT- PRICED GENERIC DRUG LIST (EMDEON) Effective August 20, 2014
PRESCRIPTION SAVINGS CLUB FLAT- PRICED GENERIC DRUG LIST (EMDEON) Effective August 20, 2014 The Prescription Savings Club provides its members with significant savings on prescription medications. The
More informationSelectHealth Advantage 2018 Step Therapy Criteria Previous trial on at least ONE: Generic topical acne treatment
ACNE ADAPAL/BEN P GEL 0.1-2.5% AZELEX CRE 20% DAPSONE GEL 5% EPIDUO FORTE GEL 0.3-2.5% TRETINOIN GEL 0.04% TRETINOIN GEL 0.05% TRETINOIN GEL 0.1% ACTONEL ANTICONVULSANT ANTIDEPRESSION ANTIPSYCHOTIC ASTHMA
More informationChapter 2 ~ Cardiovascular system
Chapter 2 ~ Cardiovascular System: General Section 1 of 6 Chapter 2 ~ Cardiovascular system 2.1 Positive inotropic drugs 2.1.1 Cardiac glycosides DIGOXIN 2.2 Diuretics Elixir 50micrograms in 1ml Injection
More informationMembers enjoy more Pharmacy savings *
Sam s Plus Members enjoy more Pharmacy savings 5 prescription drugs available for FREE Generic medications: Donepezil, Pioglitazone, Escitalopram, Finasteride and Vitamin D2 50,000 IU are $ 0 for a 30-day
More information$4 Prescription Program May 5, 2008
Allergies & Cold and Flu Benzonatate 100mg 14 42 Ceron DM syrup 120ml 360ml Ceron drops* 30ml 90ml Dec-Chlorphen drops* 30ml 90ml Dec-Chlorphen DM syrup* 118ml 354ml Loratadine 10mg 30 90 Promethazine
More informationDrug Regimen Optimization
Texas Prior Authorization Program Clinical Edit Criteria Drug/Drug Class Clinical Edit Information Included in this Document Excluding Valsartan / Ramipril Prior authorization criteria logic: a description
More informationPharmacy Provider Training
Pharmacy Provider Training Texas Managed Care Medicaid STAR and CHIP Programs Question and Answers How often are price increases updated in your system and is Navitus current with its price updates? Navitus
More informationStep Therapy Group Algorithm Steps
Step Therapy Group Algorithm Steps ACTONEL AMITIZA ANTICONVULSANT ANTIDEPRESSION Previous trial on alendronate Step 1: ALENDRONATE SODIUM Step 2: RISEDRONATE SODIUM, RISEDRONATE SODIUM DR Previous trial
More informationCommissioner 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 informationPharmaSuitables October Rich Price, MD Zach Kareus, Pharm.D. Steve Nolan, Pharm.D.
PharmaSuitables October 2017 Rich Price, MD Zach Kareus, Pharm.D. Steve Nolan, Pharm.D. Disclosures Rich, Zach, and Steve work for Rocky Mountain Health Plans. We do not have any financial interest in
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 informationMembers enjoy more Pharmacy savings *
Sam s Plus Members enjoy more Pharmacy savings 5 prescription drugs available for FREE Generic medications: Donepezil, Pioglitazone, Escitalopram, Finasteride and Vitamin D2 50,000 IU are $ 0 for a 30-day
More information2013 Step Therapy (ST) Criteria
2013 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 informationAMANTADINE 50 MG/5 ML SYRUP ACYCLOVIR 200 MG CAPSULES ACYCLOVIR 400 MG TABLETS ACYCLOVIR 800 MG TABLETS 30 90
Antibiotics Qty* DRUG NAME $0.00 Copay $ 4.00 $ 10.00 AMOXICILLIN 125 MG/5 ML (150 ML BOTTLE) 150 AMOXICILLIN 125 MG/5 ML (100 ML BOTTLE) 100 AMOXICILLIN 125 MG/5 ML (80 ML BOTTLE) 80 AMOXICILLIN 200 MG/5
More informationFactors Involved in Poor Control of Risk Factors
Factors Involved in Poor Control of Risk Factors Patient compliance Clinical inertia Health Care System structure 14781 M Limitations of Formal Studies Selection of patients Recruitment and follow-up alter
More informationVNSNY CHOICE FIDA Complete Step Therapy Requirements. Effective: 04/01/2019
VNSNY CHOICE FIDA Complete Step Therapy Requirements Effective: 04/01/2019 Updated 03/2019 AMANTADINE ER OSMOLEX ER 129 MG, EXTENDED RELEASE OSMOLEX ER 193 MG, EXTENDED RELEASE OSMOLEX ER 258 MG, EXTENDED
More informationBlue Cross KeyRx TK Preventive RX Pack Drug List Large Group Effective January 1, 2019
Blue Cross KeyRx TK Preventive RX Pack Drug List Large Group Effective January 1, 2019 Your employer may have elected to include the KeyRx Turn-Key Preventive Pack Drug List in your benefit plan. Below
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 information12.5mg, 25mg, 50mg. 25mg, 50mg. 250mg, 500mg, 250mg/5ml. 2.5mg, 5mg, 10mg. 5mg, 10mg, 20mg, 100mg. 25mg
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Blood Pressure P&T DATE: 9/11/2018 THERAPEUTIC CLASS: Cardiovascular Disorders REVIEW HISTORY: 5/17, 9/15, 2/13, 2/08, LOB
More informationAntihypertensive Agents
Antihypertensive Agents Southern California University of Health Sciences Physician Assistant Program Management and Treatment of Hypertension April 7, 08, presented by Ezra Levy, Pharm.D! Usual Dose,
More information2013 Preventive Medication List (by Therapy Class) Greater Lehigh Valley Chamber of Commerce
2013 reventive Medication List (by Therapy Class) reater Lehigh Valley Chamber of Commerce reventive medications are an important element in keeping Members healthy. Your LVCC preventive medication plan
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 informationANTICONVULSANTS. Details
ANTICONVULSANTS Aptiom 200 mg tablet Aptiom 400 mg tablet Aptiom 600 mg tablet Aptiom 800 mg tablet Banzel 200 mg tablet Banzel 40 mg/ml oral suspension Banzel 400 mg tablet Fycompa 0.5 mg/ml oral suspension
More informationMembers enjoy more Pharmacy savings *
Sam s Plus Members enjoy more Pharmacy savings 5 prescription drugs available for FREE Generic medications: Donepezil, Pioglitazone, Escitalopram, Finasteride and Vitamin D2 50,000 IU are $ 0 for a 30-day
More informationANGIOTENSIN RECEPTOR BLOCKERS STEP THERAPY
South Country Health Alliance 2017 Step Therapy Formulary ID: 17431 Last Updated: 10/20/2017 Effective Date: 11-01-2017 ANGIOTENSIN RECEPTOR BLOCKERS STEP THERAPY BENICAR 20 MG BENICAR 40 MG BENICAR 5
More informationHundreds of Choices. More Savings Every Day. 8 and $ 12 Generics Also Available. Based on 30-day supply at commonly prescribed doses
4$ Hundreds of Choices. More Savings Every Day. $ 8 and $ 12 Generics Also Available. Based on 30-day supply at commonly prescribed doses EFF. DATE 09/2017 List subject to change ALLERGIES, COLD AND FLU
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 informationGranite Alliance Insurance Company (PDP) 2018 Step Therapy Criteria Last Updated: 10/23/18
Granite Alliance Insurance Company (PDP) 2018 Step Therapy Criteria Last Updated: 10/23/18 Granite Alliance requires step therapy for certain drugs. This means prior to receiving a drug with a step therapy
More information12.5mg, 25mg, 50mg. 25mg, 50mg. 2.5mg, 5mg, 10mg. 5mg, 10mg, 20mg, 100mg. 25mg. -- $2.81 Acetazolamide (IR, 125mg, 250mg, 500mg (ER)
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Blood Pressure P&T DATE: 5/9/2017 THERAPEUTIC CLASS: Cardiovascular Disorders REVIEW HISTORY: 9/15, 2/13, 2/08, 5/07 LOB
More informationStep Therapy Requirements
An Independent Licensee of the Blue Cross and Blue Shield Association Step Therapy Requirements Effective: 05/01/2018 Updated 4/2018 H0302_2_2014 CMS Accepted 05/05/2014 1 BETA-BLOCKERS BYSTOLIC 10 MG
More informationVNSNY CHOICE FIDA Complete Step Therapy Requirements. Effective: 01/01/2017
Effective: 01/01/2017 Updated 11/2016 ANTI-INFLAMMATORY AGENTS - GI DIPENTUM PRIOR CLAIM FOR BALSALAZIDE OR APRISO WITHIN THE PAST 120 DAYS. ANTICONVULSANTS APTIOM BANZEL FYCOMPA GABITRIL OXTELLAR XR POTIGA
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 informationIEHP Medi-Cal Formulary Maintenance Drug List
IEHP Medi-Cal Formulary Maintenance Drug List The following formulary medications may be approvable up to a three-month supply. FDA-approved generic products must be used if available. Brand name products
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, EXTENDED RELEASE OSMOLEX ER 193 MG, EXTENDED RELEASE OSMOLEX ER 258 MG, EXTENDED RELEASE PRIOR CLAIM FOR AMANTADINE HCL IMMEDIATE RELEASE WITHIN THE PAST 120 DAYS. 1 ANTICONVULSANTS
More informationEveryday Low Cost Generics
Antibiotics Antifungal Antiviral Arthritis/ Pain 30 Day Qty* Free AMOXICILLIN 125 MG/5 ML (150 ML BOTTLE) AMOXICILLIN 125 MG/5 ML (100 ML BOTTLE) AMOXICILLIN 125 MG/5 ML (80 ML BOTTLE) AMOXICILLIN 200
More informationPassAssured's Pharmacy Technician Training Systems. Medication Review. Cardiovascular Drugs. Pharmacy Technician Training Systems Passassured, LLC
Medication Review Cardiovascular Drugs Pharmacy Technician Training Systems Passassured, LLC p1 Medication Review, Cardiovascular Drugs Click Here for Glossary Index! Click Here to Print Topic Help File
More informationMedicare Shared Savings Program Accountable Care Organization (ACO) Measures Deep Dive Series
Medicare Shared Savings Program Accountable Care Organization (ACO) Measures Deep Dive Series At Risk Population: Measure 33 Coronary Artery Disease (CAD-7): Angiotensin-Converting Enzyme (ACE) Inhibitor
More informationSpecial Generic Drug Pricing Program
FREE PICK-UP & DELIVERY Flu-Shots Specialty prescription Compounding Wellness center providing health screenings for hypertension and diabetes $3 Special Generic Prescription Drug Program only offered
More informationFirstCarolinaCare Insurance Company. Step Therapy Requirements
FirstCarolinaCare Insurance Company Step Therapy Requirements Effective: 12/01/2018 ANTICONVULSANTS APTIOM 200 MG APTIOM 400 MG APTIOM 600 MG APTIOM 800 MG BANZEL 200 MG BANZEL 40 MG/ML ORAL SUSPENSION
More informationAvoid paying too much for your prescriptions
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions 2017 Aetna Rx Step Program Medicine List Avoid paying too much for your prescriptions It s important to try to
More informationREVISED RESPIRATORY MEDICATION USE QUESTIONNAIRE
REVISED RESPIRATORY MEDICATION USE QUESTIONNAIRE ID NUMBER: 0a) Date of Collection / / 0b) Staff Code Instructions: This form should be completed during the participant s clinic visit. 1) Are you regularly
More informationISMJ International SportMed Journal
32 ISMJ International SportMed Journal FIMS Position Statement Antihypertensive medications and exercise Associate Professor Wayne Derman UCT/MRC Research Unit for Exercise Science and Sports Medicine,
More information$ day. $4-30day $10-90day. 473mL. 4-$9 Alendronate Sodium 35mg tablets 12-$24 12-$ $24 12-$24 12-$24 4-$9. 80mL.
Acyclovir 200mg capsules Acyclovir 400mg tablets Acyclovir 800mg tablets Albuterol 0.083% Nebulizing Solution (75ml- 30days/225ml-s) Albuterol 0.5% Nebulizer Solution (20mL-30days, 60mL-s) Albuterol 2mg
More information