2016 PRESCRIPTION DRUG LIST UPDATES
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- Ariel Gaines
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1 2016 PRESCRIPTION DRUG LIST UPDATES Evergreen Health 1 st Quarter Below are key updates to the four-tier EHB Prescription Formulary, effective January 1, Please consult the full formulary for more information MEDICATIONS WITH UTILIZATION MANAGEMENT CHANGES Program Type Rationale NEUPRO (rotigotine) Step Therapy New program. The NEUPRO ST program is intended to ensure appropriate firstline use of generics. Requires a trial of either ropinirole or pramipexole. ERTACZO (sertaconazole) EXELDERM (sulconazole) MENTAX (butenafine) NAFTIN (naftifine) cream OXISTAT (oxiconazole) XOLEGEL (ketoconazole) Step Therapy New program. The TOPICAL ANTIFUNGALS ST program is intended to ensure appropriate first-line use of generics. Requires a trial of two of the following agents: ketoconazole, miconazole, terbinafine, econazole cream, clotrimazole, tolnaftate, butenafine, or ciclopirox MEDICATIONS PREVIOUSLY EXCLUDED NOW BEING ADDED AS GENERIC CEFDITOREN PIVOXIL Generic MEDICATIONS PREVIOUSLY EXCLUDED NOW BEING ADDED AS NON-PREFERRED BRAND AKYNZEO NEO-SYNALAR
2 MEDICATIONS PREVIOUSLY CLASSIFIED AS GENERIC MOVING TO NON-PREFERRED LITHIUM MEDICATIONS PREVIOUSLY CLASSIFIED AS PREFERRED MOVING TO NON-PREFERRED PYLERA MEDICATIONS PREVIOUSLY CLASSIFIED AS GENERIC MOVING TO SPECIALTY CLOMIPHENE TAB FLUOROURACIL CREAM LOMUSTINE CAP PROGESTERONE CAP SEROPHENE TAB MEDICATIONS PREVIOUSLY CLASSIFIED AS PREFERRED MOVING TO SPECIALTY GLEOSTINE CAP LEUKERAN TAB MEDICATIONS PREVIOUSLY CLASSIFIED AS NON-PREFERRED MOVING TO SPECIALTY TAGRETIN GEL MEDICATIONS PREVIOUSLY CLASSIFIED AS PREFERRED BRAND MOVING TO EXCLUDED s ACANYA ANALPRAM ADVANCED ANALPRAM-HC BEYAZ CAVERJECT CAVERJECT IMPULSE CLINDESSE DIAZEPAM EPIDUO ESTRING FENOFIBRATE FERREX 150 FORTE PLUS
3 FERREX 28 LIPOFEN LIPTRUZET MINIVELLE MUSE PAZEO PRAMOSONE PRISTIQ PROCTOFOAM HC PROLENSA SAFYRAL SIMCOR TRAVOPROST TUSSICAPS UCERIS VIOKACE ZIANA ZYLET MEDICATIONS PREVIOUSLY CLASSIFIED AS NON-PREFERRED BRAND MOVING TO EXCLUDED ABSTRAL ADVAIR DISKUS ADVAIR HFA ALORA ALSUMA ALTOPREV ALVESCO ANDRODERM APRISO AZASITE BECONASE AQ BETOPTIC-S BINOSTO BLEPHAMIDE OIN S.O.P. BREO ELLIPTA CIPRO HC CLEOCIN VAG
4 CLOCORTOLONE PIVALATE CLODERM CONZIP DERMASORB TA DESONATE DESOWEN CREAM/CETAPHIL LOTION DESOWEN LOTION/CETAPHIL CREAM DESOWEN OINTMENT/CETAPHIL LOTION EDARBYCLOR ESTROGEL FENTORA FLECTOR FLOVENT DISKUS FLOVENT HFA FORFIVO XL GALZIN GIAZO GLUMETZA HYDROMORPHONE HCL ER INTERMEZZO JENTADUETO KADIAN KRISTALOSE LAMICTAL ODT NITRO-DUR OMNARIS PEDIADERM HC PEDIADERM TA PERTZYE POTABA PREVACID SOLUTAB PRILOSEC POW PROVENTIL HFA PRUDOXIN QNASL SILENOR SUBSYS SUMAVEL DOSEPRO
5 SYNERA TESTIM TEVETEN HCT TRAMADOL HCL ER TREXIMET ULTRESA VENTOLIN HFA VERAMYST VERDESO VIMOVO VOGELXO VOGELXO PUMP XOPENEX HFA ZEGERID ZETONNA ZIOPTAN ZONALON ZUPLENZ ZYCLARA ZYFLO MEDICATIONS PREVIOUSLY CLASSIFIED AS SPECIALTY MOVING TO EXCLUDED s ACTEMRA BRAVELLE EUFLEXXA EXTAVIA GENOTROPIN GENOTROPIN MINIQUICK HUMATROPE COMBO PACK HYALGAN KYNAMRO OMNITROPE SAIZEN STELARA SUPARTZ TEV-TROPIN XELJANZ
6
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