HMSA Formulary Newsletter August 2004

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1 HMSA Formulary Newsletter August 2004 FILING 65C PLUS DRUG CLAIMS - UPDATE In a memo dated June 25, 2004, participating pharmacies were instructed to use condition code in the prior authorization number submitted field in order for a claim to process if a member did not meet Medicare criteria. A change has been made by our claims processor to enable pharmacies to process these claims more easily. Condition code has been removed and no longer needs to be entered. Claims should continue to be processed using the criteria that became effective November NEW BRAND NAME FOR ALTOCOR In the July 2004 Formulary update, the status of Altocor was changed to GENERIC status on the Choice and Select formularies and FORMULARY status for The HMSA Plan for QUEST Members. Based on a recent federal court decision, Andrx Laboratories, the manufacturer of Altocor, will change the brand name Altocor to the brand name Altoprev. This ruling affects only the use of Altocor as a brand name. Altoprev will remain exactly the same as Altocor, including ingredients, dosage form, strengths, appearance, price, etc. Only the brand name and NDC number are changing. Please be aware that members may not be aware of the name change from Altocor to Altoprev. DOSAGE FORM CHANGE FOR ALBUTEROL Effective immediately, the billing unit standard for albuterol sulfate inhalation 0.5 percent will change from the current billing unit of ml to each. This medication, packaged in 0.5 ml singleuse units, should be billed as 30 each instead of 15 ml. PROVENTIL AND VENTOLIN STATUS FORMALIZED In 2001, Proventil and Ventolin metered dose inhalers were allowed to process as PREFERRED brand for Select and Choice plan members, and as FORMULARY agents for The HMSA Plan for QUEST Members because there were availability problems involving A-rated generic equivalents. This benefit allowance was implemented as a temporary solution to ensure adequate access to albuterol therapy for our members. Because A-rated generics for these products have not been reliably available since that time, HMSA has decided to formally change the formulary to designate Proventil and Ventolin metered dose inhalers as PREFERRED under the Select plan and as FORMULARY for The HMSA Plan for QUEST Members. DAY SUPPLY DISPENSING CLARIFICATION If a physician writes a prescription for a 90-day supply of a medication, but the member wishes to pick up only a 30-day supply, the pharmacy may dispense the 30-day supply even though the prescription indicates a 90-day supply. The maximum day supply is based on the member s plan benefits. PM04-023

2 HMSA Formulary Newsletter August 2004 DRUG DIFFERENTIAL INCREASE In the Select drug plan design, OTHER BRAND (third-tier) drugs have a member copayment differential based on GENERIC and PREFERRED drugs within the same therapeutic category. The estimated differential cost to member will vary from below $10 to over $100. The drugs in the OTHER BRAND category are reviewed periodically to reflect current drug experience. As a result, new copayment differentials are instituted or existing differentials are updated (up or down). Effective August 1, 2004, members of HMSA s Select Drug plans will see a change in copayments for the medications listed below. These medications were selected because they have had no recent cost review, or are new and have not yet had a differential calculated. Drug Name Drug Name Amoxapine Nolvadex Axert Norpramin * Azelex Orap Azmacort Pamelor Benzaclin QVAR Capitrol Riomet Carafate Sinemet Cortef Sinequan Elavil Stadol NS Eldepryl Talwin NX * Ergomar Tasmar Flovent Rotadisk Tofranil * Frova Ultracet Glucophage Ultram * Glucophage XR Vivactil Klaron * Zomig Maxalt Zomig ZMT Maxalt MLT Zovirax (tablets) *Members will see copayment increases of more than $100 for these medications. HMSA FORMULARY UPDATE Enclosed is the HMSA Formulary update. Please include it with your formulary reference material. The formulary is available on the Hawaii Healthcare Information Network (HHIN) and on the Internet at Formulary changes referred to in this newsletter will not be reflected in the online formulary until the effective date of the changes.

3 HMSA Formulary Newsletter August 2004 CONTACT INFORMATION Questions or comments regarding the HMSA Drug Formulary revisions may be directed to: Kris Nishimura, R.Ph. HMSA Pharmacy Management P.O. Box 860 Honolulu, HI Claims and eligibility questions should be directed to the applicable phone number below: HMSA Provider Teleservice Representatives at on Oahu or 1 (800) from the Neighbor Islands HMSA Membership Connection (touch-tone eligibility verification) on Oahu at or 1 (800) from the Neighbor Islands The HMSA Plan for QUEST Members Provider Services at on Oahu or 1 (800) from the Neighbor Islands Members with questions or concerns regarding their HMSA drug plans may call an HMSA Customer Service representative at the following numbers: Oahu Hilo Kona Kauai Maui, Lanai, Molokai

4 HMSA Formulary Update Please note the following changes to the HMSA Formulary, effective October 1, All changes are indicated in bold type. = Not a Benefit UA = Unavailable Generic Name Brand Name SELECT CHOICE QUEST QUEST- Net CCS Children s Plan albuterol Proventil Preferred Other Formulary albuterol Ventolin Preferred Other Formulary aminocaproic acid Generic Amicar New Generic New Generic Non-formulary anagrelide Agrylin Preferred Other Brand Formulary bosentan bupropion, sustained release bupropion, sustained release chloroquine chloroquine ciprofloxacin ciprofloxacin ciprofloxacin opthalmic solution danazol Tracleer Preferred Other Brand Formulary Generic Zyban New Generic New Generic Formulary Formulary Zyban Other Brand Other Brand Non-formulary Non-formulary Generic Aralen New Generic New Generic Formulary Aralen Other Brand Other Brand Non-formulary Generic Cipro New Generic New Generic Formulary Therapeutic Protocol Cipro Other Brand Other Brand Non-formulary Generic Ciloxan Solution New Generic New Generic Non-formulary Generic Danocrine New Generic New Generic Formulary danazol Danocrine Other Brand Other Brand Non-formulary etoposide etoposide Generic VePesid New Generic New Generic Formulary VePesid Other Brand Other Brand Non-formulary PM04-023a

5 Generic Name Brand Name SELECT CHOICE QUEST QUEST- Net CCS Children s Plan glyburide/metformin Generic Glucovance New Generic New Generic Formulary glyburide/metformin hydroxyurea hydroxyurea Glucovance Other Brand Other Brand Non-formulary Generic Hydrea New Generic New Generic Formulary Hydrea Other Brand Other Brand Non-formulary ketoconazole shampoo Generic Nizoral shampoo New Generic New Generic Formulary ketoconazole shampoo Nizoral shampoo Other Brand Other Brand Non-formulary mercaptopurine mercaptopurine Generic Purinethol New Generic New Generic Formulary Purinethol Other Brand Other Brand Non-formulary methenamine hippurate Generic Hiprex New Generic New Generic Non-formulary metronidazole cream Generic MetroCream New Generic New Generic Formulary metronidazole cream MetroCream Other Brand Other Brand Non-formulary modafanil nitrofurantoin Provigil Other Brand Other Brand Non-formulary Formulary Generic Macrobid New Generic New Generic Formulary nitrofurantoin Macrobid Other Brand Other Brand Non-formulary oxycodone extended release, 80 mg oxycodone extended release, 80 mg paroxetine Generic Oxycontin, 80 mg New Generic New Generic Non-formulary Oxycontin, 80 mg Other Brand Other Brand Non-formulary Generic Paxil New Generic New Generic Formulary Formulary paroxetine Paxil Other Brand Other Brand Non-formulary Non-formulary

6 Generic Name Brand Name SELECT CHOICE QUEST QUEST- Net CCS Children s Plan pimecrolimus Elidel Preferred Other Brand Formulary quinapril/hctz Generic Accuretic New Generic New Generic Non-formulary ribavirin ribavirin tacrolimus tiagabine Generic Rebetol New Generic New Generic Formulary Rebetol Other Brand Other Brand Non-formulary Protopic Preferred Other Brand Formulary Gabitril Preferred Other Brand Formulary Formulary tiotropium Spiriva Preferred Other Brand Formulary trifluridine Generic Viroptic New Generic New Generic Formulary trifluridine Viroptic Other Brand Other Brand Non-formulary

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