BB&T 2014 Step Therapy Program Drug List
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1 BB&T 2014 Step Therapy Program Drug List For the drug classifications listed in the table below, members must have tried one Step One medication within the past 130 days before a Step Two medication will be covered unless otherwise indicated. Step Three medications will be covered only after a medication in Step One and Step Two has been tried. Product lists may not be all inclusive and are subject to change. For the most up-to-date information, it is suggested that you visit and look up your medication with the price check feature. Please Note: Drugs highlighted in RED will be excluded from NPF in 2014
2 Drug Classification Angiotensin II Receptor Antagonists (ARBs) Antidepressants - Bupropion Antidepressants - Selective Serotonin Reuptake Inhibitors (SSRI) Antidepressants - Selective Serotonin Norepinephrine Reuptake Inhibitors (SNRI) STEP ONE: You must try one of these step drugs first benazepril, benazepril/hctz, captopril, captopril/hctz, enalapril, enalapril/hctz, fosinopril, fosinopril/hctz, lisinopril, lisinopril/hctz, ramipril, quinapril, quinapril/hctz, Quinaretic, moexipril, trandolapril, moexipril/hctz, benazepril/amlodipine, perindopril, trandolapril/verapamil, enalapril/felodipine, losartan, losartan/hctz, eprosartan, irbesartan, Irbesartan/HCTZ bupropion SR, bupropion XL, budeprion SR, budeprion XL fluoxetine/weekly, fluvoxamine, paroxetine, paroxetine CR, citalopram, sertraline, escitalopram fluoxetine, fluvoxamine, paroxetine, citalopram, sertraline, escitalopram, venlafaxine/xr, paroxetine mesylate, vilazodone STEP TWO or THREE: These drugs may be covered if Step One drugs do not work Atacand HCT, Atacand, Avalide, Avapro, Azor, Benicar, Benicar HCT,Cozaar, Diovan HCT, Diovan, Edarbi, Edarbyclor, Exforge, Exforge HCT, Hyzaar, Micardis, Micardis HCT, Teveten, Teveten HCT, Twynsta, Tribenzor Wellbutrin SR/XL, Aplenzin, Forfivo XL Brisdelle, Celexa, Lexapro, Luvox CR, Paxil CR, Paxil, Pexeva, Prozac, Prozac Weekly, Sarafem, Zoloft, Viibryd Cymbalta, Effexor, Effexor XR, Pristiq, Venlafaxine extended-release, Savella, Desvenlafaxine Avodart finasteride Avodart, Proscar, Jayln BPH Indication Heart and hypertension Depression Depression Depression Bisphosphonates Enhanced Step-One: alendronate, ibandronate Step-Two: Actonel, Actonel Plus Calcium, Atelvia, Binosto Step-Three: Boniva, Fosamax tablets, Fosamax oral solution, Fosamax Plus D Osteoporosis
3 Branded NSAID diclofenac, diclofenac sodium/misoprostol, etodolac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamate, mefenamic acid, meloxicam, nabumetone, naproxen, oxaprozin, piroxicam, sulindac, tolmetin Arthrotec, Mobic, Ponstel, Cataflam, Voltaren, Voltaren XR, Lodine, Lodine XL, Nalfon, Ansaid, Motrin, Indocin, Indocin SR, Orudis, Toradol, Relafen, Naprosyn, Naprelan, Anaprox, Anaprox DS, Daypro, Feldene, Clinoril, Flector, Voltaren Gel, IC 400, IC 800, Zipsor, Pennsaid, Cambia, Sprix, Vimovo, Duexis Arthritis/Pain COX-2 Inhibitors diclofenac, diclofenac sodium/misoprostol, Celebrex Arthritis/Pain etodolac, fenoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamate, mefenamic acid, meloxicam, nabumetone, naproxen, oxaprozin, piroxicam, sulindac, tolmetin Fenofibrate Fenofibrate, Fenofibric Acid Antara, Fenoglide, Fibricor, Lofibra, Lipofen, Cholesterol Tricor, Triglide, Trilipix, Hypnotics zolpidem/cr, zaleplon Ambien, Ambien CR, Edluar,Intermezzo, Lunesta, Insomnia Rozerem, Silenor, Sonata, Zolpimist Gabapentin (formerly called Lyrica) gabapentin Lyrica, Horizant, Neurontin, Gralise Neuropathic pain Nasal Steroids fluticasone propionate, flunisolide, triamcinolone, Nasonex, Qnasi Rhinocort Aqua, Beconase AQ, Dymista, Nasacort AQ, Nasarel, Flonase, Veramyst, Omnaris, Zetonna Allergies Ophthalmic Prostaglandins Latanoprost, travoprost Lumigan, Travatan/Z, Xalatan, Zioptan, Rescula Glaucoma
4 Tetracycline - oral Topical Acne demeclocycline, doxycycline, minocycline, tetracycline Rule 1: Generic topical BPO, antibiotic, etc containing products Rule 2: Generic topical cleansers Rule 3: One med from rule 1 AND one med from rule 2 Declomycin, Adoxa, Monodox, Avidoxy/kit, Adoxa/CK/TT/Pak, Doryx, Vibramycin, Vibra- Tabs, Oraxyl, Periostat, Oracea, Dynacin, Minocin/kit/PAC, Solodyn, Sumycin, Alodox/kit, Morgidox, Ocudox Rule 1: Brand topical BPO, antibiotic, etc containing products Rule 2: Brand topical cleansers Rule 3: Brand topical kits Dermatologic Conditions Dermatologic Conditions Topical Corticosteroids Topical Immunomodulators alclometasone, amcinonide, betamethasone dipropionate (augmented), betamethasone dipropionate, fluocinonide, fluticasone, halobetasol, betamethasone valerate, hydrocortisone, clobetasol, hydrocortisone butyrate, desonide, desoximetasone, hydrocortisone valerate, mometasone, triamcinolone, diflorasone fluocinolone, pramoxine alclometasone, amcinonide, betamethasone dipropionate (augmented), betamethasone dipropionate, clobetasol, clobetasone, fluocinonide, fluticasone, halobetasol, betamethasone valerate, hydrocortisone, hydrocortisone butyrate, hydrocortisone buteprate, hydrocortisone acetate, desonide, desoximetasone, hydrocortisone valerate, mometasone, triamcinolone, diflorasone, fluocinolone, clocortolone, flurandrenolide, halocinonide, prednicarbate Aclovate, Ala-Scalp HP, ApexiCon, Capex, Clobex, Elocon, Halog, Halonate, Florone, Kenalog, Cloderm, Cordran, Locoid, Luxiq, Olux, Pandel, Psorcon, Derma-Smooth/FS, Dermatop, Texacort, Vanos, Diprolene/AF, Verdeso, Desonate, Olux-Olux-E, Desowen, Cutivate, Zytopic, Nucort Lotion, Florone, Ultravate, Topicort/LP, Lidex, Westcort, Momexin, Pediaderm/TA, Triderm, Scalacort, Samol-HC, Pramosone, Pramosone E, Desonil/kit, Aqua Glycolic HC Elidel, Protopic Dermatologic Conditions Dermatologic Conditions
5 Preferred HMG (Statin) lovastatin, pravastatin, simvastatin, atorvastatin Crestor, atorvastin/amlodipine, fluvastatin Altoprev, Caduet, Lescol, Lescol XL, Lipitor, Liptruzet, Livalo, Mevacor, Pravachol, Vytorin, Zocor Cholesterol Preferred Proton Pump Inhibitors Rule 1: omeprazole (Rx), lansoprazole (Rx), omeprazole-sodium bicarbonate (Rx), pantoprazole, Nexium Rule 1: Aciphex, Dexilant (formerly Kapidex), Esomeprozole Strontium, Prevacid, Prilosec, Protonix, Zegerid Stomach acid conditions Rule 2: Pylera Rule 2: Prevpac Preferred Overactive Bladder (OAB) Overactive bladder Oxybutynin IR/ER (generic only), Enablex, Vesicare, trospium IR/XR, tolterodine IR, myrbetriq, Detrol/LA, Toviaz, Gelnique Ditropan, Ditropan XL, Sanctura/XR, Oxytrol Combination B- agonist/ Inhaled Corticosteroids (ICS) Symbicort, Dulera Advair Diskus, Advair HFA, Breo Ellipta
6 Inhaled Corticosteroids (ICS) Asmanex, Pulmicort, Qvar Flovent HFA, Flovent Diskus, Alvesco Members may call Express Scripts with any questions at Physicians can call the PA Hotline at SPECIALTY Step Therapy Program STEP ONE: Your program points you to one of these first step drugs STEP TWO or THREE: These drugs may be covered if Step One drugs do not work INDICATION: Alpha-1 Inhibitors Aralast Prolastin, Zemaira, Glassia Lung Disorders Cryopyrin-Associated Periodic Syndrome (CAPS) Ilaris Arcalyst Erythroid Stimulants Procrit, Aranesp Epogen Rare Inflammatory Disease Anemia; Blood dyscracias Growth Hormones Must Try 3: Genotropin, Norditropin, Norditropin Nordiflex, Humatrope Tev-Tropin, Nutropin, Nutropin AQ, Omnitrope, Saizen Endocrine; Growth Deficiency Infertility- Follitropins Gonal-F, Gonal-F RFF Follistim AQ, Bravelle Infertiltiy
7 Infertility- GnRH Antagonists Ganirelix Cetrotide Infertility- Chorionic Gonadotropin Chorionic Gonadotropin, Novarel Pregnyl, Ovidrel Infertility Infertility Inflammatory Conditions Enbrel and Humira Simponi, Cimzia, Kineret, Orencia SQ, Stelara, Rituzin, Remicade, Orencia IV, Actemra, Simponi Aria, Xeljanz Rheumatoid Arthritis, Crohn s Disease, Inflammatory Conditions Multiple Sclerosis- Injectable Avonex, Copaxone, Extavia, Rebif Betaseron Multiple Sclerosis- Oral Avonex, Extavia, Copaxone, Rebif Gilenya, Aubagio, Tecfidera Multiple Sclerosis- Oral Betaseron, Rebif, Extavia, Avonex, Gileyna Aubagio Multiple Sclerosis Multiple Sclerosis Multiple Sclerosis Prostate Cancer GnRH Analogs Eligard Firmagon, Lupron Depot, Trelstar, Trelstar Depot Oncology Hypertension - Endothelin Receptor Antagonists Tracleer Letairis Hypertension - PDE-5 Inhibitors sildenafil Revatio tablets, Adcirca Hypertension - Inhaled Prostacyclin Tyvaso Ventavis Hypertension Hypertension Hypertension
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