MAKING THE MOST OF YOUR PRESCRIPTION BENEFIT PROGRAM IN 2015 Your health and well-being is important to Houston Methodist and CVS/caremark. Keeping healthy includes having prescription care that is convenient and affordable. This information outlines new changes to your benefit plan in 2015 and includes Generic Step Therapy and Personalized Pharmacy Care for your Complex Condition. Great benefits that have always been part of your plan. Below are four ways to make the most of your plan in 2015. TRY GENERICS FIRST BEFORE BRAND-NAME DRUGS Your prescription benefit plan asks that you try a generic first instead of brand-name drugs. If you do not try a generic first, the brand-name drug will not be covered by your plan. The chart below shows the brand-name drugs and the generic alternatives that are available. If you are currently taking one of these brand-name drugs, speak with your doctor soon to get a prescription for a generic alternative. Blood Pressure* Skin Disorders Prostate TRADITIONAL GENERIC STEP THERAPY Drug Class Drugs Requiring Step Therapy Covered Generic Alternatives Benicar/Benicar HCT Tekturna/Tekturna HCT Acanya Akne-Mycin Azelex Cardura XL Rapaflo amlodipine-benazepril benazepril/benazepril HCTZ candesartan/candesartan HCTZ captopril/captopril HCTZ enalapril/enalapril HCTZ eprosartan fosinopril/fosinopril HCTZ irbesartan/irbesartan HCTZ lisinopril/lisinopril HCTZ losartan/losartan HCTZ moexipril/moexipril HCTZ quinapril/quinapril HCTZ ramipril telmisartan/telmisartan HCTZ trandolapril trandolapril-verapamil ext-rel valsartan/valsartan HCTZ benzoyl peroxide clindamycin solution clindamycin-benzoyl peroxide erythromycin solution erythromycin-benzoyl peroxide sodium sulfacetamide sulfacetamide-sulfur alfuzosin ext-rel doxazosin tamsulosin terazosin Prostate Avodart finasteride
Osteoporosis Pain and Inflammation High Triglyceride Cholesterol TRADITIONAL GENERIC STEP THERAPY Drug Class Drugs Requiring Step Therapy Covered Generic Alternatives Migraine, Selective Serotonin Agonists / Combinations Atelvia Binosto Fosamax Plus D Cambia Celebrex Nalfon Voltaren Gel Zipsor Zorvolex Fenoglide Triglide Crestor (excluding 40 mg) Simcor Vytorin Alsuma Axert Frova Relpax Sumavel Dosepro Treximet alendronate ibandronate risedronate 150mg diclofenac sodium/misoprostol diclofenac sodium diclofenac sodium solution ibuprofen meloxicam naproxen Additional generic NSAIDs available fenofibrate fenofibrate acid gemfibrozil amlodipine-atorvastatin atorvastatin fluvastatin lovastatin pravastatin simvastatin naratriptan rizatriptan sumatriptan zolmitriptan Nasal Steroids Nasonex budesonide flunisolide fluticasone triamcinolone Glaucoma Ulcer Depression Depression Insomnia Overactive Bladder Travatan Z Zioptan Dexilant Nexium Prilosec Packets Zegerid Powder for Oral Susp Fetzima Khedezla Pristiq Brintellix Pexeva Viibryd Edluar Silenor Zolpimist Enablex Gelnique Myrbetriq Vesicare latanoprost travoprost lansoprazole omeprazole omeprazole-sodium bicarbonate capsule pantoprazole rabeprazole duloxetine venlafaxine venlafaxine ext-rel citalopram escitalopram fluoxetine fluvoxamine/fluvoxamine ext-rel paroxetine/paroxetine ext-rel sertraline eszopiclone zaleplon zolpidem zolpidem ext-rel oxybutynin/oxybutynin ext-rel tolterodine/ tolterodine ext-rel trospium/trospium ext-rel *Please note: A Member s Plan determines whether the member must try one or two generics before a brand-name drug is allowed in select drug classes. The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers that are not affiliated with CVS/caremark. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber. Targeted therapeutic classes and specific drug targets are subject to change based on new generic drug launches, product approvals, drug withdrawals, and other market changes. Plan member privacy is important to us. Our employees are trained regarding the appropriate way to handle members private health information. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission.
PERSONALIZED PHARMACY CARE FOR YOUR COMPLEX CONDITION Health conditions such as arthritis, osteoporosis, hepatitis C and others require specialty drugs. The CVS Caremark Specialty Pharmacy provides you with your specialty drugs. You will receive personalized support from a team of clinical experts led by a pharmacist or nurse. You can reach a specialty pharmacist by phone 24 hours a day, 365 days a year. Our Specialty Guideline Management program ensures that your medication use is appropriate, safe and effective based on the most current clinical guidelines. Learn more about our personalized pharmacy care at www.cvscaremarkspecialtyrx.com. FORMULARY DRUG REMOVALS Below is a list of medicines by drug class that have been removed from your plan s formulary. If you continue using one of the drugs listed below and identified as a Formulary Drug Removal, you may be required to pay the full cost. If you are currently using one of the formulary drug removals, ask your doctor to choose one of the generic or brand formulary options listed below. CATEGORY* DRUG CLASS Allergic Reaction (Anaphylaxis) Treatment* Allergies* Nasal Steroids / Combinations Allergies* Ophthalmic Anti-infectives, Antivirals* Hepatitis C Agents Anti-infectives, Antivirals* Herpes Agents Asthma* Beta Agonists, Short-Acting Asthma* Steroid Inhalants Asthma* or Chronic Obstructive Pulmonary Disease (COPD)* Steroid / Beta Agonist Combinations Attention Deficit Hyperactivity Disorder Agents Cardiovascular Antilipemics* Fibrates FORMULARY DRUG REMOVALS ADRENACLICK BECONASE AQ OMNARIS QNASL RHINOCORT AQUA VERAMYST ZETONNA DYMISTA LASTACAFT VIEKIRA PAK VALTREX PROVENTIL HFA VENTOLIN HFA XOPENEX HFA AEROSPAN ALVESCO SYMBICORT ADDERALL XR TRICOR AUVI-Q, EPIPEN, EPIPEN JR flunisolide spray, fluticasone spray, triamcinolone spray, NASONEX flunisolide spray, fluticasone spray, triamcinolone spray, or NASONEX WITH azelastine spray or PATANASE azelastine, cromolyn sodium, PATADAY, PATANOL HARVONI acyclovir, valacyclovir PROAIR HFA ASMANEX, FLOVENT, PULMICORT FLEXHALER, QVAR ADVAIR, DULERA amphetamine-dextroamphetamine mixed salts ext-rel fenofibrate, fenofibric acid
FORMULARY DRUG REMOVALS CATEGORY* DRUG CLASS Cardiovascular Antilipemics* HMG Co-A Reductase Inhibitors (HMGs or Statins) / Combinations Chronic Obstructive Pulmonary Disease (COPD)* Anticholinergics Depression* Antidepressants Dermatology Skin Inflammation and Hives* Corticosteroids Biguanides Dipeptidyl Peptidase-4 (DPP-4) Inhibitors Dipeptidyl Peptidase-4 (DPP-4) Inhibitor Combinations Injectable Incretin Mimetics FORMULARY DRUG REMOVALS ADVICOR ALTOPREV LESCOL XL LIPITOR LIPTRUZET LIVALO TUDORZA OLEPTRO OLUX-E APEXICON E FORTAMET GLUMETZA RIOMET NESINA ONGLYZA KAZANO KOMBIGLYZE XR OSENI BYETTA atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin, CRESTOR, SIMCOR, VYTORIN SPIRIVA trazodone clobetasol propionate foam 0.05%, CLOBEX SPRAY, desoximetasone, fluocinonide metformin, metformin ext-rel JANUVIA, TRADJENTA JANUMET, JANUMET XR, JENTADUETO BYDUREON, VICTOZA Insulins Insulin Sensitizers APIDRA HUMALOG NOVOLOG HUMALOG MIX 50/50 NOVOLOG MIX 70/30 HUMALOG MIX 75/25 NOVOLOG MIX 70/30 HUMULIN 70/30 NOVOLIN 70/30 HUMULIN N HUMULIN R NOTE: Humulin R U-500 concentrate will not be subject to removal and will continue to be covered. ACTOS NOVOLIN N NOVOLIN R pioglitazone Sodium-Glucose Co-Transporter-2 (SGLT2) Inhibitors Supplies 1,2 Erectile Dysfunction* Phosphodiesterase Inhibitors FARXIGA ACCU-CHEK STRIPS AND KITS BREEZE 2 STRIPS AND KITS CONTOUR STRIPS AND KITS CONTOUR NEXT STRIPS AND KITS FREESTYLE STRIPS AND KITS 3 All other test strips that are not ONETOUCH brand LEVITRA INVOKANA ONETOUCH ULTRA STRIPS AND KITS 1, ONETOUCH VERIO STRIPS AND KITS 1 CIALIS, VIAGRA
FORMULARY DRUG REMOVALS CATEGORY* DRUG CLASS Gastrointestinal Agents* Proton Pump Inhibitors (PPIs) Glaucoma* Prostaglandin Analogs Growth Hormones* Hematologic* Platelet Aggregation Inhibitors High Blood Pressure* Angiotensin II Receptor Antagonists High Blood Pressure* Angiotensin II Receptor Antagonist / Diuretic Combinations High Blood Pressure* Calcium Channel Blockers FORMULARY DRUG REMOVALS PREVACID PROTONIX LUMIGAN GENOTROPIN NUTROPIN AQ OMNITROPE SAIZEN TEV-TROPIN PLAVIX ATACAND EDARBI TEVETEN ATACAND HCT DIOVAN HCT EDARBYCLOR TEVETEN HCT NORVASC lansoprazole, omeprazole, omeprazole-sodium bicarbonate capsule, pantoprazole, DEXILANT, NEXIUM latanoprost, travoprost, TRAVATAN Z, ZIOPTAN HUMATROPE, NORDITROPIN clopidogrel, BRILINTA, EFFIENT candesartan, eprosartan, irbesartan, losartan, telmisartan, valsartan, BENICAR candesartan-hydrochlorothiazide, irbesartanhydrochlorothiazide, losartan-hydrochlorothiazide, valsartan-hydrochlorothiazide, BENICAR HCT amlodipine Inflammatory Bowel Disease (IBD), Ulcerative Colitis* Aminosalicylates ASACOL HD DELZICOL balsalazide, sulfasalazine, sulfasalazine del-rel, APRISO, LIALDA, PENTASA, UCERIS Multiple Sclerosis Agents* REBIF 4 AVONEX, COPAXONE, EXTAVIA, GILENYA, TECFIDERA Musculoskeletal Agents* AMRIX cyclobenzaprine Opioid Dependence Agents* SUBOXONE FILM buprenorphine-naloxone sublingual tablet, ZUBSOLV Osteoarthritis* Viscosupplements Overactive Bladder / Incontinence* Urinary Antispasmodics Pain and Inflammation* Corticosteriods Pain and Inflammation* Nonsteroidal Anti-inflammatory Drugs (NSAIDs) / Combinations EUFLEXXA ORTHOVISC DETROL LA OXYTROL TOVIAZ RAYOS ARTHROTEC DUEXIS VIMOVO FLECTOR PENNSAID GEL-ONE, HYALGAN, SUPARTZ oxybutynin ext-rel, tolterodine, tolterodine ext-rel, trospium, trospium ext-rel, GELNIQUE, MYRBETRIQ, VESICARE dexamethasone, methylprednisolone, prednisone CELEBREX, diclofenac sodium, meloxicam, or naproxen WITH lansoprazole, omeprazole, omeprazole/ sodium bicarbonate capsule, pantoprazole, DEXILANT or NEXIUM diclofenac sodium, diclofenac sodium solution, meloxicam, naproxen, VOLTAREN GEL Prostate Condition* Benign Prostatic Hyperplasia Agents / Combinations Sleep* Hypnotics, Non-benzodiazepines NAPRELAN JALYN INTERMEZZO LUNESTA ROZEREM diclofenac sodium, meloxicam, naproxen, CELEBREX finasteride or AVODART WITH alfuzosin ext-rel, doxazosin, tamsulosin, terazosin or RAPAFLO eszopiclone, zolpidem, zolpidem ext-rel, SILENOR
FORMULARY DRUG REMOVALS CATEGORY* DRUG CLASS Testosterone Replacement* Androgens Transplant* Immunosuppressants, Calcineurin Inhibitors CATEGORY* DRUG CLASS New to Market Agents 3 The listed formulary options are subject to change. FORMULARY DRUG REMOVALS testosterone gel ANDROGEL NATESTO TESTIM VOGELXO Hecoria ANDRODERM, AXIRON, FORTESTA tacrolimus New to market products and new variations of products in the marketplace will not be added to the formulary until the product has been evaluated, determined to be clinically appropriate and costeffective, and approved by the CVS/caremark Pharmacy and Therapeutics Committee (or other appropriate reviewing body). ACCU-CHEK STRIPS AND KITS 2 ACTOS ADDERALL XR ADRENACLICK ADVICOR AEROSPAN ALTOPREV ALVESCO AMRIX ANDROGEL APEXICON E APRIDA ARTHROTEC ASACOL HD ATACAND ATACAND HCT BECONASE AQ BREEZE 2 STRIPS AND KITS 2 BYETTA CONTOUR NEXT STRIPS AND KITS 2 CONTOUR STRIPS AND KITS 2 DELZICOL DETROL LA DOIVAN HCT DUEXIS DYMISTA EDARBI EDARBYCLOR EUFLEXXA FARXIGA FLECTOR FORTAMET FREESTYLE STRIPS AND KITS 2,3 LIST OF FORMULARY DRUG REMOVALS GENOTROPIN GLUMETZA Hecoria HUMALOG HUMALOG MIX 50/50 HUMALOG MIX 75/25 HUMULIN 70/30 HUMULIN N HUMULIN R INTERMEZZO JALYN KAZANO KOMBIGLYZE XR LASTACAFT LESCOL XL LEVITRA LIPITOR LIPTRUZET LIVALO LUMIGAN LUNESTA NAPRELAN NATESTO NESINA NORVASC NUTROPIN AQ OLEPTRO OLUX-E OMNARIS OMNITROPE ONGLYZA OTHORVISC OSENI OXYTROL PENNSAID PLAVIX PREVACID PROTONIX PROVENTIL HFA QNASL RAYOS REBIF 4 RHINOCORT AQUA RIOMET ROZEREM SAIZEN SUBOXONE FILM SYMBICORT TESTIM testosterone gel TEVETEN TEVETEN HCT TEV-TROPIN TOVIAZ TRICOR TUDORZA VALTREX VENTOLIN HFA VERAMYST VIEKIRA PAK VIMOVO VOGELXO XOPENEX HFA ZETONNA This list represents brand products in CAPS, branded generics in upper- and lowercase, and generic products in lowercase italics. This is not an all-inclusive list of available drug options. Log in to www.caremark.com to check coverage and copay information for a specific drug. Discuss this information with your doctor or health care provider. This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about this information and any health-related questions you have. CVS/caremark assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result of this information. This list is subject to change. There may be additional plan restrictions. Please consult your plan for further information. Subject to applicable state law restrictions. * This list indicates the common uses for which the drug is prescribed. Some drugs are prescribed for more than one condition. 1 A OneTouch blood glucose meter will be provided at no charge by the manufacturer to those individuals currently using a meter other than OneTouch. For more information on how to obtain a blood glucose meter, call toll-free: 1-800-588-4456. Members must have CVS Caremark Mail Service Pharmacy benefits to qualify. 2 OneTouch brand test strips are the only preferred options. 3 An exception process is in place for specific clinical circumstances that may require continued coverage for Freestyle diabetic test strips. If your doctor believes you have a specific clinical need for this product, he or she should fax an exception request toll-free to: 1-888-487-9257. Your plan may choose to provide an exception process for additional medications on this list and new to market agents. 4 Members on existing Rebif therapy will not be subject to exclusions while remaining adherent on these therapies.
GETTING THE BEST PRICE FOR YOUR MEDICINES Here are several ways to do so:» Choose a network pharmacy for short-term prescriptions There are more than 68,000 network pharmacies nationwide, including independent pharmacies, chain pharmacies and more than 7,700 CVS/pharmacy locations. Find a network pharmacy closest to you at www.caremark.com» Ask your doctor to prescribe a generic Generics can save you up to 80% off the price of a brand-name drug. Generics are safe and effective, and have been approved by the U.S. Food and Drug Administration (FDA).» Order long-term medications through Maintenance Choice This program lets you choose to receive 90-day supplies of your long-term** medications through CVS Caremark Mail Service Pharmacy OR by picking them up at a CVS/pharmacy near you. Either way, your copay will be the same. Many people find mail service the most convenient way to get their prescriptions. You can choose to have your medicines delivered to your home, office or other location. It s easy to sign up for mail service simply call the FastStart toll-free number at 1-800-875-0867. Learn more about Maintenance Choice by signing on to www.caremark.com and clicking on My Prescription Plan. CAREMARK.COM: YOUR COMPLETE RESOURCE FOR PRESCRIPTION AND HEALTH CARE Sign on to Caremark.com anytime to manage all aspects of your prescription and health care including:» Find Savings and Opportunities Compare drug prices and find other ways to save on your prescriptions.» Order Prescriptions Conveniently set up and manage your prescriptions from anywhere.» Learn About Medicines Our database of drugs and interactions, generic alternatives, and health conditions helps you stay informed about your medicines.» Ask-A-Pharmacist Get confidential and reliable answers to all of your prescription and over-the-counter drug questions. It s takes just a few minutes to set up your account at Caremark.com. Look for the Not Registered Yet? link on the homepage. Have your prescription ID card on hand, and then follow the online instructions.
EXTRA SAVINGS ON HEALTH ITEMS Your ExtraCare Health Card helps you save money on the health-related items you use most. Use your card to enjoy 20 percent savings on CVS/pharmacy Brand, heath-related items that are flexible spending account (FSA)-eligible including:» pain relievers» allergy relief products» first-aid supplies» cold & cough medicines» and more ExtraCare Health Questions? Customer Care is here. You re always welcome to contact CVS/caremark Customer Care toll-free at 1-855-465-0024 for any questions on your prescription benefits. www.caremark.com *Actual quantity may vary depending on your plan. **A long-term medication is taken regularly for chronic conditions or long-term therapy. A few examples include medications for managing high blood pressure, asthma, diabetes or high cholesterol. ***Copay, copayment or coinsurance means the amount a plan member is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, or a fixed amount or other charge, with the balance, if any, paid by the Plan. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS/caremark. The 20 percent discount is restricted to items purchased for the health care of the cardholder, spouse or dependents. Excludes alcohol, gift cards, lottery, money orders, prescriptions, postage stamps, pre-paid cards and tobacco products. The FSA summary of your receipt includes the items (and tax) that may be eligible for reimbursement from your FSA/HRA/HSA plan. Plan restrictions may apply. Check with your plan administrator for more details. As mandated by law, excludes pharmacy items paid for in whole or in part by state and/or federal health care programs. This includes programs such as Medicare and Medicaid. Not valid on prescriptions purchased in NJ or NY. In Louisiana, not valid on any prescription for a controlled or dangerous substance. Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information. This document contains confidential and proprietary information of CVS/caremark and cannot be reproduced, distributed or printed without written permission from CVS/caremark. CVS/caremark may receive rebates, discounts and service fees from pharmaceutical manufacturers for certain listed products. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS/caremark. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the doctor. 2015 CVS/caremark. All rights reserved. 012315