Effective 10/01/2009
The Pharmacy and Therapeutics Committee approved the following changes to the Preferred Drug List.
| Recently Added Drugs | |||
| Asmanex | |||
| Avelox | |||
| Banzel (subject to step-therapy requirements) | |||
| Cefprozil | |||
| Celebrex (subject to prior authorization) | |||
| Cetrizine D | |||
| Econazole Cream | |||
| Fluvoxamine | |||
| Ketorolac Tablets (quantity limits apply) | |||
| Lyrica (subject to prior authorization) | |||
| Meloxicam | |||
| Mepron | |||
| Oxaprozin | |||
| Paramomycin | |||
| Paroxetine | |||
| Pristiq (subject to step-therapy requirements) | |||
| Ritalin LA (subject to step-therapy requirements) | |||
| Saizen (subject to prior authorization) | |||
| Strattera (subject to step-therapy requirements) | |||
| Suprax 400mg Tablet (quantity limits apply) | |||
| Symbicort (subject to step-therapy requirements) | |||
| Tev-Tropin (subject to prior authorization) | |||
| Utira-C | |||
| Ventolin HFA | |||
| Vesicare (subject to step-therapy requirements) | |||
| Zyvox (subject to prior authorization) | |||
| No Longer Requre Prior Authorization | |
| Bupropion SR | |
| Fluconazole | |
| Lamotrigine | |
| Topiramate | |
| Zonisamide | |
| Removed from Preferred Drug List | |
| Albuterol Respules 1.25mg and 0.63mg (current users were grandfathered) | |
| Alupent | |
| Axid Solution (current users were grandfathered) | |
| Azmacort (current users were grandfathered) | |
| Buproban (generic Zyban - current users were grandfathered) | |
| Ceclor-CD (no longer manufactured) | |
| Condylox Gel | |
| Diflunisal | |
| Etodolac XL | |
| Flurbiprofen | |
| Furadantin Suspension (current users were grandfathered) | |
The following Growth Hormone Products:
|
|
| Indomethacin Suspension | |
| Indomethacin SR | |
| Ketoprofen ER | |
| Mephobarbital (current users were grandfathered) | |
| Methenamine Mandelate (no longer manufactured) | |
| Naproxen EC, Naproxen SA | |
| Nardil (current users were grandfathered) | |
| Oxytrol | |
| ProAir HFA | |
| Proventil HFA | |
| Tolmetin | |
| Modifications to the Preferred Drug List | |
| Stimulant Age Edit - prior authorization is required for adults 21 years of age and older for the CNS Stimulants (e.g. Adderall XR, Amphetamine Salt Combination [Adderall], Concerta, Dextroamphetamine, Methylphenidate, Methylphenidate SR) | |
Quantity Limits - quantity limits will apply to the following:
|
|
Effective 09/01/2009
The Pharmacy and Therapeutics Committee approved the following changes to the Preferred Drug List.
| No Longer Require Prior Authorization | |||
| Adderall XR - subject to a quantity limit of 1 capsule per day | |||
Please Note:
|
|||
Effective 08/01/2009
The Pharmacy and Therapeutics Committee approved the following changes to the Preferred Drug List.
| Recently Added Drugs | |||
| Metoprolol Succinate (generic Toprol XL) | |||
| Bisoprolol (generic Zebeta) | |||
| Quinapril (generic Accupril) | |||
| Quinapril HCT (generic Accuretic) | |||
| Simcor (Niacin/Simvastatin) | |||
| Micardis (subject to prior notification) | |||
| Micardis HCT (subject to prior notification) | |||
| Opana ER (subject to prior notification) | |||
| Crestor (subject to prior notification) | |||
| Prevacid (subject to prior notification) | |||
| No Longer Requre Prior Authorization | |
| Omeprazole 10 mg caps, 20 mg caps/tabs (generic Prilosec, Prilosec OTC) | |
| Require Prior Authorization | |||
| Frova | |||
| Maxalt, Maxalt MLT | |||
| Removed from Preferred Drug List | |
| Pentazocine HCl/Acetaminophen (generic Talacen) | |
| Relpax | |
| Zomig, Zomig ZMT | |
| Altoprev | |
| Sotalol HCl (Betapace AF) | |
| Cardene SR | |
| Benicar, Benicar HCT | |
| Antara | |
| Triglide | |
| Aciphex | |
| All strengths of Oxycodone HCl/Acetaminophen Caps and Tabs other than: 5/500 mg and 5/325 mg tablets and Tylox capsules | |
Effective 04/01/2009
The Pharmacy and Therapeutics Committee approved the following changes to the Preferred Drug List.
| Recently Added Drugs | |||
| Cymbalta (subject to prior authorization) | |||
| Humira (subject to prior authorization) | |||
| Hycamptin (subject to prior authorization) | |||
| Xenazine (subject to prior authorization) | |||
| No Longer Require Prior Authorization | |
| Terbinafine (generic Lamisil); subject to quantity limit of 90 per 180 days | |
| Recently Removed Drugs | |
| Actonel; current users grandfathered | |
| Fosamax plus D; current users grandfathered | |
| Humulin products | |
| Humalog products | |
All Novolin and Novolog products will remain on the Preferred Drug List
Current users of Humulin and Humalog products were directed to use the equivalent Novolin or Novolog product. For the Humulin/Humalog products where there was no equivalent Novolin/Novolog product (i.e. Humulin 50/50, Humalog mix 50/50), those users were grandfathered.
Preferred Drug List
This Preferred Drug List (PDL) is a compilation of drugs in various therapeutic classes for use in meeting the prescription therapy needs of enrollees in Medicaid and related UnitedHealthcare and AmeriChoice government-funded health care products. These include State Child Health Insurance Programs (SCHIP) and various programs for uninsured adults administered by AmeriChoice and UnitedHealthcare. Some of the medications included in the PDL are not covered for some enrollees. The list applies to prescriptions dispensed at network pharmacies. It does not include inpatient medications or drugs obtained from or administered in a physician’s office.