Formulary changes announced

Formulary changes announced

Changes to the Independent Health Drug formularies resulting from the June 2015 Independent Health Pharmacy and Therapeutics Committee are summarized below and are currently in effect unless otherwise noted.

The following Medications were added to Drug Formularies I, II, and III:
Aptensio XR – T3, AL
Asmanex HFA – T1 (Drug Formulary I), T2 (Drug Formulary II, III)
Cholbam – T3, PA
Corlanor – T3, PA
Elepsia XR – T3, ST
Jadenu – T3 PA
Natesto – T3, PA
Nuvessa – T3
Stiolto – T2, AL
Toujeo – T2
Viberzi – T3, PA

The following Medications were added to the Medicaid Drug Formulary:
Asmanex HFA – T2
Stiolto – T2, AL
Toujeo – T2

The following changes will be made to the Drug Formularies:
Akyneo – Add ST
Anaprox – NF
Angeliq – NF (Medicaid Only)
Arixtra – PA applies to non-oncology prescribers
Brisdelle – NF (Medicaid Only)
Entocort – Add PA except Gastroenterology or Colorectal Surgeons (Drug Formulary II, III)
fluoxetine tablets – NF
Generess Chew – NF
Gilenya – NF (Medicaid Only)
Kombiglyze – NF (Medicaid Only)
Lansoprazole – Remove ST Requirement
Lotronex – Add PA (Drug Formularies I, II, and III), NF for Medicaid
Osphena – NF (Medicaid Only)
PEG 3350 Packets – NF
Rabeprazole – Remove ST Requirement
Tecfidera – NF (Medicaid Only)
Uloric – NF (Medicaid Only)
zafirlukast – NF (Medicaid Only)

The following new generic medications are available:
aripiprazole (Abilify)
darifenacin (Enablex)
fluorouracil cream (Carac Cream)
glatiramer acetate injection (Copaxone Inj)
triamcinolone acetonide (Kenalog Spray)
vardenafil hcl (Staxyn ODT)

The following medications were reviewed and will remain non-formulary for all Independent Health Drug Formularies:
Cresemba
Dutrebis
Fentanyl patch 37.5/62.5/87.5 mcg
Flowtuss
Hycofenix
Obredon
Pazeo
Tuzistra
Zarxio

The following medications were reviewed and will remain non-formulary for Independent Health Medicaid Drug Formulary:
Aptensio XR
Cholbam
Corlanor
Elepsia XR
Jadenu
Natesto
Nuvessa
Viberzi

The following medications were reviewed and will be covered as a medical benefit:
Avycaz
Invega Trinza
Signifor LAR
Unituxin


Changes to the Independent Health Drug formularies resulting from the March 2015 Independent Health Pharmacy and Therapeutics Committee are summarized below and are currently in effect unless otherwise noted.

The following Medications were added to Drug Formularies I, II, and III:
Cosentyx – T3, PA, SP
Duopa – T3, PA (limited to Neurology)
Evotaz – T3
Farydak – T3, PA, SP
Glyxambi – T3, ST
Ibrance – T3, PA, SP
Kitabis Pak – T3, PA, QL, SP
Lenvima – T3, PA, SP
Lynparza – T3, PA, SP
Namzaric – T3, PA
Natpara – T3, PA, SP
Prezcobix – T3
Savaysa – T3, PA
Soolantra – T3, PA except Dermatology
Synribo – T3, PA (self-injection only)
Viekira Pak – T3, PA, SP

The following changes will be made to the drug formularies effective July 1, 2015:
Cambia – Remove PA
Celebrex – Remove step therapy
Cephalexin Tabs – NF
Flonase (fluticasone) – NF
ipratropium bromide/albuterol sulfate (generic Duoneb) – Move to T1
modafanil (generic Provigil) – Move to T1
Muti-Source Brand Diabetic Medications – NF
Oracea – NF
Prostaglandin Analogs – Age restriction does not apply to ophthalmology
Relpax – NF
Vyvanse – PA new starts only
Zegerid (omeprazole/sodium bicarbonate) – NF

The following new generic medications are available:
desvenlafaxine (Pristiq)
esomeprazole (Nexium)
miglitol (Glyset)
ritonavir (Norvir)

The following medications were reviewed and will remain non-formulary for all Independent Health Drug formularies:
Prestalia
Rytary
Xtoro

The following medications were reviewed and approved as a Medical Benefit:
Blincyto – PA
Dyloject – PA
Lemtrada – PA
Opdivo – PA
Rapivab – PA
Zerbaxa – PA except Infectious Disease



Key:
PA = Prior Authorization Required
NF = Non formulary
ST = Step Therapy
SP = Specialty Pharmacy Restriction
QL = Quantity Limit
T1 = First Tier
T2 = Second Tier
T3 = Third Tier