HHSC Preferred Drug List (PDL) Recommendations April 27, of 19

Size: px
Start display at page:

Download "HHSC Preferred Drug List (PDL) Recommendations April 27, of 19"

Transcription

1 ANTI-ALLERGENS, ORAL GRASTEK (SUBLINGUAL) NPD NPD ORALAIR (SUBLINGUAL) NPD NPD For this, the Board believed that none of the drugs meet the fiscal requirements of the state RAGWITEK (SUBLINGUAL) NPD NPD ANTIBIOTICS, INHALED BETHKIS (INHALATION) PDL PDL X For this, the Board believed CAYSTON (INHALATION) PDL PDL that all of the drugs being recommended as KITABIS PAK (INHALATION) PDL PDL X preferred meet the fiscal requirements of the state TOBI (INHALATION) NPD NPD TOBI PODHALER (INHALATION) PDL PDL X TOBRAMYCIN PAK (AG) (INHALATION) NPD NPD TOBRAMYCIN SOLUTION (AG) (INHALATION) NPD NPD TOBRAMYCIN SOLUTION (INHALATION) NPD NPD ANTICOAGULANTS ARIXTRA (SUBCUTANE.) NPD NPD For this, the Board believed COUMADIN (ORAL) NPD NPD that all of the drugs being recommended as ELIQUIS (ORAL) PDL PDL X preferred meet the fiscal requirements of the state ENOXAPARIN SODIUM VIAL (AG) (SUBCUTANEOUS) PDL PDL ENOXAPARIN SODIUM VIAL (SUBCUTANEOUS) PDL PDL ENOXAPARIN SYRINGE (AG) (SUBCUTANE.) PDL PDL ENOXAPARIN SYRINGE (SUBCUTANE.) PDL PDL FONDAPARINUX (SUBCUTANE.) NPD NPD FRAGMIN DISP SYRIN (SUBCUTANE.) PDL PDL FRAGMIN VIAL (SUBCUTANE.) NPD NPD LOVENOX SYRINGE (SUBCUTANE.) NPD NPD X LOVENOX VIAL (SUBCUTANE.) NPD NPD X PRADAXA (ORAL) PDL PDL X SAVAYSA (ORAL) NPD NPD WARFARIN (ORAL) PDL PDL XARELTO (ORAL) PDL PDL X XARELTO DOSE PACK (ORAL) PDL PDL X 1 of 19

2 ANTIDEPRESSANTS, OTHER APLENZIN (ORAL) NPD NPD For this therapeutic drug class, the Board believed BUPROPION (ORAL) PDL PDL that all of the drugs being recommended as BUPROPION SR (ORAL) PDL PDL preferred demonstrated the greatest safety, BUPROPION XL (ORAL) PDL PDL efficacy, and value and provided clinicians with the DESVENLAFAXINE ER (KHEDEZLA) (AG) (ORAL) NPD NPD greatest number of first line options to use before DESVENLAFAXINE ER (NO BRAND) (ORAL) NPD NPD requiring Prior Authorization. DESVENLAFAXINE ER (PRISTIQ) (AG) (ORAL) NPD NPD DESVENLAFAXINE ER (PRISTIQ) (ORAL) NPD NPD DESVENLAFAXINE FUMARATE ER (ORAL) NPD NPD EFFEXOR XR (ORAL) NPD NPD EMSAM (TRANSDERMAL) NPD NPD FETZIMA (ORAL) NPD NPD FORFIVO XL (ORAL) NPD NPD KHEDEZLA (ORAL) NPD NPD MARPLAN (ORAL) PDL PDL MIRTAZAPINE ODT (ORAL) PDL PDL MIRTAZAPINE TABLET (ORAL) PDL PDL NARDIL (ORAL) NPD NPD NEFAZODONE (ORAL) NPD NPD PARNATE (ORAL) NPD NPD PHENELZINE (ORAL) PDL PDL PRISTIQ (ORAL) NPD NPD REMERON ODT (ORAL) NPD NPD REMERON TABLET (ORAL) NPD NPD TRANYLCYPROMINE SULFATE (ORAL) NPD NPD TRAZODONE (ORAL) PDL PDL TRINTELLIX (ORAL) NPD NPD VENLAFAXINE (ORAL) NPD NPD VENLAFAXINE ER CAPSULES (ORAL) PDL PDL VENLAFAXINE ER TABLETS (AG) (ORAL) NPD NPD VENLAFAXINE ER TABLETS (ORAL) NPD NPD VIIBRYD (ORAL) NPD NPD VIIBRYD DOSE PACK (ORAL) NPD NPD WELLBUTRIN SR (ORAL) NPD NPD WELLBUTRIN XL (ORAL) NPD NPD 2 of 19

3 ANTIDEPRESSANTS, SSRIs BRISDELLE (ORAL) NPD NPD For this therapeutic drug class, the Board believed CELEXA TABLET (ORAL) NPD NPD that all of the drugs being recommended as CITALOPRAM SOLUTION (ORAL) PDL PDL preferred demonstrated the greatest safety, CITALOPRAM TABLET (ORAL) PDL PDL efficacy, and value and provided clinicians with the ESCITALOPRAM SOLUTION (ORAL) NPD NPD greatest number of first line options to use before ESCITALOPRAM TABLET (ORAL) PDL PDL requiring Prior Authorization. FLUOXETINE 60 MG (ORAL) PDL PDL FLUOXETINE CAPSULE (ORAL) PDL PDL FLUOXETINE CAPSULE DR (ORAL) NPD NPD FLUOXETINE SOLUTION (ORAL) PDL PDL FLUOXETINE TABLET (ORAL) PDL PDL FLUVOXAMINE (ORAL) PDL PDL FLUVOXAMINE ER (ORAL) NPD NPD LEXAPRO SOLUTION (ORAL) NPD NPD LEXAPRO TABLET (ORAL) NPD NPD PAROXETINE (BRISDELLE) (AG) (ORAL) NPD NPD PAROXETINE (BRISDELLE) (ORAL) NPD NPD PAROXETINE CR (ORAL) NPD NPD PAROXETINE TABLET (ORAL) PDL PDL PAXIL (ORAL) NPD NPD PAXIL CR (ORAL) NPD NPD PAXIL SUSPENSION (ORAL) NPD NPD PEXEVA (ORAL) NPD NPD PROZAC CAPSULE (ORAL) NPD NPD SARAFEM (ORAL) NPD NPD SERTRALINE CONC (ORAL) PDL PDL SERTRALINE TABLET (ORAL) PDL PDL ZOLOFT CONC (ORAL) NPD NPD ZOLOFT TABLET (ORAL) NPD NPD ANTIDEPRESSANTS, TRICYCLIC AMITRIPTYLINE (ORAL) PDL PDL For this, the Board believed AMOXAPINE (ORAL) NPD NPD that all of the drugs being recommended as ANAFRANIL (ORAL) NPD NPD preferred meet the fiscal requirements of the state CLOMIPRAMINE (ORAL) NPD NPD DESIPRAMINE (ORAL) NPD NPD DOXEPIN CAPSULE (ORAL) PDL PDL DOXEPIN CONC (ORAL) PDL PDL IMIPRAMINE (ORAL) PDL PDL IMIPRAMINE PAMOATE (ORAL) NPD NPD MAPROTILINE (ORAL) PDL NPD Financial 3 of 19

4 ANTIDEPRESSANTS, TRICYCLIC CONTINUED NORPRAMIN (ORAL) NPD NPD NORTRIPTYLINE CAPSULE (ORAL) PDL PDL NORTRIPTYLINE SOLUTION (ORAL) NPD NPD PAMELOR CAPSULE (ORAL) NPD NPD PROTRIPTYLINE (ORAL) NPD NPD SURMONTIL (ORAL) NPD NPD TRIMIPRAMINE (ORAL) NPD NPD ANTIHYPERURICEMICS ALLOPURINOL (ORAL) PDL PDL For this, the Board believed COLCHICINE CAPSULE (AG) (ORAL) NPD NPD that all of the drugs being recommended as COLCHICINE TABLET (AG) (ORAL) NPD NPD preferred meet the fiscal requirements of the state COLCRYS (ORAL) NPD NPD DUZALLO (ORAL) NR NPD Financial MITIGARE (ORAL) NPD NPD X PROBENECID (ORAL) PDL PDL PROBENECID / COLCHICINE (ORAL) PDL PDL ULORIC (ORAL) NPD NPD ZURAMPIC (ORAL) NPD NPD ZYLOPRIM (ORAL) NPD NPD ANTIPARKINSON'S AGENTS AMANTADINE CAPSULE (ORAL) PDL PDL NPD/PDL/No Changes: For this therapeutic drug AMANTADINE SYRUP (ORAL) PDL PDL class, the Board believed that all of the drugs being AMANTADINE TABLET (ORAL) PDL PDL recommended as preferred demonstrated the AZILECT (ORAL) NPD NPD greatest safety, efficacy, and value and provided BENZTROPINE (ORAL) PDL PDL clinicians with the greatest number of first line BROMOCRIPTINE (ORAL) PDL PDL options to use before requiring Prior Authorization. CARBIDOPA (ORAL) NPD CARBIDOPA / LEVODOPA (ORAL) PDL PDL NPD CARBIDOPA / LEVODOPA ER (ORAL) PDL PDL CARBIDOPA / LEVODOPA ODT (ORAL) NPD NPD CARBIDOPA/LEVODOPA/ENTACAPONE (ORAL) PDL PDL DUOPA (MISCELL) NPD NPD ENTACAPONE (ORAL) NPD NPD GOCOVRI (ORAL) NR NPD Financial LODOSYN (ORAL) NPD NPD MIRAPEX (ORAL) NPD NPD MIRAPEX ER (ORAL) NPD NPD NEUPRO (TRANSDERM) NPD NPD PRAMIPEXOLE (ORAL) PDL PDL PRAMIPEXOLE ER (ORAL) NPD NPD 4 of 19

5 ANTIPARKINSON'S AGENTS CONTINUED RASAGILINE (ORAL) NPD NPD REQUIP (ORAL) NPD NPD REQUIP XL (ORAL) NPD NPD ROPINIROLE (ORAL) PDL PDL ROPINIROLE ER (ORAL) NPD NPD RYTARY (ORAL) NPD NPD SELEGILINE CAPSULE (ORAL) NPD NPD SELEGILINE TABLET (ORAL) NPD NPD SINEMET (ORAL) NPD NPD SINEMET CR (ORAL) NPD NPD STALEVO (ORAL) NPD NPD TASMAR (ORAL) NPD NPD TOLCAPONE (ORAL) NPD NPD TRIHEXYPHENIDYL ELIXIR (ORAL) PDL PDL TRIHEXYPHENIDYL TABLET (ORAL) PDL PDL XADAGO (ORAL) NPD NPD ZELAPAR (ORAL) NPD NPD ANXIOLYTICS ALPRAZOLAM ER (ORAL) NPD NPD For this, the Board believed ALPRAZOLAM INTENSOL (ORAL) NPD NPD that all of the drugs being recommended as ALPRAZOLAM ODT (ORAL) NPD NPD preferred meet the fiscal requirements of the state ALPRAZOLAM TABLET (ORAL) PDL PDL ATIVAN TABLET (ORAL) NPD NPD BUSPIRONE (ORAL) PDL PDL CHLORDIAZEPOXIDE (ORAL) PDL PDL CLORAZEPATE (ORAL) PDL PDL DIAZEPAM INTENSOL (ORAL) NPD NPD DIAZEPAM SOLUTION (ORAL) PDL PDL DIAZEPAM TABLET (ORAL) PDL PDL LORAZEPAM INTENSOL (ORAL) PDL PDL LORAZEPAM TABLET (ORAL) PDL PDL MEPROBAMATE (ORAL) NPD NPD OXAZEPAM (ORAL) NPD NPD TRANXENE T-TAB (ORAL) NPD NPD VALIUM TABLET (ORAL) NPD NPD XANAX TABLET (ORAL) NPD NPD XANAX XR (ORAL) NPD NPD 5 of 19

6 BETA-BLOCKERS ACEBUTOLOL (ORAL) PDL PDL For this therapeutic drug class, the Board believed ATENOLOL (ORAL) PDL PDL that all of the drugs being recommended as ATENOLOL / CHLORTHALIDONE (ORAL) PDL PDL preferred demonstrated the greatest safety, BETAPACE / AF (ORAL) NPD NPD efficacy, and value and provided clinicians with the BETAXOLOL (ORAL) NPD NPD greatest number of first line options to use before BISOPROLOL (ORAL) PDL PDL requiring Prior Authorization. BISOPROLOL HCTZ (ORAL) PDL PDL BYSTOLIC (ORAL) NPD NPD CARVEDILOL (ORAL) PDL PDL CARVEDILOL ER (ORAL) NPD NPD COREG (ORAL) NPD NPD COREG CR (ORAL) NPD NPD CORGARD (ORAL) NPD NPD DUTOPROL (ORAL) NPD NPD HEMANGEOL (ORAL) NPD NPD X INDERAL LA (ORAL) NPD NPD INDERAL XL (ORAL) NPD NPD INNOPRAN XL (ORAL) NPD NPD LABETALOL (ORAL) PDL PDL LEVATOL (ORAL) NPD NPD LOPRESSOR (ORAL) NPD NPD METOPROLOL (ORAL) PDL PDL METOPROLOL / HCTZ (ORAL) NPD NPD METOPROLOL XL (ORAL) PDL PDL NADOLOL (ORAL) NPD NPD NADOLOL / BENDROFLUMETHIAZIDE (ORAL) NPD NPD PINDOLOL (ORAL) NPD NPD PROPRANOLOL / HCTZ (ORAL) NPD NPD PROPRANOLOL ER (ORAL) NPD NPD PROPRANOLOL SOLUTION (ORAL) PDL PDL PROPRANOLOL TABLET (ORAL) PDL PDL SOTALOL (ORAL) PDL PDL SOTYLIZE (ORAL) NPD NPD TENORETIC (ORAL) NPD NPD TENORMIN (ORAL) NPD NPD TIMOLOL (ORAL) NPD NPD TOPROL XL (ORAL) NPD NPD ZIAC (ORAL) NPD NPD 6 of 19

7 BILE SALTS ACTIGALL (ORAL) NPD NPD CHENODAL (ORAL) NPD NPD CHOLBAM (ORAL) NPD NPD For this, the Board believed OCALIVA (ORAL) NPD NPD that all of the drugs being recommended as URSO/URSO FORTE TABLET (ORAL) NPD NPD preferred meet the fiscal requirements of the state URSODIOL 300 MG CAPSULE (ORAL) NPD NPD URSODIOL TABLET (ORAL) PDL PDL BPH TREATMENTS ALFUZOSIN (ORAL) PDL PDL For this, the Board believed AVODART (ORAL) NPD NPD that all of the drugs being recommended as CARDURA (ORAL) NPD NPD preferred meet the fiscal requirements of the state CARDURA XL (ORAL) NPD NPD DOXAZOSIN (ORAL) PDL PDL DUTASTERIDE (ORAL) NPD NPD DUTASTERIDE/TAMSULOSIN (ORAL) NPD NPD FINASTERIDE (ORAL) PDL PDL FLOMAX (ORAL) NPD NPD JALYN (ORAL) NPD NPD PROSCAR (ORAL) NPD NPD RAPAFLO (ORAL) NPD NPD TAMSULOSIN (ORAL) PDL PDL TERAZOSIN (ORAL) PDL PDL UROXATRAL (ORAL) NPD NPD BRONCHODILATORS, BETA AGONIST ALBUTEROL ER (ORAL) NPD NPD For this, the Board believed ALBUTEROL NEB SOLN 0.63, 1.25 MG (INHALATION) PDL PDL that all of the drugs being recommended as ALBUTEROL NEB SOLN 100 MG/20 ML (INHALATION) PDL PDL preferred meet the fiscal requirements of the state ALBUTEROL NEB SOLN 2.5 MG/0.5 ML (INHALATION) PDL PDL ALBUTEROL NEB SOLN 2.5 MG/3 ML (INHALATION) PDL PDL ALBUTEROL SYRUP (ORAL) PDL PDL ALBUTEROL TABLET (ORAL) NPD NPD ARCAPTA NEOHALER (INHALATION) NPD NPD X BROVANA (INHALATION) NPD NPD LEVALBUTEROL HFA (AG) (INHALATION) NPD NPD LEVALBUTEROL NEB SOLN (INHALATION) NPD NPD LEVALBUTEROL NEB SOLN CONC (INHALATION) NPD NPD METAPROTERENOL SYRUP (ORAL) NPD NPD METAPROTERENOL TABLET (ORAL) NPD NPD PERFOROMIST (INHALATION) NPD NPD PROAIR HFA (INHALATION) PDL PDL 7 of 19

8 BRONCHODILATORS, BETA AGONIST CONTINUED PROAIR RESPICLICK (INHALATION) NPD NPD PROVENTIL HFA (INHALATION) PDL NPD Safety SEREVENT (INHALATION) NPD NPD STRIVERDI RESPIMAT (INHALATION) NPD NPD X TERBUTALINE (ORAL) NPD NPD VENTOLIN HFA (INHALATION) NPD NPD XOPENEX HFA (INHALATION) NPD NPD XOPENEX NEB SOLN (INHALATION) NPD NPD COPD AGENTS ANORO ELLIPTA (INHALATION) NPD NPD X For this, the Board believed ATROVENT HFA (INHALATION) PDL PDL that all of the drugs being recommended as BEVESPI AEROSPHERE (INHALATION) NPD PDL X Clinical and financial preferred meet the fiscal requirements of the state COMBIVENT RESPIMAT (INHALATION) PDL PDL X DALIRESP (ORAL) NPD NPD INCRUSE ELLIPTA (INHALATION) NPD NPD X IPRATROPIUM / ALBUTEROL (INHALATION) PDL PDL IPRATROPIUM NEBULIZER (INHALATION) PDL PDL SEEBRI NEOHALER (INHALATION) PDL NPD X Financial SPIRIVA (INHALATION) PDL PDL SPIRIVA RESPIMAT (INHALATION) NPD NPD X STIOLTO RESPIMAT (INHALATION) PDL PDL X TUDORZA PRESSAIR (INHALATION) NPD NPD UTIBRON NEOHALER (INHALATION) PDL NPD X Financial COUGH AND COLD, COLD AFRIN SPRAY OTC (NASAL) NPD NPD For this therapeutic drug class, the Board believed ALA-HIST IR TABLET OTC (ORAL) NPD PDL X Financial that all of the drugs being recommended as ALA-HIST PE TABLET OTC (ORAL) PDL PDL X preferred demonstrated the greatest safety, BROTAPP LIQUID OTC (ORAL) NPD NPD efficacy, and value and provided clinicians with the CHILD DELSYM COUGH+COLD LIQUID OTC (ORAL) NPD NPD greatest number of first line options to use before CHILDREN'S MUCINEX LIQUID OTC (C) (ORAL) PDL PDL X requiring Prior Authorization. DALLERGY DROPS OTC (ORAL) NPD NPD DALLERGY LIQUID OTC (ORAL) NPD NPD DECONEX IR TABLET OTC (ORAL) PDL PDL X DELSYM COUGH & COLD LIQUID OTC (C) (ORAL) PDL PDL X DIMETAPP SOLUTION OTC (ORAL) NPD NPD DIPHENHYDRAMINE/PHENYLEPHRINE/APAP LIQUID OTC (ORAL) NPD NPD ED A-HIST LIQUID OTC (ORAL) PDL PDL ED A-HIST PSE TABLET OTC (ORAL) NPD NPD 8 of 19

9 COUGH AND COLD, COLD CONTINUED ED A-HIST TABLET OTC (ORAL) PDL PDL ED BRON GP LIQUID OTC (ORAL) PDL PDL ED CHLORPED D DROPS OTC (ORAL) PDL NPD Financial GUAIFENESIN 200 MG TABLET OTC (ORAL) PDL PDL GUAIFENESIN 400 MG TABLET OTC (ORAL) PDL PDL GUAIFENESIN LIQUID OTC (ORAL) PDL PDL GUAIFENESIN TABLET ER OTC (ORAL) PDL PDL GUAIFENESIN/PHENYLEPHRINE LIQUID OTC (ORAL) NPD NPD GUAIFENESIN/PHENYLEPHRINE TABLET OTC (ORAL) NPD NPD GUAIFENESIN/PHENYLEPHRINE/APAP TABLET OTC (ORAL) NPD NPD GUAIFENESIN/PSE TABLET ER OTC (ORAL) PDL PDL HISTEX-PE LIQUID OTC (ORAL) PDL PDL X IBUPROFEN/PSE TABLET OTC (ORAL) NPD NPD LODRANE D CAPSULE OTC (ORAL) PDL NPD Financial LOHIST-D LIQUID OTC (ORAL) PDL NPD Financial MUCINEX COLD & SINUS LIQUID OTC (ORAL) NPD NPD X MUCINEX D TABLET ER 12H OTC (ORAL) PDL PDL X MUCINEX ER TABLET OTC (ORAL) PDL PDL X MUCINEX FAST-MAX COLD-SINUS TABLET OTC (ORAL) PDL PDL MUCINEX FAST-MAX NITE COLD-FLU LIQUID OTC (ORAL) NPD NPD X MUCINEX GRAN PACK OTC (ORAL) PDL PDL X MUCINEX SINUS-MAX LIQUID OTC (ORAL) PDL PDL X MUCINEX SINUS-MAX TABLET OTC (ORAL) PDL PDL X NAPROXEN/PSE TABLET OTC (ORAL) NPD NPD NASOPEN PE LIQUID OTC (ORAL) PDL PDL X NEO-SYNEPHRINE SPRAY OTC (NASAL) NPD NPD NOHIST-LQ LIQUID OTC (ORAL) PDL PDL OXYMETAZOLINE 12 HR NASAL SPRAY OTC (NASAL) PDL PDL OXYMETAZOLINE MIST OTC (NASAL) NPD NPD PHENYLEPHRINE FOUR SPRAY OTC (NASAL) NPD NPD PHENYLEPHRINE NOSE DROPS OTC (NASAL) NPD NPD PHENYLEPHRINE/APAP TABLET OTC (ORAL) NPD NPD PHENYLEPHRINE/BROMPHENIRAMINE SOLUTION OTC (ORAL) PDL PDL PHENYLEPHRINE/BROMPHENIRAMINE TABLET OTC (ORAL) NPD NPD PHENYLEPHRINE/CHLORPHENIRAMINE TABLET OTC (ORAL) NPD NPD PHENYLEPHRINE/PROMETHAZINE SYRUP (ORAL) NPD NPD 9 of 19

10 COUGH AND COLD, COLD CONTINUED PHENYLEPHRINE/PYRILAMINE TABLET OTC (ORAL) NPD NPD POLY HIST FORTE TABLET OTC (ORAL) PDL PDL X POLY-VENT IR TABLET OTC (ORAL) PDL PDL X PROMETHAZINE VC SYRUP (QUALITEST) (ORAL) NPD NPD PSE/CHLORPHENIRAMINE TABLET OTC (ORAL) PDL PDL PSE/TRIPROLIDINE TABLET OTC (ORAL) PDL PDL RESCON-GG LIQUID OTC (ORAL) NPD NPD RESPAIRE-30 CAPSULE OTC (ORAL) NPD NPD RYMED TABLET OTC (ORAL) PDL NPD Financial RYNEX PE SOLUTION OTC (ORAL) PDL PDL RYNEX PSE LIQUID OTC (ORAL) PDL PDL STAHIST AD TABLET OTC (ORAL) NPD NPD VICKS VAPOINHALER OTC (NASAL) NPD NPD COUGH AND COLD, NARCOTIC FLOWTUSS SOLUTION (ORAL) NPD NPD For this, the Board believed GUAIFENESIN/CODEINE LIQUID OTC (ORAL) PDL PDL that all of the drugs being recommended as GUAIFENESIN/PSE/CODEINE SYRUP OTC (ORAL) NPD NPD preferred meet the fiscal requirements of the state HISTEX-AC SYRUP OTC (ORAL) NPD NPD X HYCOFENIX SOLUTION (ORAL) NPD NPD HYDROCODONE/CHLORPHENIRAMINE SUSPENSION ER 12H (ORAL) NPD NPD HYDROCODONE/HOMATROPINE SYRUP (ORAL) NPD NPD HYDROCODONE/HOMATROPINE TABLET (ORAL) NPD NPD M-CLEAR WC LIQUID (ORAL) NPD NPD X M-END PE LIQUID (ORAL) NPD NPD X NINJACOF-XG LIQUID OTC (ORAL) NPD NPD POLY-TUSSIN AC LIQUID OTC (ORAL) NPD NPD X PROMETHAZINE/CODEINE SYRUP (ORAL) PDL PDL PROMETHAZINE/PHENYLEPHRINE/CODEINE (QUALITEST) SYRUP (ORAL) NPD NPD PROMETHAZINE/PHENYLEPHRINE/CODEINE SYRUP (ORAL) NPD NPD PSE/HYDROCODONE/CHLORPHENIRAMINE SOLUTION (ORAL) NPD NPD ROBAFEN AC (ORAL) NPD NPD TUSSICAPS CAPSULE ER 12H (ORAL) NPD NPD TUSSIONEX SUSPENSION ER 12H (ORAL) NPD NPD TUZISTRA XR SUSPENSION (ORAL) NPD NPD 10 of 19

11 COUGH AND COLD, NON-NARCOTIC ALAHIST CF TABLET OTC (ORAL) NPD PDL X Financial For this therapeutic drug class, the Board believed ALA-HIST DM LIQUID OTC (ORAL) PDL PDL X that all of the drugs being recommended as ALKA-SELTZER PLUS DAY & NIGHT CAPSULE OTC (ORAL) NPD NPD preferred demonstrated the greatest safety, BENZONATATE CAPSULE (ORAL) PDL NPD Clinical efficacy, and value and provided clinicians with the BROMFED DM SYRUP (ORAL) NPD NPD greatest number of first line options to use before BROMPHENIRAMINE/PHENYLEPHRINE/DM LIQUID OTC requiring Prior Authorization. (ORAL) PDL PDL BROMPHENIRAMINE/PHENYLEPHRINE/DM SOLUTION OTC (ORAL) PDL PDL BROM-PSE-DM SYRUP (ORAL) PDL PDL BROTAPP DM ELIXIR OTC (ORAL) PDL PDL CHILD COLD-COUGH DAY-NIGHT SOLUTION SEQUELS OTC (ORAL) NPD NPD CHILD MUCINEX M-S COLD DAY-NTE LIQUID SEQUELES OTC (ORAL) PDL PDL X CHILDREN'S MUCINEX LIQUID OTC (NN) (ORAL) PDL PDL X CHLO HIST SOLUTION OTC (ORAL) PDL PDL X CHLO TUSS LIQUID OTC (ORAL) PDL PDL X CHLORASEPTIC TOTAL LOZENGE OTC (ORAL) NPD NPD CORICIDIN HBP SOFTGEL OTC (ORAL) NPD NPD DECONEX DMX TABLET OTC (ORAL) PDL PDL X DELSYM COUGH & COLD LIQUID OTC (NN) (ORAL) PDL PDL DELSYM SUSPENSION ER 12H OTC (ORAL) PDL PDL X DEXTROMETHORPHAN CAPSULE OTC (ORAL) NPD NPD DEXTROMETHORPHAN LIQUID OTC (ORAL) NPD NPD DEXTROMETHORPHAN SUSPENSION ER 12H OTC (ORAL) PDL PDL DEXTROMETHORPHAN SYRUP OTC (ORAL) NPD NPD DIMETAPP DM SOLUTION OTC (ORAL) NPD NPD DM/APAP/DOXYLAMINE CAPSULE OTC (ORAL) NPD NPD DM/APAP/DOXYLAMINE LIQUID OTC (ORAL) NPD NPD DM/CHLORPHENIRAMINE TABLET OTC (ORAL) NPD NPD DM/PHENYLEPHRINE/APAP CAPSULE OTC (ORAL) NPD NPD DM/PHENYLEPHRINE/APAP LIQUID OTC (ORAL) NPD NPD DM/PHENYLEPHRINE/APAP TABLET OTC (ORAL) NPD NPD DM/PHENYLEPHRINE/APAP/CHLORPHENIRAMINE TABLET OTC (ORAL) NPD NPD DM/PSE/CHLORPHENIRAMINE LIQUID OTC (ORAL) PDL PDL DURAFLU TABLET OTC (ORAL) PDL NPD X Financial ED A-HIST DM TABLET OTC (ORAL) PDL NPD Financial 11 of 19

12 COUGH AND COLD, NON-NARCOTIC CONTINUED ED-A-HIST DM LIQUID OTC (ORAL) PDL PDL GUAIFENESIN/DM CAPSULE OTC (ORAL) NPD NPD GUAIFENESIN/DM LIQUID OTC (ORAL) PDL PDL GUAIFENESIN/DM TABLET OTC (ORAL) NPD NPD GUAIFENESIN/DM/PHENYLEPHRINE LIQUID OTC (ORAL) NPD NPD GUAIFENESIN/DM/PHENYLEPHRINE SYRUP OTC (ORAL) NPD NPD HISTEX-DM SYRUP OTC (ORAL) PDL PDL X LOHIST-DM LIQUID (ORAL) PDL PDL LORTUSS DM LIQUID OTC (ORAL) PDL NPD Financial M-END DMX LIQUID OTC (ORAL) PDL PDL X MUCINEX COLD-FLU & SORE THROAT LIQUID OTC (ORAL) PDL PDL X MUCINEX COUGH GRAN PACK OTC (ORAL) PDL PDL X MUCINEX DM TABLET ER 12H OTC (ORAL) PDL PDL X MUCINEX DM TABLET ER 12H OTC (ORAL) PDL PDL X MUCINEX FAST-MAX COLD-FLU TABLET OTC (ORAL) PDL PDL MUCINEX FAST-MAX COLD-FLU-THROAT CAPSULE OTC (ORAL) NPD NPD X MUCINEX FAST-MAX COLD-SINUS CAPSULE OTC (ORAL) NPD NPD X MUCINEX FAST-MAX CONGEST-COLD TABLET OTC (ORAL) NPD NPD X MUCINEX FAST-MAX CONGEST-COUGH TABLET OTC (ORAL) PDL PDL X MUCINEX FAST-MAX DAY-NITE COLD LIQUID SEQ OTC (ORAL) NPD PDL X Financial MUCINEX FAST-MAX DAY-NITE COLD-FLU CAPSULE OTC (ORAL) PDL PDL X MUCINEX FAST-MAX DAY-NITE CONG LIQUID OTC (ORAL) PDL PDL X MUCINEX FAST-MAX DM MAX LIQUID OTC (ORAL) PDL PDL X MUCINEX FAST-MAX SEVERE COLD LIQUID OTC (ORAL) PDL PDL X MUCINEX SEVERE CONGEST-COUGH LIQUID OTC (ORAL) PDL NPD Financial NINJACOF LIQUID OTC (ORAL) NPD NPD NOHIST-DM LIQUID OTC (ORAL) PDL PDL PHENYLEPHRINE/DM LIQUID OTC (ORAL) NPD NPD PHENYLEPHRINE/DM/APAP/GUAIFENESIN CAPLET OTC (ORAL) NPD NPD PHENYLEPHRINE/DM/APAP/GUAIFENESIN LIQUID OTC (ORAL) NPD NPD 12 of 19

13 COUGH AND COLD, NON-NARCOTIC CONTINUED POLY-HIST DM LIQUID OTC (ORAL) PDL PDL X POLY-HIST PD DROPS OTC (ORAL) PDL NPD X Financial POLYTUSSIN DM OTC (ORAL) NPD NPD POLY-VENT DM TABLET OTC (ORAL) PDL PDL X PROMETHAZINE/DM SYRUP (ORAL) PDL PDL RESCON-DM LIQUID OTC (ORAL) PDL NPD Financial ROBITUSSIN CAPSULE OTC (ORAL) NPD NPD ROBITUSSIN COUGH & COLD CF LIQUID OTC (ORAL) NPD NPD ROBITUSSIN LONG-ACTING LIQUID OTC (ORAL) NPD NPD RYNEX DM SOLUTION OTC (ORAL) PDL PDL TESSALON PERLE CAPSULE (ORAL) NPD NPD VANACOF AC LIQUID OTC (ORAL) NPD NPD X VANACOF DM LIQUID OTC (ORAL) PDL PDL X VANACOF LIQUID OTC (ORAL) PDL PDL X VANATAB AC TABLET OTC (ORAL) NPD NPD X VANATAB DM TABLET OTC (ORAL) NPD NPD X ERYTHROPOIESIS STIMULATING PROTEINS ARANESP DISP SYRIN (INJECTION) NPD NPD ARANESP VIAL (INJECTION) NPD NPD EPOGEN (INJECTION) PDL PDL For this, the Board believed that all of the drugs being recommended as preferred meet the fiscal requirements of the state PROCRIT (INJECTION) PDL PDL GLUCOCORTICOIDS, INHALED ADVAIR DISKUS (INHALATION) PDL PDL For this, the Board believed ADVAIR HFA (INHALATION) PDL PDL that all of the drugs being recommended as AEROSPAN (INHALATION) NPD NPD preferred meet the fiscal requirements of the state AIRDUO RESPICLICK (INHALATION) NPD NPD ALVESCO (INHALATION) NPD NPD ARMONAIR RESPICLICK (INHALATION) NPD NPD ARNUITY ELLIPTA (INHALATION) NPD NPD X ASMANEX (INHALATION) PDL PDL ASMANEX HFA (INHALATION) NPD NPD BREO ELLIPTA (INHALATION) NPD NPD X BUDESONIDE 0.25, 0.5 MG RESPULES (INHALATION) NPD NPD BUDESONIDE 1 MG RESPULES (INHALATION) NPD NPD DULERA (INHALATION) PDL PDL FLOVENT DISKUS (INHALATION) PDL NPD Financial 13 of 19

14 GLUCOCORTICOIDS, INHALED CONTINUED FLOVENT HFA (INHALATION) PDL PDL FLUTICASONE/SALMETEROL (AIRDUO) (AG) (INHALATION) NPD NPD PULMICORT 0.25, 0.5 MG RESPULES (INHALATION) NPD PDL X Financial PULMICORT 1 MG RESPULES (INHALATION) NPD PDL X Financial PULMICORT FLEXHALER (INHALATION) NPD NPD QVAR (INHALATION) PDL NPD Financial QVAR REDIHALER (INHALATION) NR NPD X Financial SYMBICORT (INHALATION) PDL PDL TRELEGY ELLIPTA (INHALATION) NPD NPD HAE TREATMENTS BERINERT (INTRAVEN) PDL PDL For this, the Board believed that all of the drugs being recommended as preferred meet the fiscal requirements of the state CINRYZE (INTRAVEN) PDL PDL FIRAZYR (SUB-Q) PDL PDL HAEGARDA (SUB-Q) NPD NPD KALBITOR (SUB-Q) PDL PDL RUCONEST (INTRAVEN) NPD NPD X HYPOGLYCEMICS, SGLT2 FARXIGA (ORAL) PDL PEND X For this, the Board elected INVOKAMET (ORAL) NPD PEND X to postpone review until November in order to INVOKAMET XR (ORAL) NPD PEND X gather more information. INVOKANA (ORAL) NPD PEND X JARDIANCE (ORAL) PDL PEND X STEGLATRO (ORAL) NR PEND SYNJARDY (ORAL) PDL PEND X SYNJARDY XR (ORAL) NPD PEND X XIGDUO XR (ORAL) NPD PEND X IMMUNE GLOBULINS BIVIGAM (INTRAVEN) NPD NPD For this, the Board believed CARIMUNE NF NANOFILTERED (INTRAVEN) NPD NPD that all of the drugs being recommended as CUVITRU (SUBCUT.) NPD NPD preferred meet the fiscal requirements of the state CYTOGAM (INTRAVEN) PDL PDL FLEBOGAMMA DIF (INTRAVEN) NPD NPD GAMASTAN S-D VIAL (INTRAMUSC) PDL PDL GAMMAGARD LIQUID (INJECTION) PDL PDL GAMMAGARD S-D (INTRAVEN) PDL PDL GAMMAKED (INTRAVEN) NPD NPD GAMMAPLEX (INTRAVEN) NPD NPD GAMUNEX-C (INJECTION) PDL PDL HEPAGAM B (INTRAMUSC) PDL PDL 14 of 19

15 IMMUNE GLOBULINS CONTINUED HIZENTRA (SUBCUT.) PDL PDL HYQVIA (SUBCUT.) NPD NPD OCTAGAM (INTRAVEN) NPD NPD PRIVIGEN (INTRAVEN) NPD NPD IMMUNOMODULATORS, ATOPIC DERMATITIS DUPIXENT (SUBCUTANE.) NPD NPD For this, the Board believed that all of the drugs being recommended as preferred meet the fiscal requirements of the state ELIDEL (TOPICAL) NPD NPD EUCRISA (TOPICAL) NPD PDL X Clinical PROTOPIC (TOPICAL) NPD NPD TACROLIMUS (AG) (TOPICAL) NPD NPD TACROLIMUS (TOPICAL) NPD NPD LINCOSAMIDES/OXAZOLIDINONES/STREPTOGRAMI NS CLEOCIN CAPSULES (ORAL) NPD NPD For this, the Board believed CLEOCIN PALMITATE (ORAL) NPD NPD that all of the drugs being recommended as CLEOCIN PHOSPHATE PIGGYBACK (INJECTION) NPD NPD preferred meet the fiscal requirements of the state CLEOCIN PHOSPHATE VIAL (INJECTION) NPD NPD CLINDAMYCIN CAPSULES (ORAL) PDL PDL CLINDAMYCIN IN 0.9 % SODIUM CHLORIDE PIGGYBACK (INTRAVEN.) NPD NPD CLINDAMYCIN PALMITATE SOLUTION (ORAL) PDL PDL CLINDAMYCIN PHOSPHATE PIGGYBACK (INJECTION) NPD NPD CLINDAMYCIN PHOSPHATE VIAL (INJECTION) NPD NPD LINCOCIN (INJECTION) NPD NPD LINCOMYCIN (INJECTION) NPD NPD LINEZOLID (AG) (INTRAVEN) PDL PDL LINEZOLID (INTRAVEN) PDL PDL LINEZOLID SUSPENSION (AG) (ORAL) PDL PDL LINEZOLID SUSPENSION (ORAL) PDL PDL LINEZOLID TABLET (AG) (ORAL) PDL PDL LINEZOLID TABLET (ORAL) PDL PDL SIVEXTRO (INTRAVEN) NPD NPD SIVEXTRO (ORAL) NPD NPD SYNERCID (INJECTION) NPD NPD ZYVOX (INJECTION) NPD NPD ZYVOX SUSPENSION (ORAL) NPD NPD ZYVOX TABLET (ORAL) NPD NPD 15 of 19

16 LIPOTROPICS, OTHER ANTARA (ORAL) NPD NPD For this therapeutic drug class, the Board believed that all of the drugs being recommended as preferred demonstrated the greatest safety, efficacy, and value and provided clinicians with the greatest number of first line options to use before requiring Prior Authorization. CHOLESTYRAMINE/ASPARTAME (ORAL) PDL PDL CHOLESTYRAMINE/SUCROSE (ORAL) PDL PDL COLESTID GRANULES (ORAL) NPD NPD COLESTIPOL GRANULES (ORAL) NPD NPD COLESTIPOL TABLET (ORAL) PDL PDL EZETIMIBE (ORAL) NPD NPD FENOFIBRATE (ANTARA) (AG) (ORAL) NPD NPD FENOFIBRATE (ANTARA) (ORAL) NPD NPD FENOFIBRATE (FENOGLIDE) (AG) (ORAL) NPD NPD FENOFIBRATE (FENOGLIDE) (ORAL) NPD NPD FENOFIBRATE CAPSULE (LIPOFEN) (ORAL) PDL PDL FENOFIBRATE CAPSULE (LOFIBRA) (ORAL) NPD NPD FENOFIBRATE TABLET (AG) (TRICOR) (ORAL) PDL PDL FENOFIBRATE TABLET (LOFIBRA) (ORAL) NPD NPD FENOFIBRATE TABLET (TRICOR) (ORAL) PDL PDL FENOFIBRIC ACID (FIBRICOR) (ORAL) NPD NPD FENOFIBRIC ACID (TRILIPIX) (AG) (ORAL) NPD NPD FENOFIBRIC ACID (TRILIPIX) (ORAL) NPD NPD FENOGLIDE (ORAL) NPD NPD GEMFIBROZIL (ORAL) PDL PDL JUXTAPID (ORAL) PDL NPD Financial KYNAMRO (SUBCUTANE.) PDL NPD Financial LIPOFEN (ORAL) NPD NPD LOPID (ORAL) NPD NPD LOVAZA (ORAL) NPD NPD NIACIN CAPSULE ER OTC (ORAL) PDL PDL NIACIN ER (ORAL) NPD NPD NIACIN TABLET ER OTC (ORAL) PDL PDL NIACIN TABLET OTC (ORAL) PDL PDL NIACOR (ORAL) PDL PDL NIASPAN (ORAL) NPD NPD OMEGA-3 ACID ETHYL ESTERS (ORAL) NPD NPD OMEGA-3 OTC (ORAL) PDL PDL OMERA OTC (ORAL) NPD NPD PRALUENT PEN (SUBCUTANEOUS) NPD NPD REPATHA PUSHTRONEX (SUBCUTANEOUS) NPD NPD X REPATHA SURECLICK (SUBCUTANEOUS) NPD NPD X REPATHA SYRINGE (SUBCUTANEOUS) NPD NPD X RESTORA OTC (ORAL) NPD NPD 16 of 19

17 LIPOTROPICS, OTHER CONTINUED SLO-NIACIN OTC (ORAL) PDL PDL TRICOR (ORAL) NPD NPD TRIGLIDE (ORAL) NPD NPD TRILIPIX (ORAL) NPD NPD VASCEPA (ORAL) NPD NPD WELCHOL POWDER PACK (ORAL) NPD NPD WELCHOL TABLET (ORAL) NPD NPD ZETIA (ORAL) PDL PDL LIPOTROPICS, STATINS ALTOPREV (ORAL) NPD NPD For this, the Board believed AMLODIPINE-ATORVASTATIN (ORAL) NPD NPD that all of the drugs being recommended as ATORVASTATIN (ORAL) PDL PDL preferred meet the fiscal requirements of the state CADUET (ORAL) NPD NPD CRESTOR (ORAL) NPD NPD EZETIMIBE-SIMVASTATIN (ORAL) NPD NPD FLUVASTATIN (ORAL) NPD NPD FLUVASTATIN ER (AG) (ORAL) NPD NPD FLUVASTATIN ER (ORAL) NPD NPD LESCOL XL (ORAL) NPD NPD LIPITOR (ORAL) NPD NPD LIVALO (ORAL) NPD NPD LOVASTATIN (ORAL) PDL PDL PRAVACHOL (ORAL) NPD NPD PRAVASTATIN (ORAL) PDL PDL ROSUVASTATIN (ORAL) NPD NPD SIMVASTATIN (ORAL) PDL PDL VYTORIN (ORAL) NPD NPD ZOCOR (ORAL) NPD NPD PAH AGENTS, ORAL AND INHALED ADCIRCA (ORAL) PDL PDL For this, the Board believed ADEMPAS (ORAL) NPD NPD that all of the drugs being recommended as LETAIRIS (ORAL) PDL PDL X preferred meet the fiscal requirements of the state OPSUMIT (ORAL) NPD NPD X ORENITRAM ER (ORAL) NPD NPD REVATIO SUSPENSION (ORAL) NPD NPD REVATIO TABLET (ORAL) NPD NPD SILDENAFIL (ORAL) PDL PDL TRACLEER SUSPENSION (ORAL) NR NPD Financial TRACLEER TABLET (ORAL) PDL PDL X TYVASO (INHALATION) NPD NPD 17 of 19

18 PAH AGENTS, ORAL AND INHALED CONTINUED UPTRAVI (ORAL) NPD NPD UPTRAVI TABLET DOSE PACK (ORAL) NPD NPD VENTAVIS (INHALATION) NPD NPD PANCREATIC ENZYMES CREON (ORAL) PDL PDL X For this, the Board believed PANCREAZE (ORAL) NPD NPD that all of the drugs being recommended as PERTZYE (ORAL) NPD NPD X preferred meet the fiscal requirements of the state VIOKACE (ORAL) NPD NPD ZENPEP (ORAL) PDL PDL X SEDATIVE HYPNOTICS AMBIEN (ORAL) NPD NPD For this therapeutic drug class, the Board believed AMBIEN CR (ORAL) NPD NPD that all of the drugs being recommended as BELSOMRA (ORAL) NPD NPD preferred demonstrated the greatest safety, EDLUAR (SUBLINGUAL) NPD NPD efficacy, and value and provided clinicians with the ESTAZOLAM (ORAL) NPD NPD greatest number of first line options to use before ESZOPICLONE (ORAL) NPD NPD requiring Prior Authorization. FLURAZEPAM (ORAL) PDL PDL HALCION (ORAL) NPD NPD HETLIOZ (ORAL) NPD NPD INTERMEZZO (SUBLINGUAL) NPD NPD LUNESTA (ORAL) NPD NPD RESTORIL (ORAL) NPD NPD ROZEREM (ORAL) NPD NPD SILENOR (ORAL) NPD NPD TEMAZEPAM (ORAL) PDL PDL TEMAZEPAM 22.5 MG (ORAL) NPD NPD TEMAZEPAM 7.5 MG (ORAL) NPD NPD TRIAZOLAM (ORAL) PDL PDL ZALEPLON (ORAL) NPD NPD ZOLPIDEM (ORAL) PDL PDL ZOLPIDEM (SUBLINGUAL) NPD NPD ZOLPIDEM ER (ORAL) NPD NPD ZOLPIMIST (ORAL) NPD NPD 18 of 19

19 UREA CYCLE DISORDERS, ORAL BUPHENYL POWDER (ORAL) PDL PDL BUPHENYL TABLET (ORAL) PDL PDL For this, the Board believed CARBAGLU (ORAL) PDL PDL that all of the drugs being recommended as RAVICTI (ORAL) NPD NPD preferred meet the fiscal requirements of the state SODIUM PHENYLBUTYRATE POWDER (ORAL) NPD NPD SODIUM PHENYLBUTYRATE TABLET (ORAL) NPD NPD For these products, the Board believed that Enbrel met the clinical and fiscal requirements of the state. CYTOKINE AND CAM ANTAGONISTS ENBREL CARTRIDGE (SUBCUTANE.) NR PDL X Financial HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS BYDUREON BCISE (SUBCUTANE.) NR NPD X Financial HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS OZEMPIC (SUBCUTANE.) NR NPD Financial HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS QTERN (ORAL) NR NPD X Financial HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ADMELOG SOLOSTAR PEN (SUBCUTANE.) NR NPD Financial HYPOGLYCEMICS, INSULIN AND RELATED AGENTS ADMELOG VIAL (SUBCUTANE.) NR NPD Financial NEUROPATHIC PAIN LYRICA CR (ORAL) NR NPD Financial OPHTHALMICS, GLAUCOMA AGENTS VYZULTA (OPHTHALMIC) NR NPD Financial STIMULANTS AND RELATED AGENTS ADZENYS ER SUSPENSION (ORAL) NR NPD Financial TETRACYCLINES XIMINO (ORAL) NR NPD Financial ACNE AGENTS, TOPICAL RETIN-A MICRO 0.06% PUMP (TOPICAL) NR NPD Financial ANTIBIOTICS, GI SOLOSEC (ORAL) NR NPD Financial 19 of 19

HHSC Preferred Drug List (PDL) Recommendations April 27, of 17

HHSC Preferred Drug List (PDL) Recommendations April 27, of 17 ANTI-ALLERGENS, ORAL GRASTEK (SUBLINGUAL) NPD NPD NPD For this, the Board believed ORALAIR (SUBLINGUAL) NPD NPD NPD that none of the drugs meet the fiscal requirements of the state and are the most safe

More information

MANUFACTURER BRAND NAME THERAPEUTIC CLASS

MANUFACTURER BRAND NAME THERAPEUTIC CLASS ABBVIE US LLC CREON (ORAL) PANCREATIC ENZYMES ABBVIE US LLC DUOPA (MISCELL) ANTIPARKINSON'S AGENTS ABBVIE US LLC NIASPAN (ORAL) LIPOTROPICS, OTHER ABBVIE US LLC TRICOR (ORAL) LIPOTROPICS, OTHER ABBVIE

More information

Texas Drug Utilization Review April 28, 2017 Meeting

Texas Drug Utilization Review April 28, 2017 Meeting Texas Drug Utilization Review Meeting ABBVIE US LLC CREON (ORAL) PANCREATIC ENZYMES ABBVIE US LLC DUOPA (MISCELL) ANTIPARKINSON'S AGENTS ABBVIE US LLC NIASPAN (ORAL) LIPOTROPICS, OTHER ABBVIE US LLC TECHNIVIE

More information

Texas Medicaid April 2016

Texas Medicaid April 2016 ABBVIE US LLC ADVICOR (ORAL) LIPOTROPICS, STATINS ABBVIE US LLC CREON (ORAL) PANCREATIC ENZYMES ABBVIE US LLC DUOPA (MISCELL) ANTIPARKINSON'S AGENTS ABBVIE US LLC NIASPAN (ORAL) LIPOTROPICS, OTHER ABBVIE

More information

Dextromethorphan Overutilization

Dextromethorphan Overutilization Texas Prior Authorization Program Clinical Edit Criteria Drug/Drug Class Clinical Edit Information Included in this Document Drugs Requiring PA: the list of drugs requiring prior authorization for this

More information

Texas Medicaid April 2015

Texas Medicaid April 2015 ABBVIE US LLC ADVICOR (ORAL) LIPOTROPICS, STATINS ABBVIE US LLC CREON (ORAL) PANCREATIC ENZYMES ABBVIE US LLC NIASPAN (ORAL) LIPOTROPICS, OTHER ABBVIE US LLC SIMCOR (ORAL) LIPOTROPICS, STATINS ABBVIE US

More information

Texas Medicaid April 26, 2019 Meeting

Texas Medicaid April 26, 2019 Meeting ABBVIE US LLC CREON (ORAL) PANCREATIC ENZYMES ABBVIE US LLC DUOPA (MISCELL) ANTIPARKINSON'S AGENTS ABBVIE US LLC HUMIRA KIT (INJECTION) CYTOKINE AND CAM ANTAGONISTS ABBVIE US LLC HUMIRA PEN KIT (INJECTION)

More information

Acyclovir Ointment. Aetna Better Health Virginia Medallion/FAMIS 3.0. Products Affected. acyclovir ointment 5 % external Details.

Acyclovir Ointment. Aetna Better Health Virginia Medallion/FAMIS 3.0. Products Affected. acyclovir ointment 5 % external Details. Aetna Better Health Virginia Medallion/FAMIS 3.0 Acyclovir Ointment acyclovir ointment 5 % external Use of oral acyclovir in the previous 130 days 1 Adcirca tadalafil (pah) tablet 20 mg oral Use of sildenafil

More information

Dextromethorphan Overutilization

Dextromethorphan Overutilization Texas Prior Authorization Program Clinical Edit Criteria Drug/Drug Class Clinical Edit Information Included in this Document Drugs Requiring PA: the list of drugs requiring prior authorization for this

More information

Acyclovir Ointment. Aetna Better Health New Jersey. Products Affected. acyclovir ointment 5 % external Details. Criteria

Acyclovir Ointment. Aetna Better Health New Jersey. Products Affected. acyclovir ointment 5 % external Details. Criteria Acyclovir Ointment acyclovir ointment 5 % external Aetna Better Health New Jersey Use of oral acyclovir or Abreva in the previous 130 days 1 Adcirca tadalafil (pah) tablet 20 mg oral Use of sildenafil

More information

PA Prior authorization ST Step therapy QL Quantity limit AE Age Edit. More Details. Last Updated: April 1,

PA Prior authorization ST Step therapy QL Quantity limit AE Age Edit. More Details. Last Updated: April 1, Preventive Drug List Preventive drugs are used to help avoid disease and maintain health. Some insurance plans have a benefit that allows you to buy preventive drugs at a copay. Check your plan details

More information

Acyclovir Ointment. Aetna Better Health Kentucky. Products Affected. acyclovir ointment 5 % external Details. Criteria

Acyclovir Ointment. Aetna Better Health Kentucky. Products Affected. acyclovir ointment 5 % external Details. Criteria Acyclovir Ointment acyclovir ointment 5 % external Aetna Better Health Kentucky Use of oral acyclovir or Abreva in the previous 130 days 1 Adcirca ADCIRCA TABLET 20 MG ORAL Use of sildenafil in previous

More information

PA Prior authorization ST Step therapy QL Quantity limit AE Age Edit. Last Updated: January 1,

PA Prior authorization ST Step therapy QL Quantity limit AE Age Edit. Last Updated: January 1, Preventive Drug List Preventive drugs are used to help avoid disease and maintain health. Some insurance plans have a benefit that allows you to buy preventive drugs at a copay. Check your plan details

More information

Acyclovir Ointment. Aetna Better Health Louisiana. Products Affected. acyclovir ointment 5 % external Details. Criteria

Acyclovir Ointment. Aetna Better Health Louisiana. Products Affected. acyclovir ointment 5 % external Details. Criteria Acyclovir Ointment acyclovir ointment 5 % external Aetna Better Health Louisiana Use of oral acyclovir in the previous 130 days 1 Adcirca ADCIRCA TABLET 20 MG ORAL Use of sildenafil in previous 30 days

More information

PA Prior authorization ST Step therapy QL Quantity limit AE Age Edit. More Details. Last Update: July 1,

PA Prior authorization ST Step therapy QL Quantity limit AE Age Edit. More Details. Last Update: July 1, Preventive Drug List Preventive drugs are used to help avoid disease and maintain health. Some insurance plans have a benefit that allows you to buy preventive drugs at a copay. Check your plan details

More information

6.25 mg 1 tab, PO, BIDMEALS, Take with Meals, Duration: 30 day (DEF)*

6.25 mg 1 tab, PO, BIDMEALS, Take with Meals, Duration: 30 day (DEF)* DRUG AND TREATMENT Available at: BMC-B BMC-D BMC-N BMC-S Medications Antiarrhythmics amiodarone 200 mg oral tablet (Rx)* 200 mg 2 tab, PO, BID, Duration: 30 day (DEF)* 200 mg 2 tab, PO, BID, Duration:

More information

2018 Ohana Community Care Services (CCS) Comprehensive Preferred Drug List (List of Covered Drugs)

2018 Ohana Community Care Services (CCS) Comprehensive Preferred Drug List (List of Covered Drugs) 2018 Ohana Community Care Services (CCS) Comprehensive referred Drug List (List of Covered Drugs) Ohana Health lan 00 lease read: This document contains information about the drugs we cover in this plan.

More information

2019 Ohana Community Care Services (CCS) Comprehensive Preferred Drug List (List of Covered Drugs)

2019 Ohana Community Care Services (CCS) Comprehensive Preferred Drug List (List of Covered Drugs) 2019 Ohana Community Care Services (CCS) Comprehensive referred Drug List (List of Covered Drugs) Ohana Health lan 00 lease read: This document contains information about the drugs we cover in this plan.

More information

Preventive Drug List. More Details. Alcohol Dependency Alcohol Dependency acamprosate oral tablet,delayed release (dr/ec) disulfiram oral tablet

Preventive Drug List. More Details. Alcohol Dependency Alcohol Dependency acamprosate oral tablet,delayed release (dr/ec) disulfiram oral tablet Preventive Drug List Preventive drugs are used to help avoid disease and maintain health. Some insurance plans have a benefit that allows you to buy preventive drugs at a copay. Check your plan details

More information

Antibiotic Treatments. Arthritis & Pain. Asthma. Cholesterol

Antibiotic Treatments. Arthritis & Pain. Asthma. Cholesterol MAX Saver Plan Drug List 08/06/14 GENERIC NAME Allergies and Cold & Flu BENZONATATE CAP 100 MG 14 42 cap CETIRIZINE HCL TAB 10MG 30 90 tab CETIRIZINE HCL TAB 5MG 30 90 tab DIPHENHYDRAMINE HCL CAP 50 MG

More information

WELLCARE HEALTH PLAN 2015 STEP THERAPY CRITERIA (No Changes Made Since: 10/2014)

WELLCARE HEALTH PLAN 2015 STEP THERAPY CRITERIA (No Changes Made Since: 10/2014) WELLCARE HEALTH PLAN 2015 STEP THERAPY CRITERIA (No Changes Made Since: 10/2014) **To get updated information about the drugs covered by WellCare, please visit our website (https://www.wellcare.com) or

More information

New Jersey Department of Human Services State Upper Limit (SUL) List - PROPOSED Effective

New Jersey Department of Human Services State Upper Limit (SUL) List - PROPOSED Effective Generic_Name Current NJ SUL New NJ SUL Proposed ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL TABLET 300MG-30MG 0.12455 ACETAMINOPHEN WITH CODEINE PHOSPHATE ORAL TABLET 300MG-60MG 0.25688 ALBUTEROL SULFATE

More information

2016 STEP THERAPY CRITERIA

2016 STEP THERAPY CRITERIA 2016 STEP THERAPY CRITERIA Diamante Choice Platino, Diamante Extra Platino, Diamante Excel Platino, Supremo, Único Extra, Elite Ultra, Elite Excel, ELA Relax Oro, ELA Plus Plata, ELA Flex Bronce ST Criteria

More information

Allergies and Cold & Flu

Allergies and Cold & Flu MAX Saver Plan Drug List 01/23/17 GENERIC NAME Allergies and Cold & Flu BENZONATATE CAP 100 MG 14 42 cap CETIRIZINE HCL TAB 10MG 30 90 tab CETIRIZINE HCL TAB 5MG 30 90 tab DIPHENHYDRAMINE HCL CAP 50 MG

More information

Current as of November 1, 2017

Current as of November 1, 2017 Current as of November 1, 2017 ZYTIGA 500 MG ORAL TABLETS Formulary Addition TIER 5 QL = 2 PER DAY BENLYSTA 200 MG/ML AUTO- INJECTOR Formulary Addition TIER 5 BENLYSTA 200 MG/ML PREFILLED SYRINGE Formulary

More information

Membership Clinic 2015

Membership Clinic 2015 Membership Clinic 2015 ISD 15 has asked NeoPath to evaluate different options for how we can improve clinic accessibility, enhance the patient experience, boost utilization of the ISD 15 clinic and maintain

More information

Quarterly pharmacy formulary change notice

Quarterly pharmacy formulary change notice Provider Bulletin December 2017 Quarterly pharmacy formulary notice The formulary s listed in the table below apply to all Anthem HealthKeepers Plus members. These s were reviewed and approved at the third

More information

Mercy Care RBHA - Behavioral Health Drug List

Mercy Care RBHA - Behavioral Health Drug List Title 19/21 Non-SMI & Non-Title 19/21 SMI Behavioral Health Drug List Updated 3/01/2019 Mercy Care RBHA - Behavioral Health Drug List Table of Contents *ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS*...3

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide April 2018

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide April 2018 AETNA BETTER HEALTH Formulary Guide 2018 Aetna Better Health Pennsylvania Formulary Guide April 2018 AETNA BETTER HEALTH Formulary Guide 2018 What is the Aetna Better Health in Pennsylvania Formulary?

More information

Texas Medicaid October 28, 2011 Meeting Addendum

Texas Medicaid October 28, 2011 Meeting Addendum ACELLA ENTRE-B (ORAL) COUGH AND COLD, COLD ACELLA ENTRE-S (ORAL) COUGH AND COLD, NON-NARCOTIC ACELLA ESOCOR P OTC (ORAL) COUGH AND COLD, NON-NARCOTIC ALLEGIS ENDACON OTC (ORAL) COUGH AND COLD, NON-NARCOTIC

More information

QUALIFIED HEALTH PLAN FORMULARY Effective January 2018

QUALIFIED HEALTH PLAN FORMULARY Effective January 2018 QUALIFIED HEALTH PLAN FORMULARY Effective January 2018 Provided by EnvisionRx Introduction The Total Health Care (THC) Qualified Health Plan Formulary was developed to serve as a guide for physicians,

More information

PREFERRED DRUG LIST 2018

PREFERRED DRUG LIST 2018 PREFERRED DRUG LIST 2018 PDL National Formulary Preferred Drug List - May 2018 - The Preferred Drug List is a guide identifying preferred brandname medicines within select therapeutic categories. The Preferred

More information

Connecticut Medicaid P&T Meeting Minutes November 19, 2014

Connecticut Medicaid P&T Meeting Minutes November 19, 2014 The meeting started at 6:07pm Attendance Connecticut Medicaid P&T Meeting Minutes November 19, 2014 Present Members: Carl Sherter, MD Manage Nissanka, MD Emmett Sullivan, RPh Stella Cretella Kevin Chamberlin,

More information

Signature Advantage (HMO SNP) 2018 Comprehensive Formulary. List of Covered Drugs

Signature Advantage (HMO SNP) 2018 Comprehensive Formulary. List of Covered Drugs Signature Advantage (HMO SNP) 208 Comprehensive Formulary List of Covered Drugs PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File Submission

More information

Provider Partners Pennsylvania Advantage Plan Offered by Provider Partners Health Plan April 2019 Formulary Addendum

Provider Partners Pennsylvania Advantage Plan Offered by Provider Partners Health Plan April 2019 Formulary Addendum Provider Partners Pennsylvania Advantage Plan Offered by Provider Partners Health Plan April 2019 Formulary Addendum Below is a list formulary changes for the benefit year 2019. This is not a complete

More information

2017 Drug List for Qualified Health Plans

2017 Drug List for Qualified Health Plans 207 Drug List for Qualified Health Plans HAP Personal Alliance and small group Use this drug list also known as a formulary to learn about the prescription drugs we cover in all qualified health plans.

More information

APO-MELOXICAM ORAL SUSPENSION

APO-MELOXICAM ORAL SUSPENSION Canadian Owned, Canadian Manufactured INTRODUCING APO-MELOXICAM ORAL SUSPENSION Bioequivalent to Metacam Our Meloxicam is half the price of the innovator! A Veterinary labeled generic alternative to Metacam

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide December 2017

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide December 2017 AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide December 2017 http://www.aetnabetterhealth.com/virginia AETNA BETTER HEALTH Formulary Guide What is the Aetna Better

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide April 2019

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide April 2019 AETNA BETTER HEALTH Formulary Guide 2019 Aetna Better Health Pennsylvania Formulary Guide April 2019 AETNA BETTER HEALTH Formulary Guide 2019 What is the Aetna Better Health in Pennsylvania Formulary?

More information

3 Tier Formulary (List of Covered Drugs)

3 Tier Formulary (List of Covered Drugs) Effective: September 11, 2017 Large Group Non-Qualified Health Plans Small Group Non-Qualified Health Plans 3 Tier Formulary (List of Covered Drugs) What is the Drug List? Also called a formulary by doctors

More information

AMBIEN MAKES ME DIZZY IN THE MORNINGS

AMBIEN MAKES ME DIZZY IN THE MORNINGS AMBIEN MAKES ME DIZZY IN THE MORNINGS Ambien Makes Me Dizzy In The Mornings Weaning off ambien 10 mg Can ambien cause ulcers Is 15mg of ambien too much What is the difference in zolpidem and ambien Ambien

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide March 2018

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide March 2018 AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide March 2018 http://www.aetnabetterhealth.com/virginia AETNA BETTER HEALTH Formulary Guide What is the Aetna Better Health

More information

MANUFACTURER BRAND NAME THERAPEUTIC CLASS

MANUFACTURER BRAND NAME THERAPEUTIC CLASS ABBVIE US LLC DUOPA (MISCELL) ANTIPARKINSON'S AGENTS ABBVIE US LLC HUMIRA KIT (INJECTION) CYTOKINE AND CAM ANTAGONISTS ABBVIE US LLC HUMIRA PEN KIT (INJECTION) CYTOKINE AND CAM ANTAGONISTS ABBVIE US LLC

More information

MO HealthNet December 2011 Meeting

MO HealthNet December 2011 Meeting ACELLA ESOCOR P OTC (ORAL) COUGH AND COLD, NON-NARCOTIC ACTAVIS BETAMETHASONE DIPROPIONATE OINT. (TOPICAL) STEROIDS, TOPICAL HIGH ACTAVIS PROMETHAZINE VC SYRUP (ACTAVIS) (ORAL) COUGH AND COLD, COLD ACTAVIS

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide October 2017

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide October 2017 AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide October 2017 http://www.aetnabetterhealth.com/virginia AETNA BETTER HEALTH Formulary Guide What is the Aetna Better Health

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide April 2017

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide April 2017 AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide April 2017 http://www.aetnabetterhealth.com/virginia AETNA BETTER HEALTH Formulary Guide What is the Aetna Better Health

More information

Third Party Administered Health Plans 5 Tier Formulary (List of Covered Drugs)

Third Party Administered Health Plans 5 Tier Formulary (List of Covered Drugs) Effective: September 11, 2017 Large Group Non Qualified Health Plans Third Party Administered Health Plans 5 Tier Formulary (List of Covered Drugs) What is the Drug List? Also called a formulary by doctors

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide March 2019

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide March 2019 AETNA BETTER HEALTH Formulary Guide 2019 Aetna Better Health Pennsylvania Formulary Guide March 2019 AETNA BETTER HEALTH Formulary Guide 2019 What is the Aetna Better Health in Pennsylvania Formulary?

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide June 2017

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide June 2017 AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide June 2017 http://www.aetnabetterhealth.com/virginia AETNA BETTER HEALTH Formulary Guide What is the Aetna Better Health

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide August 2017

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide August 2017 AETNA BETTER HEALTH Formulary Guide Aetna Better Health Of Virginia Formulary Guide August 2017 http://www.aetnabetterhealth.com/virginia AETNA BETTER HEALTH Formulary Guide What is the Aetna Better Health

More information

Medicaid Drug Formulary January 2019

Medicaid Drug Formulary January 2019 Medicaid Drug Formulary January 2019 Key * Generic Available AG Age Limits F Females Only M Males Only OTC Over the Counter P Preventive PA Prior Authorization QL Quantity Limit SP Specialty Pharmacy ST

More information

Health First Health Plans 2018 Formulary (List of Covered Drugs)

Health First Health Plans 2018 Formulary (List of Covered Drugs) Updated: July 1, 2018 Classic Plan (HMO-POS) Value Plan (HMO) Rewards Plan (HMO) Employer Group Plus A Plan (HMO) Employer Group Plus B Plan (HMO) Employer Group POS Plan (HMO-POS) Health First Health

More information

2018 Year-to-date Formulary Additions and Deletions

2018 Year-to-date Formulary Additions and Deletions Health Choice Generations may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, add prior authorization, quantity limits and/or step therapy restrictions on

More information

Connecticut Medicaid P&T Meeting Minutes November 18 th, 2015

Connecticut Medicaid P&T Meeting Minutes November 18 th, 2015 Connecticut Medicaid P&T Meeting Minutes November 18 th, 2015 The meeting was called to order at 6:29 PM. Attendance: P&T Members Present: DSS: HP/Magellan: Carl Sherter Herman Kranc Jason Young Manage

More information

Health First Health Plans 2019 Formulary (List of Covered Drugs)

Health First Health Plans 2019 Formulary (List of Covered Drugs) Updated: 10/2018 Health First Health Plans 2019 Formulary (List of Covered Drugs) Classic Plan (HMO-POS) Value Plan (HMO) Rewards Plan (HMO) Employer Group Plus A Plan (HMO) Employer Group Plus B Plan

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide October 2018

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide October 2018 AETNA BETTER HEALTH Formulary Guide 2018 Aetna Better Health Pennsylvania Formulary Guide October 2018 AETNA BETTER HEALTH Formulary Guide 2018 What is the Aetna Better Health in Pennsylvania Formulary?

More information

Virginia Department of Medical Assistance Services April 19, 2012 Meeting

Virginia Department of Medical Assistance Services April 19, 2012 Meeting ABBOTT ANDROGEL GEL PACKET (TRANSDERM.) ANDROGENIC AGENTS ABBOTT ANDROGEL GEL PUMP (TRANSDERM) ANDROGENIC AGENTS ABBOTT HUMIRA KIT (INJECTION) CYTOKINE AND CAM ANTAGONISTS ABBOTT HUMIRA PEN IJ KIT (INJECTION)

More information

Individual Qualified Health Plans 5 Tier Commercial Formulary (List of Covered Drugs)

Individual Qualified Health Plans 5 Tier Commercial Formulary (List of Covered Drugs) Effective: September 11, 2017 What is the Drug List? Also called a formulary by doctors and pharmacists, the Drug List is an extensive list of safe and effective, FDA-approved, brand name and generic prescription

More information

Aetna Better Health of Louisiana

Aetna Better Health of Louisiana AETNA BETTER HEALTH Formulary Guide Aetna Better Health of Louisiana Formulary Guide January 2019 www.aetnabetterhealth.com/louisiana 1 AETNA BETTER HEALTH Formulary Guide What is the Aetna Better Health

More information

Aetna Better Health of Louisiana. December 2018

Aetna Better Health of Louisiana. December 2018 AETNA BETTER HEALTH Formulary Guide Aetna Better Health of Louisiana Formulary Guide December 2018 www.aetnabetterhealth.com/louisiana 1 AETNA BETTER HEALTH Formulary Guide What is the Aetna Better Health

More information

TOP$ Product Review Listing

TOP$ Product Review Listing ABBOTT LABS. HUMIRA (INJECTION) CYTOKINE AND CAM ANTAGONISTS ACELLA PHARMACE ESOCOR P (ORAL) COUGH AND COLD, NON NARCOTIC ACELLA PHARMACE HALAC (TOPICAL) STEROIDS, TOPICAL VERY HIGH ALCON LABS. ALOMIDE

More information

2019 Commercial 5-Tier Formulary (List of Covered Drugs) What is the Drug List?

2019 Commercial 5-Tier Formulary (List of Covered Drugs) What is the Drug List? Effective: January 1, 2019 Large and Small Group Health Plans Individual Health Plans Third Party Administered Health Plans 2019 Commercial 5-Tier Formulary (List of Covered Drugs) What is the Drug List?

More information

4-TIER HIGH DEDUCTIBLE HEALTH PLAN FORMULARY Effective May 2018

4-TIER HIGH DEDUCTIBLE HEALTH PLAN FORMULARY Effective May 2018 4-TIER HIGH DEDUCTIBLE HEALTH PLAN FORMULARY Effective May 2018 Provided by EnvisionRx Introduction The Total Health Care (THC) 4-Tier High Deductible Health Plan Formulary was developed to serve as a

More information

Qualified Health Plans 2018 Drug Formulary for HMOs and PPOs

Qualified Health Plans 2018 Drug Formulary for HMOs and PPOs Qualified Health Plans 2018 Drug Formulary for HMOs and PPOs THIS DOCUMENT HAS INFORMATION ABOUT THE PRESCRIPTION DRUGS WE COVER FOR QUALIFIED HEALTH PLANS. Qualified Health Plans (QHP) are Affordable

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide May 2017

AETNA BETTER HEALTH Formulary Guide Aetna Better Health Pennsylvania Formulary Guide May 2017 AETNA BETTER HEALTH Formulary Guide 2017 Aetna Better Health Pennsylvania Formulary Guide May 2017 AETNA BETTER HEALTH Formulary Guide 2017 What is the Aetna Better Health in Pennsylvania Formulary? This

More information

AMBIEN AND PAIN KILLERS

AMBIEN AND PAIN KILLERS AMBIEN AND PAIN KILLERS Ambien And Pain Killers Pt. assistance ambien program Taken prednisone and ambien together M ambien light purple 22 Ambien cr tea kava Explorer ambien sold on internet Night surgery

More information

Health First Health Plans 2019 Formulary (List of Covered Drugs)

Health First Health Plans 2019 Formulary (List of Covered Drugs) Updated: March 1, 2019 Health First Health Plans 2019 Formulary (List of Covered Drugs) SunSaver (HMO) Employer Group Plus C Plan (HMO) Employer Group Plus D Plan (HMO) Employer Group POS B Plan (HMO-POS)

More information

Aetna Better Health Virginia. Table of Contents

Aetna Better Health Virginia. Table of Contents Aetna Better Health Virginia Table of Contents *ADHD/ANTI-NARCOLEPSY/ANTI-OBESITY/ANOREXIANTS*...4 *ALTERNATIVE MEDICINES*...6 *AMINOGLYCOSIDES*... 6 *ANALGESICS - ANTI-INFLAMMATORY*...7 *ANALGESICS -

More information

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT SOME OF THE DRUGS WE COVER IN THIS PLAN.

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT SOME OF THE DRUGS WE COVER IN THIS PLAN. HealthPartners Freedom Vital with Rx (Cost) HealthPartners Freedom Balance with Rx (Cost) HealthPartners Freedom Ultimate with Rx (Cost) HealthPartners Freedom Ultimate with Enhanced Rx (Cost) HealthPartners

More information

Aetna Better Health of Louisiana

Aetna Better Health of Louisiana AETNA BETTER HEALTH Formulary Guide Aetna Better Health of Louisiana Formulary Guide January 2018 www.aetnabetterhealth.com/louisiana 1 AETNA BETTER HEALTH Formulary Guide What is the Aetna Better Health

More information

Updated: November 1, 2017 Classic Plan (HMO-POS) Value Plan (HMO) Rewards Plan (HMO) Health First Health Plans 2017 Formulary (List of Covered Drugs)

Updated: November 1, 2017 Classic Plan (HMO-POS) Value Plan (HMO) Rewards Plan (HMO) Health First Health Plans 2017 Formulary (List of Covered Drugs) Updated: November 1, 2017 Classic Plan (HMO-POS) Value Plan (HMO) Rewards Plan (HMO) Health First Health Plans 2017 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT

More information

Aetna Better Health of Louisiana. February 2018

Aetna Better Health of Louisiana. February 2018 AETNA BETTER HEALTH Formulary Guide Aetna Better Health of Louisiana Formulary Guide February 2018 www.aetnabetterhealth.com/louisiana 1 AETNA BETTER HEALTH Formulary Guide What is the Aetna Better Health

More information

Memorial Hermann Advantage HMO Formulary. (List of Covered Drugs)

Memorial Hermann Advantage HMO Formulary. (List of Covered Drugs) Memorial Hermann Advantage H 2019 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File Submission ID 19563,

More information

2018 Formulary (List of Covered Drugs) UCare for Seniors Prime (HMO-POS) UCare for Seniors Standard (HMO-POS)

2018 Formulary (List of Covered Drugs) UCare for Seniors Prime (HMO-POS) UCare for Seniors Standard (HMO-POS) 208 Formulary (List of Covered Drugs) UCare for Seniors Prime (HMO-POS) UCare for Seniors Standard (HMO-POS) This formulary was updated on 05/0/208. For more recent information or other questions, please

More information

Memorial Hermann Advantage HMO & PPO Abridged Formulary. (Partial List of Covered Drugs)

Memorial Hermann Advantage HMO & PPO Abridged Formulary. (Partial List of Covered Drugs) Memorial Hermann Advantage H & PPO 2017 Abridged Formulary (Partial List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT SOME OF THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary

More information

2018 Commercial 3-Tier Formulary (List of Covered Drugs)

2018 Commercial 3-Tier Formulary (List of Covered Drugs) Effective: July 1, 2018 Large Group Health Plans Small Group Health Plans 2018 Commercial 3-Tier Formulary (List of Covered Drugs) What is the Drug List? Also called a formulary by doctors and pharmacists,

More information

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. HealthPartners UnityPoint Health Align (PPO) HealthPartners UnityPoint Health Symmetry (PPO) (Collectively known as HealthPartners UnityPoint Health) 017 Formulary (List of Covered Drugs) PLEASE READ:

More information

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN.

PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN. HealthPartners Freedom Group (Cost) HealthPartners Journey Group (PPO) HealthPartners Retiree National Choice (PDP) (Collectively known as HealthPartners) 019 Formulary II (List of Covered Drugs) PLEASE

More information

AETNA BETTER HEALTH Formulary Guide Aetna Better Health of Kentucky Formulary Guide March 2019

AETNA BETTER HEALTH Formulary Guide Aetna Better Health of Kentucky Formulary Guide March 2019 AETNA BETTER HEALTH Formulary Guide Aetna Better Health of Kentucky Formulary Guide March 2019 http://www.aetnabetterhealth.com/kentucky AETNA BETTER HEALTH Formulary Guide What is the Aetna Better Health

More information

3 Tier Formulary (List of Covered Drugs)

3 Tier Formulary (List of Covered Drugs) Effective: August 1, 2016 Large Group Non-Qualified Health Plans Small Group Non-Qualified Health Plans 3 Tier Formulary (List of Covered Drugs) What is the Drug List? Also called a formulary by doctors

More information

PHP Commercial Large Group Plans (Non-Metal Plans) Formulary Therapeutic Class Listing

PHP Commercial Large Group Plans (Non-Metal Plans) Formulary Therapeutic Class Listing Presbyterian Health Plan Presbyterian Insurance Company, Inc. PHP Commercial Large Group Plans (Non-Metal Plans) Formulary Therapeutic Class Listing This list is in order by therapeutic class. To find

More information

Memorial Hermann Advantage HMO & PPO Formulary. (List of Covered Drugs)

Memorial Hermann Advantage HMO & PPO Formulary. (List of Covered Drugs) Memorial Hermann Advantage H & PPO 2017 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN HPMS Approved Formulary File 00017383, Version

More information

3-TIER FORMULARY Effective November 2017

3-TIER FORMULARY Effective November 2017 3-TIER FORMULARY Effective November 2017 Provided by EnvisionRx Introduction The Total Health Care (THC) 3-Tier Formulary was developed to serve as a guide for physicians, pharmacists, health care professionals

More information

OPTIMA HEALTH OPTIMA FAMILY CARE (JANUARY MARCH 2019) PRESCRIPTION DRUG FORMULARY WITH MEDICAID EXPANSION (XP) Effective: January 1, 2019

OPTIMA HEALTH OPTIMA FAMILY CARE (JANUARY MARCH 2019) PRESCRIPTION DRUG FORMULARY WITH MEDICAID EXPANSION (XP) Effective: January 1, 2019 OPTIMA HEALTH PRESCRIPTION DRUG FORMULARY OPTIMA FAMILY CARE WITH MEDICAID EXPANSION (XP) (JANUARY MARCH 2019) Revised: 1/2/2019 Table of Contents Analgesics - Drugs for Pain... 3 Analgesics - Drugs for

More information

Provider Partners Health Plan of Ohio (HMO SNP) 2019 Formulary (List of Covered Drugs)

Provider Partners Health Plan of Ohio (HMO SNP) 2019 Formulary (List of Covered Drugs) Provider Partners Health Plan of Ohio (H SNP) 2019 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN Formulary ID 19582, Version 5

More information

Florida Hospital Care Advantage 2017 Formulary (List of Covered Drugs)

Florida Hospital Care Advantage 2017 Formulary (List of Covered Drugs) Updated: November 1, 2017 Explorer Plan (HMO-POS) SunSaver Plan (HMO-POS) Florida Hospital Care Advantage 2017 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE

More information

2017 Drug List for Commercial Health Plans

2017 Drug List for Commercial Health Plans 2017 Drug List for Commercial Health Plans Use this drug list also known as a formulary to learn about the prescription drugs we cover in all commercial health plans. Commercial health plans are a type

More information

2018 List of Covered Drugs (Formulary)

2018 List of Covered Drugs (Formulary) 208 List of Covered Drugs (Formulary) UCare s MSHO and UCare Connect + Medicare This is a list of drugs that members can get in UCare s MSHO and UCare Connect + Medicare. UCare s MSHO and UCare Connect

More information

2018 Ohana Medicaid Comprehensive Preferred Drug List (QUEST Integration) (List of Covered Drugs)

2018 Ohana Medicaid Comprehensive Preferred Drug List (QUEST Integration) (List of Covered Drugs) 2018 Ohana Medicaid Comprehensive referred Drug List (QUEST Integration) (List of Covered Drugs) Ohana Health lan lease read this document. It has details about the drugs we cover for the Ohana QUEST Integration

More information

PHP Centennial Care Formulary/Preferred Drug Listing

PHP Centennial Care Formulary/Preferred Drug Listing PHP Centennial Care Formulary/Preferred Drug Listing The Centennial Care Preferred Drug List is subject to change. Presbyterian Centennial Care This list is in order by therapeutic class. To find a specific

More information

AETNA BETTER HEALTH Formulary Guide. Aetna Better Health of Florida Florida Healthy Kids Formulary Guide October 2017

AETNA BETTER HEALTH Formulary Guide. Aetna Better Health of Florida Florida Healthy Kids Formulary Guide October 2017 AETNA BETTER HEALTH Formulary Guide Aetna Better Health of Florida Florida Healthy Kids Formulary Guide October 2017 AETNA BETTER HEALTH Formulary Guide https://www.aetnabetterhealth.com/florida What is

More information

Partnership 2017 Formulary. List of Covered Drugs

Partnership 2017 Formulary. List of Covered Drugs Partnership 207 Formulary List of Covered Drugs PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN ID 7379, Version Number 26 This formulary was updated on 0/24/207.

More information

Health First Health Plans 2016 Formulary (List of Covered Drugs)

Health First Health Plans 2016 Formulary (List of Covered Drugs) Updated: November 1, 2016 Florida Hospital SunSaver Plan (HMO-POS) Florida Hospital Explorer Plan (HMO-POS) Health First Health Plans 2016 Formulary (List of Covered s) PLEASE READ: THIS DOCUMENT CONTAINS

More information

2017 Ohana Medicaid Comprehensive Preferred Drug List (QUEST Integration) (List of Covered Drugs)

2017 Ohana Medicaid Comprehensive Preferred Drug List (QUEST Integration) (List of Covered Drugs) 2017 Ohana Medicaid Comprehensive referred Drug List (QUEST Integration) (List of Covered Drugs) Ohana Health lan 00 lease read this document. It has details about the drugs we cover for the Ohana QUEST

More information

Texas August 16, 2013 Meeting

Texas August 16, 2013 Meeting ABBVIE US LLC CARDIZEM LA (ORAL) CALCIUM CHANNEL BLOCKERS ACELLA PHARMACE AURAX (OTIC) OTIC ANTI-INFECTIVES & ANESTHETICS ACELLA PHARMACE ENTRE-B OTC (ORAL) COUGH AND COLD, COLD ACELLA PHARMACE ESOCOR

More information

Step Therapy Criteria Last Updated 6/1/2018

Step Therapy Criteria Last Updated 6/1/2018 Step Therapy Last Updated 6/1/2018 For information on obtaining an updated coverage determination or an exception to a coverage determination please call Freedom Health Member Services at 1-800-401-2740

More information

Georgia Medicaid Meeting November 6, 2018

Georgia Medicaid Meeting November 6, 2018 ABBVIE US LLC DUOPA (MISCELL) ANTIPARKINSON'S AGENTS ABBVIE US LLC VENCLEXTA (ORAL) ONCOLOGY, ORAL - HEMATOLOGIC ABBVIE US LLC VENCLEXTA STARTING PACK (ORAL) ONCOLOGY, ORAL - HEMATOLOGIC ACADIA PHARMACE

More information

Partnership 2017 Formulary. List of Covered Drugs

Partnership 2017 Formulary. List of Covered Drugs Partnership 207 Formulary List of Covered Drugs PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS PLAN ID 7379, Version Number 9 This formulary was updated on 5/23/207. For

More information

PRESCRIPTION DRUGS FORMULARY 1. I ~~ [ tl-i I Classicare (HMO)

PRESCRIPTION DRUGS FORMULARY 1. I ~~ [ tl-i I Classicare (HMO) PRESCRIPTION DRUGS FORMULARY 1 2018 I ~~ [ tl-i I Classicare (HMO) MCS Classicare 2018 Formulary (List of Covered Drugs) PLEASE READ: THIS DOCUMENT CONTAINS INFORMATION ABOUT THE DRUGS WE COVER IN THIS

More information

Connecticut Medicaid P&T Meeting Minutes November 14, 2012

Connecticut Medicaid P&T Meeting Minutes November 14, 2012 Connecticut Medicaid P&T Meeting Minutes November 14, 2012 The meeting started at 6:10 pm Attendance Present Members: Carl Sherter, MD Charles Thompson, MD Emmett Sullivan, RPh Stella Cretella Hilda Slivka,

More information