Formulary Updates

The following drug products were reviewed and acted upon by the CDPHP Pharmacy and Therapeutics Committee on October 1, 2008.   Review the full CDPHP Clinical Formulary which includes tier status, prior authorization requirements and quantity limits for select drugs. Also see Medicare Drug Formulary and Medicare Formulary Updates.

Legend

  • * Covered under the NYS Diabetic Mandate
  • ** Brand only
  • # Quantity limit of 30 capsules in 30 days (cumulative by class)
  • ## Quantity limit of 30 tablets in 30 days (cumulative by class)
  • ST Subject to step therapy
  • PA Prior authorization required
  • SP Must be obtained at Caremark Specialty Pharmacy Services
  • ^ Quantity limit of #9 tablets in 30 days (cumulative by class)
DrugNew Tier / Formulary StatusPrevious Tier / Formulary Status
acarbose tablets (generic of Precose)1*New to market
Actonel with Calcium packs (risedronate sodium tablets with calcium carbonate tablets) 32, preferred
Azelex cream (azelaic acid)32
bupropion extended-release tablets 150mg (generic of Wellbutrin XL)1, preferredNew to market
calcipotriene topical solution (generic of Dovonex topical scalp solution)1New to market
Cimzia lyophilized powder for solution for injection (certolizumab pegol)Medical Benefit, PA, SPNew to market
Crestor tablets (rosuvastatin)2, preferred (effective 1/1/09)3
divalproex sodium delayed-release tablets (generic of Depakote)1New to market
Dovonex topical scalp solution (calcipotriene)3**2
dronabinol capsules (generic of Marinol)1New to market
eplerenone tablets (generic of Inspra)1New to market
epoprostenol sodium for injection (generic of Flolan)Medical BenefitNew to market
Fusilev injection (levoleucovorin for injection)Medical BenefitNew to market
galantamine tablets (generic of Razadyne)1New to market
Inspra tablets (eplerenone) 3**2
lamotrigine tablets (generic of Lamictal)1New to market
Liquadd oral solution (dextroamphetamine sulfate) 3New to market
Luvox CR capsules (fluvoxamine controlled-release)3, excludedNew to market
Marinol capsules (dronabinol) 3**2
mycophenolate mofetil capsules (generic of CellCept)1New to market
nisoldipine extended-release tablets (generic of Sular)1New to market
Ocella tablets (ethinyl estradiol/drospirenone), (generic of Yasmin)1, preferredNew to market
omeprazole delayed-release capsules 20mg (generic of Prilosec)qty of #30 capsules per 30 days (cumulative by class)qty of #60 capsules per 30 days (cumulative by class)
pantoprazole sodium delayed-release tablets (generic of Protonix)1, preferred ##,ST (effective 1/1/09)1, preferred ##
paroxetine HCl sustained-release tablets (generic of Paxil CR)1, preferredNew to market
Patanase nasal spray (olopatadine)3New to market
Paxil CR tablets (paroxetine HCl sustained-release)3**2, preferred
Precose tablets (acarbose) 3* (brand only)2*
Proventil HFA inhalation (albuterol)32, preferred
QVAR inhalation (beclomethasone dipropionate)2, preferred3, excluded
Razadyne tablets (galantamine)3**2
Relistor subcutaneous injection (methylnaltrexone bromide)3New to market
Requip tablets (ropinirole HCl) 3**2
Requip XL tablets (ropinirole extended-release) 3New to market
risperidone tablets (generic of Risperdal)1New to market
Ritalin LA capsules (methylphenidate extended-release)32
ropinirole HCl tablets (generic of Requip)1New to market
Simcor tablets (niacin extended-release/simvastatin)3New to market
Singulair tablets/chewable tablets/oral granules (montelukast sodium)2, preferred, ST (effective 1/1/09)2, preferred
Solodyn tablets (minocycline extended-release) 3, excluded, PA3, excluded
Tazorac gel; cream (tazarotene)32
Treanda injection (bendamustine HCl)Medical BenefitNew to market
Treximet tablets (sumatriptan/naproxen sodium)3^New to market
Ventolin HFA inhalation (albuterol)2, preferred3
Vytorin tablets (ezetimibe/simvastatin)3 (effective 1/1/09)2, preferred
Xibrom ophthalmic solution (bromfenac) 23
Yasmin tablets (ethinyl estradiol/drospirenone)3**2, preferred
zaleplon capsules (generic of Sonata)1#New to market
Zamicet solution (hydrocodone/APAP)3New to market

The drug names listed here are the registered and/or unregistered trademarks of third-party pharmaceutical companies unrelated to and unaffiliated with CDPHP. These trademarked brand names are included here for informational purposes only and are not intended to imply or suggest any affiliation between CDPHP and such third-party pharmaceutical companies.

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