Formulary Updates

The following drug products were reviewed and acted upon by the CDPHP Pharmacy and Therapeutics Committee on October 14, 2009.   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

  • E Excluded from the closed formulary
  • PA Prior authorization required
  • * Quantity limit of 9 tablets per 30 days (cumulative by class)
  • ** Brand only
  • # Quantity limit of # 30 tablets in 30 days (cumulative by class)
DrugNew Tier / Formulary StatusPrevious Tier / Formulary Status
Adcirca tablets (tadalafil)3, PANew to market
Alagesic LQ oral solution (acetaminophen/butalbital/caffeine)3, ENew to market
Aplenzin extended-release tablets (bupropion)3, ENew to market
Asacol HD delayed-release tablets (mesalamine)2New to market
Atacand HCT tablets (candesartan cilexetil/hydrochlorothiazide)32
Atacand tablets (candesartan cilexetil)32
BenzaClin topical gel (clindamycin phosphate/benzoyl peroxide)3**2
Besivance ophthalmic solution (besifloxacin)3New to market
bicalutamide tablets (generic for Casodex)1New to market
Casodex tablets (bicalutamide)3**2
Catapres-TTS transdermal patch (clonidine)3**2
Cetraxal otic solution (ciprofloxacin)3New to market
clindamycin phosphate/benzoyl peroxide topical gel (generic for BenzaClin)1New to market
clonidine TDS extended-release film, transdermal (generic for Catapres-TTS)1New to market
Coartem tablets (artemether/lumefantrine)3New to market
CombiPatch transdermal patch (estradiol/norethindrone acetate)32
Cuprimine capsules (penicillamine)32
Edluar sublingual tablets (zolpidem tartrate)3#, E 
Effient tablets (prasugrel)3New to market
Entocort EC enteric-coated granules in capsules (budesonide micronized)32
Exforge HCT tablets (amlodipine/valsartan/hydrochlorothiazide)2New to market
Fanapt tablets (iloperidone)3,PANew to market
Fosamax Plus D tablets (alendronate sodium/cholecalciferol)32
Lamictal XR extended-release tablets (lamotrigine)3New to market
malathion topical lotion (generic for Ovide)1New to market
minocycline HCl extended-release tablets (generic for Solodyn)1, PA, ENew to market
Nucynta tablets (tapentadol)3, quantity limit of one 90-day course per 12 monthsNew to market
Nuvigil tablets (armodafinil)3, PANew to market
Ovide topical lotion (malathion)3**2
Rapaflo capsules (silodosin)3New to market
Renvela tablets (sevelamer carbonate)2New to market
risperidone orally disintegrating tablets (generic for Risperdal-M)1New to market
Samsca tablets (tolvaptan)3New to market
Sanctura XR extended-release capsules (trospium chloride)2, preferred3
Simponi injection (golimumab)2, PA, SPNew to market
Synthetic conjugated estrogen cream3New to market
tacrolimus capsules (generic for Prograf)1New to market
Toprol-XL extended-release tablets (metoprolol succinate)3**2
Treximet tablets (sumatriptan succinate/naproxen sodium)2, preferred*3*
Tri-Lo-Sprintec tablets (ethinyl estradiol/norgestimate generic for Ortho Tri-Cyclen Lo)1New to market
Ulesfia topical lotion (benzyl alcohol)3New to market
Urso and Urso Forte tablets (ursodiol)3**2
ursodiol tablets (generic for Urso and Urso Forte)1New 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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