Preferred Drug List Updates

April 2012

• P.36: Cetirizine syrup: changed QLL – Under 6 years of age QLL=150
  ml/30 days. 6 years and older QLL= 300ml/30Days
• P.19: Diltiazem ER/XT products: changed QLL to 60/30 days
• P.19: Matzim LA: added to formulary

March 2012

• P.27: Omeprazole rx 10mg, 20mg and 40mg: added to formulary
  omeprazole 10mg QLL=30 caps/30 days
  omeprazole 20mg QLL=120 caps or tabs/30 days
  omeprazole 40mg QLL=270 caps/30 days
• P.29: Celebrex: added to formulary with STEP

February 2012

• P.17: Zyprexa removed from formulary. Olanzapine added to formulary COVERED FOR MCY ALTCS; MCY ACUTE/DD REQUIRE PA

January 2012

• P.10: Complera: added to formulary
• P.25: Januvia: added to formulary with STEP
• P.22: Atorvastatin: added to formulary; QLL=30 tabs/30 days

December 2011

• P.13: Acetaminophen Elixir: age restriction removed

November 2011

• P.30: OTC Fish Oil: added to formulary
• P.14: Buspirone: added QLL=60 tabs/30 days for 30mg tablets
• P.10: Edurant: added to formulary

October 2011

• P.17: Risperidone tabs: changed QLL=60 tabs/30 days
• P.16: Paroxetine tabs: changed QLL=60 tabs/30 days

September 2011

• P15:Gabapentin: removed QLL

August 2011

• P.8: Clarithromycin extended-release: QLL=28 tabs/30 days
• P.24: Natroba: added to the formulary with STEP

July 2011

• P.15: topiramate: removed QLL
• P.10: Intelence: PA required removed

June 2011

• P.9: fluconazole QLL for 150 mg=1 tab/Rx: removed QLL
• P.10: Fortovase: no longer available and removed from formulary
• P.11: Viramune XR: added to formulary
• P.11: Zovirax 5% cream: added to formulary
• P.15: fluoxetine 20 mg QLL=60 tabs or caps/30 days: removed QLL
• P.16: granisetron QLL=2 tabs/Rx: removed QLL
• P.21: losartan/losartan HCTZ: added to formulary
• P.22: Nitrostat: added to formulary
• P.24: calcipotriene ointment: added to formulary
• P.25: OTC oxymetazoline nasal spray: added to formulary
• P.28: Pancrease MT 4, 10, 16, 20: no longer available and removed from formulary
• P.28: Ultracaps MT 20: no longer available and removed from formulary
• P.31: Select-OB, Select-OB + DHA: added to formulary
• P.33: levofloxacin 0.5% ophth soln: added to formulary
• P.38: OTC Alcohol Prep Pads: added to formulary

March 2011

• P.19: nifediac cc: added to formulary
• P.19: acetazolamide ER: added to formulary
• P.21: ramipril: added to formulary
• P.22: Revatio: changed PA requirement to allow for “COVERED FOR CARDIOLOGISTS AND PULMONOLOGISTS; ALL OTHERS REQUIRE PA.”
• P.24: pyrethrin 0.33% OTC shampoo: added to formulary
• P.27: Senokot OTC (brand and generic OTC dosage forms): added to formulary
• P.27: lansoprazole oral disintegrating tablet: replaced Brand Prevacid Solu-Tab with generic; requirements still apply-COVERED FOR PULMONOLOGISTS (INCLUDING PEDIATRIC PULMONOLOGISTS) AND PEDIATRIC GASTROENTEROLOGISTS FOR CHILDREN 17 YEARS OF AGE AND YOUNGER
• P.30: cholecalciferol (Vitamin D): added to formulary
• P.31-32: added the following prescription prenatals to formulary: natalcare glosstabs, natatab Rx, prenafirst, prenatabs FA, prenatabs rx, vinate II, vinate az , vinate calcium, vinate gt, vinate m, vinate one; requirements still apply-PRENATAL VITAMINS (COVERED FOR FEMALES AGES 11 to 49), QLL=100 tabs/90 days for all legend prenatal vitamins
• P.33: Zymaxid: added to formulary
• P.36: sildec PE-DM drops, syrup: added to formulary