2008 Preferred Care Pharmacy Updates for Health Care Professionals
Pharmacy-related updates and advisories from
Preferred Care regarding changes effective
January 1, 2008 are published on this Web page,
in addition to being distributed via FastFax.
If you have any questions, please contact
Preferred Care’s Professional Relations
Service Center by phone or e-mail (left) weekdays,
from 7:00 a.m. – 6:00 p.m. Eastern Time.
2007 changes are listed below 2008. |
|
2008 Formulary Changes |
Effective January 1, 2008, the drugs listed below will be limited to a quantity of 15 tablets/capsules per 30 days. Quantities greater than 15 tablets/capsules per 30 days will require prior authorization from Preferred Care. |
| Dalmane® (flurazepam) |
| Doral® (quazepam) |
| Halcion® (triazolam) |
| Prosom® (estazolam) |
| Restoril® (temazepam) |
The following drug(s) have will require Prior Authorization in 2008. |
Hepsera (adefovir dipivoxil) |
Posted: November 1, 2007 |
2007 Formulary Changes for COMMERCIAL Members |
The Preferred Care Pharmacy and Therapeutics Committee has made the following changes to the three-tier formulary. These changes will become effective 1/1/2007. Your patients’ copays will change accordingly. These changes are based upon new clinical information, changes in the drugs available in the marketplace and contractual changes.
The following medications are moving from the Second Tier to the Third Tier.
|
Estrostep FE |
Lo Ovral |
Ortho-Novum |
Triphasil |
Flonase |
Nasonex |
Maxalt/MLT |
Frova |
Rowasa |
Eulexin |
|
|
The following drugs will require prior authorization in 2007. |
| Chantix |
Atacand/HCT |
Thalomid |
Infergen* |
| Nexium |
Aciphex |
Micardis/HCT |
Zegerid |
| Teveten/HCT |
Cozaar/Hyzaar |
Fertility Agents: Clomid, Profasi, Ovidrel |
* must be purchased through CuraScript |
These drugs will have a limit to the amount dispensed per month. |
Aciphex* |
Actiq |
Ambien/CR |
Avinza |
Kadian |
Lunesta |
Morphine SR |
MS Contin |
Nexium* |
omeprazole |
Oramorph SR |
Ortho-Evra |
Oxycodone SR |
Oxycontin |
Prevacid/Naprapac |
PrevPac |
Prilosec Rx |
Protonix |
Rozerem |
Sonata |
Zegerid* |
Fentanyl patch |
Duragesic |
Nuva-Ring |
| * Requires prior authorization |
Effective January 1, 2007, Preferred Care will cover medications used to treat erectile dysfunction with a quantity limit of 4 tablets or 6 injections per month. These drugs include Viagra, Levitra, Muse, Cialis, Caverject, Edex and alprostadil.
The following drugs have will have new step therapy rules in 2007. |
Accolate |
Avalide |
Avapro |
Benicar/HCT |
Diovan/HCT |
Singulair |
Zyflo |
|
Refer to the current Three-tier Drug List and Prescription Drug Quantity Limits policy on the Preferred Care Web site. For additional information, please contact Preferred Care’s Professional Relations Service Center weekdays, from 7:00 a.m. – 6:00 p.m. Eastern Standard Time, at (585) 325-3114 or (800) 999-3920, option #1 and TTY users call
(585) 325-2629 or (800) 662-1220.
Posted: November 1, 2006 |
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MEDICARE PART D Formulary Changes for 2007 |
Preferred Care has made significant improvements to our formulary beginning on January 1, 2007. Our new tiering structure is simple. Generic drugs will take a Tier 1 copayment (with few exceptions). Brand Name drugs will take a Tier 2 copayment, unless defined as a specialty drug, which will take a Tier 3 copayment. These changes may not affect the Medicare Part D members who are enrolled in the low-income subsidy program.
The following drugs will be newly designated as Specialty Drugs (Tier 3) in 2007. |
Arranon |
Gleevec |
Norditropin |
Rebetron |
Baraclude |
Iressa |
Nutropin/AQ/Depot |
Revlimid |
Exjade |
Matulane |
Orencia |
ribavirin/all Brands |
Genotrope |
Nexavar |
ProAir (will pay at Tier 2) |
Sutent |
The Centers for Medicare & Medicaid Services has discontinued coverage of drugs used to treat erectile dysfunction in 2007. These drugs include Viagra, Levitra, Muse, Cialis, Caverject, Edex and alprostadil. We will only cover these drugs under an employer-purchased enhanced plan.
The following drugs will require prior authorization beginning January 1, 2007. |
| Solutions which are used in a nebulizer machine |
Infergen |
Thalomid |
| The following drugs will not require prior authorization unless requesting an amount over the quantity limit. |
Aciphex |
Kadian |
Oramorph SR |
Prilosec Rx |
Actiq |
Lunesta |
Ortho-Evra |
Protonix |
Ambien/CR |
Morphine SR |
Oxycodone SR |
Rozerem |
Avinza |
MS Contin |
Oxycontin |
Sonata |
Duragesic |
Nexium |
Prevacid/Naprapac |
Zegerid |
Fentanyl patch |
omeprazole |
PrevPac |
|
| The following drugs have new step therapy rules and will require prior authorization if the required pre-requisites are not met. |
Accolate |
Avapro |
Diovan/HCT |
Singulair |
Atacand/HCT |
Benicar/HCT |
Hyzaar |
Teveten/HCT |
Avalide |
Cozaar |
Micardis/HCT |
Zyflo |
Refer to the Medicare Part D section of the Preferred Care Web site for the current Medicare Part D list and drug formulary changes. For additional information, please contact Preferred Care’s Professional Relations Service Center weekdays,
from 7:00 a.m. – 6:00 p.m. Eastern Standard Time, at (585) 325-3114 or
(800) 999-3920, option #1 and TTY users call (585) 325-2629 or (800) 662-1220.
Source: FastFax #105 (10/26/06)
Posted: October 26, 2006 |
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Drugs Available through CuraScript for 2007 |
Preferred Care is adding the following drugs to our Specialty Pharmacy Program. CuraScript will be the sole source for these drugs for Preferred Care Commercial members. For Medicare members, CuraScript is the preferred vendor. These changes will become effective 1/1/2007.
Generic Name |
Brand Name |
interferon alfacon-1 |
Infergen* |
palivizumab |
Synagis+ |
omalizumab |
Xolair* |
adefovir dipivoxil |
Hepsera* |
enfuvirtide |
Fuzeon |
teriparatide |
Forteo* |
entecavir |
Baraclude* |
* requires prior authorization through Preferred Care
+ if drug is provider-purchased, use of CuraScript is not mandatory
Some members maintain their prescription coverage through another carrier while using Preferred Care for their medical benefits. If these members purchase the drug through their pharmacy vendor, they may be subject to the carrier’s prior justification requirements and benefit limitations.
If you have a patient that is currently receiving one of the above medications, you may receive a letter from Preferred Care reflecting these changes. Members will also be receiving written notification of these changes. To initiate the process, prescriptions may be faxed to CuraScript at 1-888-773-7386 or call 1-888-773-7376.
If you have any questions about the Preferred Care Specialty Drug Program, please
call the Preferred Care Professional Relations Center. Representatives are available weekdays from 7:00AM – 6:00PM Eastern Time, at (585) 325-3114 (Option #2) or
(800) 999-3920 (Option #2). TTY users may call (585) 325-2629 or (800) 252-2452.
If you have any questions about ordering these medications, please call CuraScript at (888) 773-7376, ext. 234037.
Source: FastFax #118 (11/27/06)
Posted: November 29, 2006 |
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