Quarterly pharmacy changes that are effective January 1, 2009 are noted below:

Drug Name	Indication	Description of Change (by Formulary Type)	Generic Alternatives	Tier 2 Alternatives
Byetta	Diabetes	Prior Authorization Removed (no tier changes) Commercial-Tier 3 Generics Plus- Tier 3 Medicare-  Tier 2 Medicaid – Non-Formulary	n/a	n/a
EvaMist	Hormone Replacement	New Medication Commercial-Tier 4 Generics Plus- Non-formulary Medicare-  Non-Formulary Medicaid – Non-Formulary	Estradiol	Premarin
Flector	Pain Inflammation	New Medication Commercial- Tier 4 Generics Plus- Non-formulary Medicare-  Non-formulary Medicaid – Non-formulary	Diclofenac Ibuprofen	n/a
Frova, Axert, Amerge, Maxalt, Zomig	Headaches	Step-edit through sumatriptan Patients will be required to step through generic sumatriptan before using all other agents in the class, except Relpax
IVIG	Immunodeficiency Syndromes	Prior Authorization Update Criteria now includes use for Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus infections, and hyperbilirubinemia in the newborn	n/a	n/a
Kinrix	Vaccine (polio, diphtheria, tetanus, pertussis)	New Medication Added as a medical benefit, and to Medicare Part D	n/a	n/a
Luvox CR	Obsessive-compulive disorder, Anxiety disorder	New Medication Commercial- Tier 4, Step-edit through 2   SSRIs, or 1 SSRI and Effexor XR Generics Plus- Non-formulary Medicare-  Non-formulary Medicaid – Non-formulary	fluvoxamine	n/a
Omnaris	Allergic Rhinitis	New Medication Commercial- Tier 4, Step-edit through fluticasone Generics Plus- Non-formulary Medicare-  Non-formulary Medicaid – Non-formulary	Fluticasone	Nasonex
Patanase	Allergic Rhinitis	New Medication Commercial- Tier 4 Generics Plus- Non-formulary Medicare-  Non-formulary Medicaid – Non-formulary	n/a	n/a
Pentacel	Vaccine (polio, diphtheria, tetanus, pertussis, Hib)	New Medication Added as a medical benefit, and to Medicare Part D	n/a	n/a
Pristiq	Depression	New Medication Commercial- Tier 4, Step-edit through Effexor XR Generics Plus- Non-formulary Medicare-  Tier 3 Medicaid – Non-formulary	Paroxetine Sertraline Fluoxetine Citalopram	n/a
Regranex	Diabetic Ulcers	Dose Limits Lifetime limit of 2 tubes unless there has been consultation with the physician on the potential for increased risk of death from cancer	n/a	n/a
Rotarix	Vaccine (rotavirus, oral)	New Medication Added as a medical benefit, and to Medicare Part D	n/a	n/a
Renvela	Phosphate Binder	New Medication Commercial- Tier 2 Generics Plus- Tier 2 Medicare-  Tier 2 Medicaid –Formulary	n/a	n/a
Seroquel, Abilify, Geodon, Zyprexa	Psychiatric medications	Step-edit through risperidone Unless the patient is taking a medication for cholesterol-lowering, diabetes, Parkinsons, osteoporosis; or has a history of breast cancer or pituitary tumor.  Patients currently on these medications will be grand-fathered
Treximet	Headaches	New Medication Commercial- Tier 4 Generics Plus- Non-formulary Medicare-  Non-formulary Medicaid – Non-formulary	Naproxen	Imitrex
Voltaren (topical gel)	Pain Inflammation	New Medication Commercial- Tier 4 Generics Plus- Non-formulary Medicare-  Non-formulary Medicaid – Non-formulary	Diclofenac	n/a

* For groups without a four-tier pharmacy plan, drugs listed as moving to Tier 4 will remain at Tier 3.

If you have questions or comments regarding these changes, please contact your Account Executive.