Quarterly pharmacy changes that are effective October 1, 2008 are noted below:

Drug Name	Treatment	Change Effective 10/1/08	Generic Alternative	Tier 2 Alternatives
Antiemetics	Nausea	Quantity Limit Updates Ondansetron:  no quantity limits Anzemet (Dolasetron):  10 tablets/Rx Granisetron: 15 tablets/Rx Emend (Aprepitant):  3 tablets/Rx	n/a	n/a
Avandaryl	Diabetes	Tier Change (moving down a Tier) Commercial-Tier 2 Generics Plus- Tier 3 Medicare-  Tier 2 Medicaid – Formulary	n/a	n/a
Bystolic	High blood pressure	New Medication Commercial- Tier 4 Generics Plus- Non-formulary Medicare-  Non-formulary Medicaid – Non-formulary	Atenolol Metoprolol Carvedilol
Emend Injection	Nausea	New Medication Not added to formulary. (medical)	Ondansetron Granisetron
Humira	Crohn’s disease Rheumatoid arthritis Psoriasis	Form Change Dermatologist added as an acceptable prescriber and new indication of psoriatic arthritis.	None	None
Janumet	Diabetes	Tier Change (moving down a Tier) Remove Prior Authorization Criteria Commercial- Tier 2 Generics Plus- Tier 3 Medicare-  Tier 2 Medicaid – Formulary	n/a	n/a
Januvia	Diabetes	Tier Change (moving down a Tier) Remove Prior Authorization Criteria Commercial- Tier 2 Generics Plus- Tier 3 Medicare-  Tier 2 Medicaid – Formulary	n/a
Jolessa, Quasense	Birth control	Tier Change (moving down an Tier) Commercial- Tier 2 Generics Plus- Tier 2 Medicare-  Tier 1 Medicaid - Formulary	Aviane Trivora
Keppra	Seizures	Prior Authorization Update Criteria now include use for off-label indications of myoclonic and primary generalized tonic-clonic seizures.	Carbamazepine Phenytoin	Lyrica
Lantus	Diabetes	Tier Change (moving down a Tier) Commercial-Changing to Tier 2 Generics Plus-Changing to Tier 3 Medicare-  Changing to Tier 2 Medicaid – Formulary	None	None
Levemir	Diabetes	Tier Change (moving up a Tier) Commercial-Changing to Tier 3 Generics Plus-changing to Non-formulary Medicare-  Changing to Tier 3 Medicaid – Non-formulary	None	Lantus
MoviPrep	Pre-Colonoscopy	New Medication Commercial- Tier 4 Generics Plus- Non-formulary Medicare-  Non-formulary Medicaid – Non-formulary	PEG electrolytes	Colyte GoLytely
Neulasta	Low white blood cell count	Prior Authorization Update Criteria expanded to include specific diseases where neutropenia can occur.	None	Neupogen
Prevident Gel	Prevention of dental cavities and tooth decay	Addition Commercial- Tier 2 Generics Plus- Non-formulary Medicare-  Tier 2 Medicaid – Formulary	Sodium Fluoride Paste
Provigil	Daytime sleepiness	Prior Authorization Update Criteria now include use for off-label indications of narcolepsy, shift work sleep disorder, Parkinson’s disease fatigue, and myotonic dystrophy.	None	None
Pulmicort Respules	Asthma	Restrictions Restrict use to children ages 12 months to 8 years of age, and to all individuals who cannot use MDIs.  Also, restrict to MDI only when other MDIs are being used by the member.	None	Flovent Asmanex
Relistor	Constipation due to pain medication	New Medication Commercial-  Tier 4 with prior auth Generics Plus- Non-formulary Medicare-  Non-formulary Medicaid – Non-formulary *Use is limited to patients on chronic opioid therapy, or trial and failure of stool softener plus stimulant laxative.	None	None
Simcor	High cholesterol	New Medication Commercial-  Tier 3 with prior auth Generics Plus- Non-formulary Medicare-  Non-formulary Medicaid – Non-formulary	Simvastatin	Crestor Niaspan
Tasigna	Leukemia	New Medication Commercial-  Tier 4 Generics Plus- Non-formulary Medicare-  Non-formulary Medicaid – Non-formulary *Use is limited to patients with CML resistant or intolerant to Gleevac.	None	Gleevec
Tussionex	Cough	Age Restrictions ≤5 years:  claim will reject (drug not indicated) 6-11 years:  Qty limit of 5 ml/day ≥12 years:  Qty limit of 10 ml/day	Guaifenesin AC Guaifenesin DAC Promethazine w/codeine
Changes under the Medical Benefit
Treanda	Leukemia	Added to Formulary- Medical Benefit	n/a (medical benefit)	n/a (medical benefit)
Ixempra	Breast cancer	Added to Formulary- Medical Benefit	n/a (medical benefit)	n/a (medical benefit)
Remicade	Crohn’s disease Ulcerative colitis Rheumatoid arthritis Psoriasis	Prior Authorization Update Criteria now include use for ocular sarcoidosis, as a third-line agent after corticosteroids and immunosuppressants.	n/a (medical benefit)	n/a (medical benefit)
Cimzia	Crohn’s disease	New Medication Added as a non-preferred agent with the same prior authorization criteria as Humira for the treatment of Crohn's disease. (medical benefit)	n/a (medical benefit)	n/a (medical benefit)

* 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.