Untitled
Prescription
Program
Drug List — To be used by members
who have a tiered drug plan.
AnThem BLUe CROSS AnD BLUe ShIeLD DRUG LISTYour prescription drug beneit includes coverage for medicines that you’ll ind on the Anthem Drug List. You can often ind more savings when your doctor prescribes medicine that is on our drug list. Here are some commonly asked questions and answers about how the drug list works with your prescription drug plan.
For more information
about your drug plan,
A. The Anthem Drug List, also called a formulary is a list of U.S. Food and Drug Administration
you can do the following:
(FDA)-approved brand-name and generic drugs that have been reviewed and recommended
for their quality and how well they work. The review is done by the National Pharmacy and
Go to anthem.com
Therapeutics (P&T) Process. The P&T Process is performed by an independent group of
•
Call customer service
practicing doctors and pharmacists in charge of the research and decisions surrounding
at the number on your
our drug list. This group meets regularly to review new and existing drugs and they choose the top drugs for our list—based on their safety, how they work and their value.
Because the drugs on our list are reviewed from time to time, it’s a good idea to check
•
Speech and hearing
the list to ind out if any drugs have been added or removed. You can do this by going to
impaired users
(TDD/TTY) should call
800-221-6915, Monday
A. Drugs on the Anthem Drug List are grouped into tiers. There are several factors that are
– Friday, 8:30 a.m. –
used to determine under which tier a drug will be put in. This can include (but it’s not
5:00 p.m., ET
•
Bring a copy of this drug
• Cost of the drug in comparison to other drugs used for the same type of treatment
list to your next doctor’s
• Availability of over-the-counter options
visit to help you and
• Other clinical and cost factors.
your doctor select the
lowest cost medicine
A. These are drugs that are developed by a company who holds the rights to sell them.
When the rights expire, other drug companies can make their own version of the drugs (see generic drugs below). You may be more familiar with brand-name drugs through advertising or because you know people who take them.
Q.
What is a generic drug? A. Generics are simply copies of brand-name drugs. Brand-name and generic drugs have the
same active ingredients, strength and dose. And the FDA requires that generic drugs meet the same high standards for purity, quality, safety and strength. With generics, you get
KEY FOR DRUG LIST
Tier 1 – Lowest copayment – Drugs
Q.
What if my doctor or I choose a brand-name drug when a generic version is available?
that offer the greatest value compared to others that treat the same
A. In most cases, you would be responsible for the copay that’s listed on the tier the drug is
on. This copay may include an added charge for the cost difference between the brand-
name medication and the generic version.
Tier 2 – Medium copayment – Brand-
Q.
What are “clinically equivalent” medications? How does this affect my drug coverage?
A. When drugs are compared in studies, some drugs have been found to be just as effective
as others. These drugs are called “clinically equivalent” so it means they work just as
well. Part of the P&T Process is to review the most current studies to see if multiple drugs
used to treat a disease or a condition have the same effect on a patient. When this is the
case, the Process review team may suggest that we cover only the lower cost drug (so we
can help keep the overall cost of care as low as possible). This means your speciic drug
effects, if they’re more affordable, etc.
plan may not cover some drugs (indicated by a ^ symbol next to the drug name) that have
Tier 3 – Highest copayment – These are
Q.
What if my medication is not on the drug list?
Tier 3 drugs may have generic versions in Tier 1 and may cost more than the
A. You may want to irst check with your doctor about prescribing a drug that is on the drug
list. If your doctor prescribes a drug that’s not on the drug list, you will need to pay the copayment that applies to drugs that are not on the list.
Tier 4 – Many drugs on this tier
are “specialty” drugs used to treat
Q.
Can I request that a drug be added to the drug list?
A. You or your doctor can put in a request to add a drug to the drug list. You can do this either
in writing or on our website. Requests are reviewed by the P&T Process team during the drug
list review. Please note that if a drug request is approved, it does not guarantee coverage.
Some drugs, such as those used for cosmetic purposes, may be excluded from your
beneits. Please refer to your insurance Certiicate or Evidence of Coverage to know for sure.
Cartia XT
DO,
QL
Aviane
PA
ethynodiol diacetate
PA Glycolax
Granisetron
QL
Azelastine
QL
norethindrone
PA
Azelastine nasal
QL
Azithromycin
QL
Bacitracin zinc/polymyxin B Cefuroxime
QL
Felodopine
DO,
QL
Diltia XT
DO,
QL
Diltiazem CD
DO,
QL
Diltiazem CR
DO,
QL
Fentanyl
PA,
QL
Alendronate
QL
Diltiazem SR
DO,
QL
Fexofenadine
QL
Hydrocodone/APAP
QL
Disopyramide CR 150mg Flunisolide Nasal Spray
Ciproloxacin
QL
Citalopram
DO,
QL
Fluoxetine
DO,
QL
Amlodipine
DO,
QL
Budeprion XL
DO,
QL
Amnesteem
QL
Budesonide
QL
Imiquimod
QL
Buprenorphine
QL
Fluvoxamine
DO
soln/nasal spray
QL
Codeine/APAP
QL
Fosinopril
DO,
QL
Amoxicillin/clavulanate, Butorphanol tartrate
10mg/ml N.S.
QL
Calcipotriene Oint & Soln. Cyclophosphamide
APAP/caffeine/butalbital Carbamazepine, ER
Isotretinoin
QL
Gianvi
PA
Itraconazole
PA
norethindrone
PA
Ketorolac
QL
spray and inj.
QL
Propoxyphene/APAP
QL
Lansoprazole, ODT
QL
Nifedipine ER
DO,
QL
Terbinaine
PA
Nisoldipine
DO,
QL
Leuprolide
PA*
estradiol
PA
Ocella
PA
Levora
PA
Oloxacin
QL
Microgestin
PA
Omeprazole
QL
Omeprazole/bicarb
QL
Ondansetron
QL
Tramadol, ER
QL
Tramadol/APAP
QL
Sertraline
DO,
QL
Pravastatin
DO,
QL
Simvastatin
DO,
QL
Morphine SR
QL
Tretinoin
PA
Losartan
DO,
QL
Losartan/HCTZ
DO,
QL
Lovastatin
DO,
QL
Oxycodone ER
QL
Oxycodone/APAP
QL
and minerals/iron/folic Sodium sulfacetamide/
Oxymorphone
QL
Sotret
QL
Pantoprazole
QL
Paroxetine, SR
DO,
QL
Tri-nessa
PA
Naratriptan
QL
Meloxicam
QL
Trivora
PA
prednisoloneophth sol. Trypsin/balsam peru/
Plan B 1.5mg
QL
Plavix
QL
Tamilu
QL
Tarceva
PA
Lipitor
DO,
QL
Pradaxa
QL
Zaleplon
ST,
QL
Flovent, HFA
QL
Tekturna, HCT
DO,
QL
Temodar
PA†
Zolpidem, ER
QL
Combivent
QL
Maxalt, MLT
QL
Testim
PA,
QL
Foradil
QL
Thalomid
PA
Fosamax Plus D
QL
Fosamax solution
QL
Pristiq
DO,
QL
Accu-chek Product Line
QL Creon
ProAir HFA
QL
Activel a 0.1-0.5
PA†
Crestor
DO,
QL
Actonel
QL
Actonel with Calcium
QL
Trilipix
QL
ActoPlus Met, XR
QL
Protopic
ST
Proventil HFA
QL
Gleevec
PA
Pulmicort Respules
QL†
Advicor
DO
Neulasta
PA,
QL*
Neupogen
PA*
Nexavar
PA
Valturna
DO,
QL
Nexium
QL
Androgel
PA,
QL
Diovan
DO,
QL
Retin-A Micro
PA
Diovan HCT
DO,
QL
Veramyst
QL
Iressa
PA
Duetact
QL
Asmanex
QL
Dulera
QL
Janumet
QL
Astepro
QL
Januvia
QL
Efient
DO,
QL
Avinza
QL
Elidel
ST
Savel a
QL
Kombiglyze
QL
Serevent Diskus
QL
Oforta
PA
Vyvanse
PA
One Touch Product Line
QL
Singulair
QL
Onglyza
DO,
QL
Xeloda
PA
Spiriva
QL
Ortho Evra
PA
Sprycel
PA
Ortho Tri-Cyclen Lo
PA
OxyContin
QL
SL Film
PA,
QL
Leukine
PA*
Byetta
ST,
QL
Levaquin
QL
Pataday
QL
Sutent
PA
Exforge
DO,
QL
Patanol
QL
Symbicort
QL
Exforge HCT
DO,
QL
Lexapro
DO,
QL
Perforomist
QL
Arthrotec
ST
Astelin
QL
Flonase
QL
Malarone
PA
Plan B 0.75mg
QL
Abstral
PA,
QL
Atacand
DO,
QL
Atacand HCT
DO,
QL
Covera HS
DO
Augmentin, XR
QL
Cozaar
DO,
QL
Forteo
PA,
QL*
Maxair
QL
Avalide
DO,
QL
Fortesta
PA,
QL
Maxaquin
QL
Avandamet
ST,
QL
Fosamax tablets
QL
Aciphex
ST,
QL^
Avandaryl
ST,
QL
Actemra
PA*
Avandia
ST,
QL
Acthar HP
PA,
QL*
Avapro
DO,
QL
Gelnique
ST
Miacalcin Spray
QL
Avelox
QL
Genotropin
PA,
QL*
Micardis, HCT
DO,
QL
Prevacid
ST,
QL^
Activella 1.0-0.5
PA
Gilenya
PA,
QL*
Migranal
QL
Prevpac
QL
Actiq
PA,
QL
Axert
ST,
QL
Prilosec
ST,
QL^
Axiron
PA,
QL
Primaxin
QL
Azor
DO,
QL
Kapidex)
ST,
QL
Adcirca
PA
Beconase AQ
ST,
QL
Benicar, HCT
DO,
QL
Differin
PA
Humatrope
PA,
QL*
Procrit
PA*
Aerobid, M
QL
Benzaclin
ST
Humira
PA,
QL*
Prolia
PA,
QL*
Aggrenox
QL
Bepreve
ST,
QL^
Hybolin
PA
Alamast
ST,
QL^
Hyzaar
DO,
QL
Protonix
ST,
QL^
Aldara
QL
Betaseron
ST*
Provigil
PA,
QL
Imitrex
QL
Nasacort AQ
ST,
QL
Prozac, Weekly
QL
Allegra, D
ST,
QL^
Boniva
ST,
QL
Edarbi
DO,
QL
Imitrex Nasal Spray
QL
Nasarel
QL
Pulmicort Flexhaler
QL
Alocril
ST,
QL^
Edex
PA,
QL
Infergen*
PA
Neumega
PA*
Alomide
ST,
QL^
Caduet
DO
Edluar SL
ST
Qualaquin
PA,
QL
Cambia
QL
Effexor, XR
DO,
QL
Intron A
PA*
Raptiva
PA
Elestat
ST,
QL^
Norditropin
PA,
QL*
Alsuma
ST,
QL
Noroxin
QL
Kadian
QL
Norvasc
DO,
QL
Relenza
QL
Altoprev
ST,
DO
Emadine
ST,
QL^
Nucynta
QL
Relpax
ST,
QL
Cardizem CD, LA
DO,
QL Embeda
QL
Kineret
PA*
Nutropin, AQ
PA,
QL*
Remicade
PA*
Alvesco
QL
Nuvaring
PA,
QL
Ambien
QL
Enablex
ST
Kytril
QL
Ambien CR
ST,
QL
Enbrel
PA,
QL*
Lamictal chew 5 & 25mg, Omnaris
ST,
QL
Revatio
PA,
QL
Amerge
QL
Caverject
PA,
QL
Amevive
PA*
Epogen
PA*
Omnitrope
PA,
QL*
Ceftin
QL
Lamisil Tablet
PA
Onsolis
PA,
QL
Rhinocort Aqua
ST,
QL
Ampyra
PA,
QL*
Celebrex
ST,
QL
Lastacaft
ST,
QL
Roxicet
QL
Anadrol-50
PA
Opana ER
QL
Rozerem
ST,
QL
Androderm
ST,
QL
Lescol, XL
ST,
DO,
QL
Optivar
ST,
QL^
Android
PA
Levitra
PA,
QL
Ryzolt
QL
Cialis
PA,
QL
Orencia
PA*
Saizen
PA,
QL*
Anzemet
QL
Cimzia
PA,
QL*
Livalo
ST,
DO,
QL
Ovidrel
PA*
Sanctura, XR
ST
Apidra
ST
Cipro XR
QL
Extavia
ST*
Oxandrin
PA
Sancuso
QL
Aplenzin
DO,
QL
Clarinex, D
ST,
QL^
Factive
QL
Oxytrol
ST
Sarafem
QL
Patanase
QL
Seasonale
PA
Aranesp
PA*
Serostim
PA,
QL*
Fentora
PA,
QL
Lunesta
QL
Paxil CR
DO,
QL
Simcor
QL
Lupron Depot
PA*
Pegasys
PA,
QL*
Simponi
PA,
QL*
Peg-Intron
PA*
Flector
ST
Lyrica
PA
Penlac
PA
Treximet
ST,
QL
Vytorin
ST,
QL
Nutropin, AQ
PA,
QL
Sonata
ST,
QL
Wellbutrin XL
DO,
QL
Actemra
PA
Forteo
PA,
QL
Omnitrope
PA,
QL
Winstrol
PA
Acthar HP
PA,
QL
Orencia
PA
Sporanox Solution
PA
Genotropin
PA,
QL
Peg-Intron
PA
Stadol
QL
Xgeva
PA,
QL*
Amevive
PA
Gilenya
PA,
QL
Pegasys
PA,
QL
Xifaxan
ST,
QL
Ampyra
PA,
QL
Stelara
PA,
QL*
Xolair
PA*
Procrit
PA
Striant
PA
Uloric
ST
Xopenex HFA
QL
Humatrope
PA,
QL
Subutex
QL
Ultram, ER
QL
Aranesp
PA
Humira
PA,
QL
Sular
DO,
QL
Prolia
PA,
QL
Sumavel Dosepro
ST,
QL Univasc
Xyzal
ST,
QL^
Increlex
PA
Suprax
QL
Yasmin
PA
Infergen
PA
Remicade
PA
Repronex
PA
Synagis
PA
Zegerid
ST,
QL^
Caverject
PA,
QL
Intron-A
PA
Roferon-A
PA
Synarel
PA
Saizen
PA,
QL
Kineret
PA
Tekamlo
DO,
QL
Ventavis
PA
Cimzia
PA,
QL
Leukine
PA
Serostim
PA,
QL
Tequin
QL
Ventolin HFA
QL
Zetia
ST,
QL
Leuprolide
PA
Simponi
PA,
QL
Tekamlo
DO,
QL
Verelan PM
DO,
QL
Zithromax
QL
Testopel
PA
Lupron, Depot
PA
Stelara
PA,
QL
Testred
PA
Teveten, HCT
DO,
QL
Zofran
QL
TevTropin
PA,
QL
Tev-Tropin
PA,
QL*
Viagra
PA,
QL
Zoladex
PA
Zoloft
DO,
QL
Tiazac
DO,
QL
Zolpimist
ST,
QL
Viibryd
ST,
QL
Zomig, ZMT
ST,
QL
Edex
PA,
QL
Vimovo
QL
Zorbtive
PA,
QL*
Eligard
PA
Neulasta
PA,
QL
Vivaglobulin
PA
Zyclara
QL
Enbrel
PA,
QL
Neumega
PA
Xgeva
PA,
QL
Toradol
QL
Epogen
PA
Neupogen
PA
Xolair
PA
Tradjenta
QL
Extavia
ST
Norditropin
PA,
QL
Zorbtive
PA
† = A generic equivalent of this drug recently became available or wil be available soon. After the generic drug becomes available and notiication
requirements are met, this brand-name drug wil become Tier 3 or may no longer be covered by your prescription drug plan. Check anthem.com to ind out about changes in tier status.
^ = This product has clinically equivalent alternatives included on the drug list and, as a consequence, such product may not be covered under
your pharmacy beneit. Please consult your on-line pharmacy account through your health plan website, anthem.com, for details on coverage.
* = These drugs are Tier 4 for those members that do not have a Tier 4 plan.
PA = PRIOR AUTHORIZATION REQUIRED. Prior authorization is the process of obtaining approval of beneits before certain prescriptions may
be illed.
QL = QUANTITY LIMITS. Certain prescription drugs have speciic quantity limits per prescription or per month.
ST = STEP THERAPY REQUIRED. You may need to use one medication before beneits for the use of another medication can be authorized.
Please note: Foradil and Serevent are safety edits that prevent duplication of therapy.
DO = DOSE OPTIMIZATION REQUIRED. Normally involves the conversion from twice-daily dosing to a once-daily dosing schedule.
Not all medications and not all plans are subject to prior authorization and quantity limits. For more information regarding prior authorization or quantity limits, contact Member Services at the telephone number listed on your identiication card.
For Kentucky Residents Only:
In selecting medications for the prescription drug formulary, the therapeutic efi cacy and cost effectiveness are addressed for each category. All therapeutic categories are represented on the formulary by at least one medication. When a closed formulary is in effect, only medications that are included on the formulary are a covered service. In certain clinical situations, a member may require use of a non-formulary product. Anthem has criteria that permits a member to obtain a non-formulary medication in a closed formulary plan. If specii c criteria are met, a member can receive a non-formulary drug for a formulary copay. The criteria preserves the clinical integrity of the drug formulary and provides a process by which deviations from the formulary may be allowed. An appeals process is in place for any medications that do not meet the criteria.
For more information, please visit anthem.com.
•
If you have additional questions about your prescription
benefi ts please call the Member Services number on your
ID card
•
Speech and hearing impaired (TDD/TTY users) should call
800-221-6915, Monday – Friday, 8:30 a.m. – 5:00 p.m., ET
•
For the most current version of this prescription drug list,
please visit anthem.com
•
Bring a copy of this drug list/formulary to your next doctor’s
visit to assist in selecting the lowest cost medications
Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain afi liates administer non-HMO benei ts underwritten by HALIC and HMO benei ts underwritten by HMO Missouri, Inc. RIT and certain afi liates only provide administrative services for self-funded plans and do not underwrite benei ts. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia (excluding the city of Fairfax, the town of Vienna and the area east of State Route 123): Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin (“BCBSWi”), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation (“Compcare”), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and
Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.
Source: http://images.pcmac.org/Uploads/JenningsSD/JenningsSD/Divisions/DocumentsCategories/Documents/RX%20Formulary%20072011.pdf
December, 2005 Melanoma and Redox: A riddle wrapped in a mystery inside an enigma * Frank L Meyskens Jr M.D., FACP Professor of Medicine and Biological Chemistry, Director Chao Family Comprehensive Cancer Center, Senior Associate Dean of Health Sciences College of Health Sciences University of California Irvine, [email protected] I very much liked the title of the SMR article authorized by
INDICADORES DE INNOVACIÓN TECNOLÓGICA Gustavo Lugones, Fernando Peirano, Miguel Giudicatti y Julio Raffo* Ha tomado ya un consenso generalizado el hecho que la conducta tecnológica de las empresas tiene tanto importantes consecuencias en sus competencias individuales, como fuertes implicancias en la elección tácita del sendero de De esta manera, contar con firmas innovativas supon