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What's New in Pharmacy

Highlights of Changes in Preferred Drug List (PDL) effective January 2014

Antidepressants, SSRI
Escitalopram and paroxetine (immediate release only not controlled release) are now preferred agents.  Fluoxetine CAPSULES remain preferred while fluoxetine TABLETS are now NON-preferred.

Antihistamines
Fexofenadine is now NON-preferred.  Preferred agents remain: cetirizine tablets/syrup and loratadine.

Antihypertensives, Sympatholytics
NEW class of medications on the preferred drug list.  Brand name Catapres TTS patches are preferred over generic clonidine patches.

Epinephrine – Self Injected
Epi-Pen and Epi-Pen Jr are preferred agents.  Auvi-Q and generic epinephrine self-injector pens are non-preferred.

Steroids, Topical
New class of medications on the preferred drug list.  Please refer to the detailed listing on the new PDL categorized by potency.

Tobacco Cessation
Tobacco cessation products will now be covered by Idaho Medicaid – limitations include two quit attempts every 12 months.


Prior Authorization Request Forms

 Title
A Universal Form - Can't find the form you need?
ACE Inhibitors
Acne Topical
Advair
Age Override Form
Aldara
Alprazolam XR
Alzheimer's Agents
Amitiza
Ampyra
Analgesics, Topical
Androgenic Agents
Angiotensin Modulators-Calcium Channel Blockers
Antibiotics, Otic (For The Ear)
Antibiotics, Topical
Anticoagulants
Antidepressants, Other
Antidepressants, SSRI
Antiemetics, Oral
Antiepileptic Agents for Pain and Mood Disorders
Antiepileptics
Antifungals, Topical
Antihistamine, Minimally Sedating
Antihyperuricemics, Oral
Antiparasitics, Topical
Antiparkinson Agents
Antivirals, Topical
ARB - Angiotensin II Receptor Antagonists
Benzaclin/DUAC
Benzamycin
Beta Blockers
Bone Resorption Suppression
Botox for Migraines
Botulinumtoxin, Other
Brand Name
Bronchodilators, Inhaled - Long Acting
Bronchodilators, Inhaled - Short Acting
Celebrex
Cephalosporins and Related Antibiotics
Chantix
Ciclopirox Nail Lacquer
Clindamycin Pledgets
Clonazepam Orally Disintegrating Tablets
Colcrys
Cymbalta
Cytokine and CAM Antagonists
Direct Renin Inhibitors
Dulera
Emsam
EPSDT
Erythromycin Pledgets
Erythropoiesis Stimulating Proteins
Fentanyl Transmucosal
Fibromyalgia Agents
Fluoroquinolones, Oral
Glucocorticoids, Inhaled
Growth Hormone
Hepatitis C Agents-Interferons
Hepatitis C Agents-Ribavirin
Hospice
Hypoglycemics - Incretin Enhancers
Hypoglycemics - Incretin Mimetics
Immune Globulin
Immunosuppressives, Oral
Inhaled Antibiotics
Insulins
Intranasal Rhinitis Agents
Intranasal Vitamin B12
Intuniv
Kapvay
Leukotrienes
Lipotropics, Other
Macrolides-Ketolides, Oral
Marinol
Narcotic Analgesics, Long Acting
Narcotic Analgesics, Short Acting
Non-Stimulant Therapy for ADHD
NSAIDS
Ophthalmic Antibiotic – Steroid Combinations
Ophthalmic Antibiotics
Ophthalmic Anti-Inflammatories
Ophthalmic Glaucoma Drugs
Ophthalmics for Allergic Conjunctivitis
Otic Antibiotics
Otic Anti-Infectives and Anesthetics
Oxycontin
Pancreatic Enzymes
Phosphate Binders
Platelet Aggregation Inhibitors
PPI
Proton Pump Inhibitors (PPI)
Provigil & Nuvigil
Pulmonary Arterial Hypertension
Quantity Override
Regranex
Restless Leg Syndrome
Retinoids, Oral
Sedative Hypnotics
Skeletal Muscle Relaxants
SSRI Antidepressants
Statins
Stimulants
Strattera
Suboxone/Subutex
Symbicort
Symlin
Synagis
Tobacco Cessation without Chantix
Topical Analgesics
Topical Antibiotics
Topical Antifungals
Topical Antivirals
Topical Narcotic Analgesics, Long Acting
Triptans
Ulcerative Colitis
Uloric
Urinary Incontinence
Vitamin B12 - Intranasal
Vytorin
Xenazine
Xenical
Xolair
Zetia