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June 25, 2016

What's New in Pharmacy

Highlights of Changes in Preferred Drug List (PDL) effective January 2016

Antidepressants, Other
Pristiq is now a preferred agent.

Bronchodilators
ProAir Respiclick is a non-preferred agent and requires trial and failure of a preferred albuterol MDI (ProAir HFA or Proventil HFA).

Glucocorticoids, Inhaled
Flovent MDI switched from preferred to non-preferred status.  Aerospan and Asmanex switched from non-preferred to preferred status.  QVAR remains a preferred agent.

NSAIDS
Celecoxib (generic Celebrex) is non-preferred and requires trial and failure (or contra-indication to) at least one preferred NSAID. Diclofenac immediate release switched from preferred to non-preferred status but diclofenac sustained release has remained a preferred agent.

 

Prior Authorization Request Forms

 Title
A Universal Form - Can't find the form you need?
ACE Inhibitors
Acne Oral Antibiotics
Age Override Form
Aldara
Alprazolam XR
Alzheimer's Agents
Ampyra
Analgesics, Topical
Androgenic Agents
Angiotensin Modulators-Calcium Channel Blockers
Antibiotics, Otic (For The Ear)
Antibiotics, Topical
Anticoagulants
Anticonvulsants
Anticonvulsants for Pain and Mood Disorders
Antidepressants, Other
Antidepressants, SSRI
Antiemetics, Oral
Antifungals, Oral
Antifungals, Topical
Antihistamine, Minimally Sedating
Antihyperuricemics, Oral
Antiparasitics, Topical
Antiparkinson Agents
Antipsychotics, Injectable Long Acting
Antipsychotics, Oral
Antivirals, Topical
ARB - Angiotensin II Receptor Antagonists
Beta Blockers
Bone Resorption Suppression
Botox for Migraines
Botulinumtoxin, Other
Brand Name
Bronchodilators, Inhaled - Long Acting
Bronchodilators, Inhaled - Short Acting
Cephalosporins and Related Antibiotics
Chantix
Clonazepam Orally Disintegrating Tablets
Cymbalta
Cytokine and CAM Antagonists
Direct Renin Inhibitors
Emsam
EPSDT
Erythropoiesis Stimulating Proteins
Fentanyl Transmucosal
Fibromyalgia Agents
Fluoroquinolones, Oral
GI Motility
Glucocorticoid/Bronchodilator Combination, Inhaled
Glucocorticoids, Inhaled
Growth Hormone
H pylori Treatment
Hepatitis C Agents
Hospice
Hypoglycemics - Incretin Enhancers
Hypoglycemics - Incretin Mimetics
Hypoglycemics – SGLT2 Inhibitors
Immune Globulin
Immunosuppressives, Oral
Inhaled Antibiotics
Insulins
Intranasal Rhinitis Agents
Intranasal Vitamin B12
Leukotrienes
Lipotropics, Other
Macrolides-Ketolides, Oral
Marinol
Methadone, Initial Request
Methadone, Reauthorization
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
Opiate Dependence Treatments
Otic Antibiotics
Otic Anti-Infectives
OxyContin
Pancreatic Enzymes
Phosphate Binders
Physician Administered Drugs
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
Symlin
Synagis
Tobacco Cessation without Chantix
Topical Agents For Acne
Topical Analgesics
Topical Antibiotics
Topical Anti-fungal Nail Lacquer
Topical Antifungals
Topical Antivirals
Topical Narcotic Analgesics, Long Acting
Triptans
Ulcerative Colitis
Urinary Incontinence
Vitamin B12 - Intranasal
Xenazine
Xenical
Xolair
Zetia