Formulary updates

UPMC Health Plan regularly updates its prescription drug formulary to provide its members with the best values and latest innovations in the marketplace. The Health Plan Pharmacy and Therapeutics Committee, which is made up of community physicians and pharmacists, makes decisions about which medications to include in the prescription drug formulary. The table below describes changes to the formulary.

Brand Name	Generic Name	Current Formulary Status	January 2008 Formulary Status	Clinical Summary
Diabetes Medications
Januvia	sitagliptin phosphate	Tier 3	Tier 2	Januvia is a once-daily medication in a new class used for type 2 diabetes.
Janumet	sitagliptin phosphate/metformin	Tier 3	Tier 2	Janumet is a combination product consisting of Januvia and metformin and is used for type 2 diabetes.
Glumetza	metformin	Tier 2	Non-covered	Glumetza is a long-acting metformin product used for type 2 diabetes. Generic metformin is available on the formulary.
Ascensia Contour and test strips	Bayer	Tier 3	Tier 2	Lifescan has been the single preferred agent for blood glucose testing machines and strips. We are adding a second preferred agent to offer new technology and more choice for diabetic members.
Ascensia Breeze 2 and test strips	Bayer	Tier 3	Tier 2	Lifescan has been the single preferred agent for blood glucose testing machines and strips. We are adding a second preferred agent to offer new technology and more choice for diabetic members.
Behavioral Health Medications
Branded Selective Serotonin Reuptake Inhibitors (SSRIs)		Tier 2	Tier 2 - Step Therapy	Branded SSRI products for depression, such as Lexapro, Paxil CR, Pexeva, Sarafem, and Prozac Weekly will now require a prior authorization to ensure the trial of generic alernative SSRIs (fluoxetine, citalopram, paroxetine, and sertraline) that are available. Members currently on this medication will be grandfathered to continue.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)		Tier 2	Tier 2 - Step Therapy	Currently this class includes Effexor XR and Cymbalta. The prior authorization is to ensure the trial of SSRI medications. Members currently on this medication will be grandfathered to continue.
Seroquel	quetiapine fumarate	Tier 2	Tier 2 - Prior Authorization on doses 200 mg and below	Seroquel is approved for use in patients with schizophrenia and bipolar disorder. The purpose of the prior authorization is to prevent the off-label use as a sleep aid.
Oncology Medications
Oral oncology medications - Gleevec, Tarceva, Iressa, Sutent, Nexavar, Sprycel, Tykerb, Revlimid, Targretin		Specialty Medication	Specialty Medication - Prior Authorization	The purpose of the prior authorization is to ensure appropriate (FDA-approved or compendia-supported) use of oral oncology medications. Members currently on these medications will be grandfathered to continue.
Cholesterol Medications
Vytorin	ezetimibe/simvastatin	Tier 2 - Step Therapy	Tier 3 - Step Therapy	Vytorin is a combination product containing generic Zocor and Zetia.
Niaspan	niacin	Tier 3	Tier 2	Niaspan is an extended-release formulation of niacin that is approved to help improve cholesterol.
Specialty Medications
Lucentis	ranibizumab	Specialty Medication	Specialty Medication - Prior Authorization	Lucentis is an injection used for age-related wet macular degeneration. The purpose of the prior authorization is to ensure it is being used for the appropriate diagnosis.
Trelstar, Trelstar LA	triptorelin pamoate	Specialty Medication - Prior Authorization	Non-covered	Trelstar and Trelstar LA are injectable specialty medications used in the treatment of prostate cancer and will now be considered non-covered medications. The preferred alternatives are Lupron and Zoladex. Members currently on this medication will be grandfathered to continue.
Intravenous immune globulin (IVIG)		Specialty Medication	Specialty Medication - Prior Authorization	IVIG is used to increase circulation levels of gamma globulin in certain immunoglobulin deficiency states and in treatment of a limited number of specified diseases. The purpose of the prior authorization is to ensure appropriate (FDA-approved or compendia-supported) use of IVIG.
Genotropin, Nutropin, Tevtropin, Omnitrope, and Saizen	growth hormones	Specialty Medication - Prior Authorization	Non-covered	Genotropin, Nutropin, Tevtropin, Omnitrope, and Saizen will now be considered non-covered medications with the preferred alternatives being Humatrope and Norditropin. All growth hormone agents are considered clinically equivalent and have the same chemical ingredient — somatropin.