GRANDFATHERED DRUGS

Jul 25, 2019 | News

GRANDFATHERED DRUGS

Effective January 1, 2016, any NEW prescriptions for the medications in the chart below are subject to the Step Therapy requirements set forth above.  If, however, you are currently taking a medication in one of these categories, the Fund will continue to provide benefits for your medication.

GRANDFATHERED DRUGS

Effective January 1, 2016, any NEW prescriptions for the medications in the chart below are subject to the Step Therapy requirements set forth above. If, however, you are currently taking a medication in one of these categories, the Fund will continue to provide benefits for your medication.

CATEGORY

STEP I

STEP II

ADD & ADHD

AMPHETAMINE SALTS

D-AMPHETAMINE ER

DEXMETHYLPHENIDATE 

DEXTROAMPHETAMINE

METHAMPHETAMINE

METHYLPHENIDATE

& ALL OTHER GENERICS

 

ADDERALL

ADZENYS

CONCERTA

DAYTRANA

DESOXYN

DEXEDRINE

EVEKEO

FOCALIN

JORNAY

METADATE

METHYLIN

PROCENTRA

QUILLIVANT

RELEXXII

RITALIN

VYVANSE

ZENZEDI

ANTI-MIGRAINE

DIHYDROERGOTAMINE

ERGOTAMINE-CAFFEINE TABLET

NARATRIPTAN

RIZATRIPTAN

SUMATRIPTAN

ZOLMITRIPTAN

& ALL OTHER GENERICS

 

AIMOVIG

AJOVY

AMERGE

CAFERGOT

D.H.E.45

EMGALITY

ERGOMAR

FROVA

IMITREX

MAXALT

MIGERGOT

MIGRANAL

RELPAX

SUMAVEL

TREXIMET

ZOMIG

ANTI-CONVULSANTS

CARBAMAZEPINE

CLONAZEPAM

DIVALPROEX

ETHOSUXIMIDE

FELBAMATE

FOSPHENYTOIN

GABAPENTIN

LAMOTRIGINE

LEVETIRACETAM OXCARBAZEPINE

PHENYTOIN

PRIMIDONE

TIAGABINE

TOPIRAMATE

VALPROATE

VALPROIC ACID

ZONISAMIDE

& ALL OTHER GENERICS

APTIOM

BANZEL

CARBATROL

CELONTIN

CEREBYX

DEPACON

DEPAKENE

DEPAKOTE

DILANTIN

EPIDIOLEX

FANATREX

FELBATOL

FYCOMPA

GABITRIL

KEPPRA

KLONOPIN

LAMICTAL

MYSOLINE

NEURONTIN

ONFI

OXTELLAR

PEGANONE

PHENYTEK

QUDEXY

SYMPAZAN

TEGRETOL

TOPAMAX

TRILEPTAL

TROKENDI

VIMPAT

ZARONTIN

ZONEGRAN

PROTON PUMP INHIBITORS

OVER THE COUNTER (“OTC”):

LANSOPRAZOLE DR OTC

NEXIUM OTC

OMEPRAZOLE OTC

OMEPRAZOLE-BICARB OTC

PREVACID OTC

PRILOSEC OTC

ZEGERID OTC

ACIPHEX

DEXILANT

ESOMEPRAZOLE

NEXIUM

OMEPRAZOLE-BICARB

PANTOPRAZOLE

PREVACID

PRILOSEC

PROTONIX

ZEGERID

ULCERATIVE COLITIS

AZULFIDINE

BALSALAZIDE

MESALAMINE

SULFASALAZINE

SULFAZINE

& ALL OTHER GENERICS

 

APRISO

ASACOL

COLAZAL

DELZICOL

DIPENTUM

ENTYVIC

HUMIRA

LIALDA

PENTASA

SIMPONI

STELARA