GRANDFATHERED DRUGS

Jan 9, 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

ADDERALL

CONCERTA

DAYTRANA

DESOXYN

DEXEDRINE

EVEKEO

FOCALIN

METADATE

METHYLIN

PROCENTRA

QUILLIVANT

RITALIN

VYVANSE

ZENZEDI

ANTI-MIGRAINE

ANTI-MIGRAINE CONTINUED….

DIHYDROERGOTAMINE ERGOTAMINE-CAFFEINE TABLET

ISOMETHEPT-CAFF- ACETAMINOPHEN

ISOMETHEPT-DICHLORALP-ACETAMIN

NARATRIPTAN

RIZATRIPTAN

SUMATRIPTAN

ZOLMITRIPTAN

ALSUMA

AMERGE

AXERT

CAFERGOT

D.H.E.45

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

APTIOM

BANZEL

CARBATROL

CELONTIN

CEREBYX

DEPACON

DEPAKENE

DEPAKOTE

DILANTIN

FANATREX

FELBATOL

FYCOMPA

GABITRIL

KEPPRA

KLONOPIN

LAMICTAL

MYSOLINE

NEURONTIN

ONFI

OXTELLAR

PEGANONE

PHENYTEK

POTIGA

QUDEXY

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

LANSOPRAZOLE

OMEPRAZOLE

LANSOPRAZOLE

NEXIUM

OMEPRAZOLE

OMEPRAZOLE-BICARB

PANTOPRAZOLE

PREVACID

PRILOSEC

PROTONIX

ZEGERID

ULCERATIVE COLITIS

AZULFIDINE

BALSALAZIDE

SULFASALAZINE

SULFAZINE

APRISO

ASACOL

COLAZAL

DELZICOL

DIPENTUM

GIAZO

LIALDA

PENTASA