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Marylandphysicianscare.com

PREFERRED DRUG LIST UPDATES
March 1, 2014
Myfortic brand removed from formulary due to generic availability PrevPac brand removed from formulary due to generic availability February 1, 2014
Mycophenolic acid Generic added to formulary Sumatriptan Nasal Spray QL change from 12/month to 6/month January 1, 2014
Nicotine lozenge OTC: added to formulary QL = 90day supply/year MONTHLY QLL=324 lozenges/30 days Nicotrol Nasal Spray added to formulary 90day supply/year, MONTHLY QLL=15 bottle/30 days Nicotine gum OTC added to formulary QL = 90day supply/year, MONTHLY QLL 2 MG=660 pieces/30 days; MONTHLY QLL 4 MG=330 pieces/30 days Januvia, Janumet: PA removed, added STEP Brevicon, Estrostep FE: Brand name oral contraceptives were removed from the formulary Alyacen, Amethia, Amethia- Lo, Amethyst, Aubra, Azurette, Balziva, Beyaz, Briellyn, Camrese, Camrese Lo, Chateal, Dasetta 1/35, Elinest, Enskyce, Estarylla, Falmina Gildagia, Gildess, Heather, Introvale, Jencycla, Kurvelo, Larin FE, Levnorgestrel 1.5mg (Next Choice, My Way), Levonest, Lo Minastrin FE, Lornya, Lyza, Marlissa, Minastrin FE, Mono-Linyah, Natazia, Pimtrea, Pirmella, Ortho Tri Cyclen Lo, Orsythia, Philith, Quartette, Safyral, Syeda, Tri-Estaryll, Tri-Linyah, Vestura, Viorele, Wera, Zarah, Zenchent: added to the formulary Tamsulosin: Step therapy requirements removed December 1, 2013
Lidoderm 5% patch (brand): removed from formulary hydrocortisone w/pramoxine cream: removed from formulary due to medication being a DESI drug gatifloxacin 0.5% ophthalmic solution: added to formulary PREFERRED DRUG LIST UPDATES
November 1, 2013
Lidocaine 5% patch generic: added to formulary October 1, 2013
Terbinafine oral tablets: quantity limit of 84 tablets/365 days Metrogel 1% Gel: removed from the formulary September 1, 2013
Benzoyl peroxide 2.5% and 5% formulations: added to formulary Allegra 30 mg/5 ml Suspension: added to formulary August 1, 2013
July 1, 2013
children’s Tylenol elixir (OTC): added to formulary QL = 4grams APAP/day Zolmitriptan: added to formulary QL = 6 tabs/30days June 1, 2013
OTC acetaminophen tablets and drops: added to formulary with QLL of 4gm / day OTC bismuth subsalicylate (generic for Pepto Bismol): added to formulary Pantoprazole: PA requirement removed, added Step Therapy requirement PREFERRED DRUG LIST UPDATES
OTC ibuprofen 200mg tablets: added to formulary OTC calcium carbonate (generic for Tums): added to formulary OTC calcium citrate (generic for Citracal): added to formulary OTC multivitamins with Iron: added to formulary OTC neomycin/bacitracin/polymycin B (generic forNeosporin): added to formulary Dilantin Infatabs 50mg Chew: removed from formulary Hydrocortisone suppositories: removed from formulary Zovirax 5% ointment: removed from formulary Acyclovir 5% ointment: added to formulary Suboxone 2mg-0.5mg, Suboxone 8mg-2mg: removed from formulary buprenorphine-naloxone 2mg-0.5mg, 8mg-2mg: added to formulary with PA required for age < 16, QLL = 24 mg/day added fenofibrate 48mg, 145mg (generics for Tricor): added to formulary Phenytoin 50mg infatabs chew: added to formulary Januvia, Janumet, Janumet XR: added to formulary with PA glimepiride-pioglitazone: added to formulary with QLL of 30/30 days ondansetron 4mg, 8mg tabs, ODT, oral solution: PA removed, QLL changed to 30/30 days, (150ml/30 days for oral solution) Bosulif: added to formulary with PA, Requires authorization from eviti oncology services Stivarga: added to formulary with PA, Requires authorization from eviti oncology services Xtandi: added to formulary with PA, Requires authorization from eviti oncology services April 2013
Fluocinolone acetonide scalp oil and shampoo: added to formulary Clindamycin-benzoyl-peroxide gel (generic for Duac gel): added to formulary Desmopressin: QLL changed from 4 fills per 180 days to 4 fills per 130 days PREFERRED DRUG LIST UPDATES
April 2013
March 2013
Nasacort AQ: removed from formulary. Generic triamcinolone nasal spray added to formulary with ST required. February 2013
P.14: Comtan: removed from formulary. Generic entacapone added to formulary. P.16: Dovonex cream: removed from formulary. Generic calcipotriene cream added to P.16: Klaron 10% topical suspension: removed from formulary. Generic sulfacetamide sodium 10% topical suspension added to formulary P.30: Sanctura XR: removed from formulary. Generic trospium XR added with STEP, January 2013

Source: http://www.marylandphysicianscare.com/assets/pdf/providers/Approved%20Drug%20Benefits/MPC%20PREFERRED%20DRUG%20LIST%20UPDATES.pdf

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