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Microsoft word - global current 2014.doc

Disease Management
ABOUT OUR FORMULARY
FORMULARIES
What is a formulary?
“Open” Formulary
A formulary is a listing of prescription medications that are preferred for use A plan that has adopted an “Open” formulary allows coverage for both by a plan and are dispensed through participating pharmacies to covered formulary and non-formulary drugs. Drug coverage is not dependent upon persons. This list is subject to periodic review and modification by the plan. the formulary list. By adhering to the formulary, the patient will be aiding their plan in cost-effective pharmacy management. Our formulary is based on the following criteria: effectiveness, safety (both of which are established by the FDA), therapeutic role in treatment and “Closed” Formulary
overall cost effectiveness. All medications on our formulary are FDA A plan that has adopted a “Closed” formulary ONLY allows coverage of
approved to be safe and effective for their therapeutic indications. This is our primary consideration when evaluating any medication. Any rebate or discount that is negotiated with the manufacturing pharmaceutical company A “closed” formulary affects the coverage of drugs in the following ways: takes place only after a medication has been recognized as therapeutically effective. And it is entirely up to a patient’s physician as to whether a certain Generic drugs are covered at the lowest copayment level. ** medication should be prescribed for said patient. Should a prescription be written for a non-preferred medication, the patient’s pharmacist may contact Brand name drugs on the formulary are covered at the lowest the physician and request substitution with a preferred medication. copayment level or the middle copayment level, depending on plan It is best that a patient show this formulary to his/her physician before a medication is prescribed. This will help to avoid any delay in filling the Brand name drugs that do not appear on the formulary will not be prescription should the patient later wish to have a preferred medication as opposed to a non-preferred medication. All generic medications are included on the formulary, however, only some are listed due to limited space. Any
“Multi-Tier” Formulary
new generic medications that are approved by the FDA as
A plan that has adopted a “Multi-Tier” formulary allows coverage for all therapeutically equivalent and bioequivalent are automatically covered
drugs, however a patient will pay higher copay for brand name drugs that do under this formulary in accordance with plan policy. We believe, in
general, that generic drugs are the most cost effective medications in
many cases since they are far lower in price than brand name drugs and
Generic drugs are covered at the lowest copayment level. since they are older drugs, physicians are more familiar with them in
regard to their side effects.
Brand name drugs on the formulary are covered at the lowest copayment level or the middle copayment level, depending on plan Note that generic medications are listed on the formulary in lower case
letters and brand name medications are listed on the formulary in upper case
letters.
Under a “multi-tier” formulary, the patient will be responsible for BRAND NAME DRUGS: Name identifying a drug as the product of a
specific pharmaceutical company. Also known as proprietary trademark name. Brand name drugs under patent protection are drugs protected by a patent issued to the original innovator or marketer. The patent prohibits the manufacture of the drug by other companies without consent of the innovator, as long as the patent remains in effect. * PREFERRED BRAND NAME DRUGS: Brand name drugs chosen by our
P. & T. Committee as preferred over other brand name drugs within the same therapeutic class. * GENERIC DRUGS : Drugs that are approved by the FDA, which have been
shown to be safe and effective, and are therapeutically equivalent and bio- equivalent to brand name drugs. These drugs contain the identical active ingredients and amounts as the brand name drugs. However, the generic drugs may be different in appearance in manners such as shape, size or color. The substitution of brand name drugs with generics will, in virtually all cases, Therapeutic class and drug form are plan specific and may or may not be covered. ** Not all generic drugs appear on the formulary due to space limitation.
produce the greatest savings for the client.
ANALGESICS
HIV Agents
All oral medications used for the treatment of ANTI-INFECTIVES
Influenza Agents
Cephalosporins
Lincosamides
Macrolides
Non-steroidal anti-inflammatory agents ANTINEOPLASTIC
Nitrofurantoin
Penicillins
Quinolones
Sulfonamides
Tetracycline
All oral antineoplastic agents under this class CARDIOVASCULAR
Ace Inhibitors & Combinations: Miscellaneous
Hepatitis Agents
* Therapeutic class and drug form are plan specific and may or may not be covered. ** Not all generic drugs appear on the formulary due to space limitation. Angiotensin Receptor Blockers & Combinations: Bile Acid Sequestrants
Miscellaneous Anti-hypertensives: Fibric Acid Derivatives
CNS AGENTS
HMG-CoA Reductase Inhibitors/Combo
Miscellaneous
Nicotinic Acids
Beta Blockers & Combinations: Calcium Antagonists & Combos: * Therapeutic class and drug form are plan specific and may or may not be covered. ** Not all generic drugs appear on the formulary due to space limitation. Biguanides
DERMATOLOGICALS
EARS, NOSE, & THROAT
Combination Products
Insulins
Meglitinides
Miscellaneous
Decongestants & Combinations: Sulfonylureas
GASTROINTESTINAL AGENTS
ENDOCRINE
* Therapeutic class and drug form are plan specific and may or may not be covered. ** Not all generic drugs appear on the formulary due to space limitation. OPHTHALMIC AGENTS
HEMATOLOGY
IMMUNOLOGICALS & VACCINES
RESPIRATORY AGENTS
IMMUNOSUPPRESSANTS
NUTRITION
Vitamins/Minerals/Electrolyte Modifiers: * Therapeutic class and drug form are plan specific and may or may not be covered. ** Not all generic drugs appear on the formulary due to space limitation.

SMOKING CESSATION
UROLOGICAL AGENTS
DETROL LA oxybutynin oxybutynin ER flavoxate hcl tolterodine TOVIAZ Benign Prostatic Hypertrophy Agents doxazosin finasteride tamsulosin caps terazosin
WEIGHT MANAGEMENT
* Therapeutic class and drug form are plan specific and may or may not be covered. ** Not all generic drugs appear on the formulary due to space limitation.

Source: http://www.globalrxcare.com/grc_formulary.pdf