Microsoft word - metroplus formulary summary10 22 07 final.doc

MetroPlus Formulary Update for CHP and FHP Program Members

In an effort to deliver the best and most efficient health care to its members MetroPlus
has implemented a formulary on October 1. As some members may currently have
prescriptions for excluded or restricted products MetroPlus will grandfather most of its existing members for 90 days (some therapeutic classes will have different grandfathering rules applied*). MetroPlus has contacted affected members and we strongly encourage all providers to do the same. For a full listing of formulary updates visit the MetroPlus website and go to the provider section; www.metroplus.org For questions call Customer Services: 1-800-303-9626 Mon-Sun 8am-8pm For authorizations call: 1-800-227-7269 Mon-Fri 9am-5pm, fax 1-866-511-2202
Coverage Changes
MetroPlus is implementing some changes in the products it covers in some therapeutic
Lescol XL, Lipitor, Mevacor, Pravachol, Zocor Mobic, Motrin, Naprosyn, Prevacid Nap Pak, Voltaren, Voltaren XR Zoloft, Paxeva, Celexa, Prozac, Prozac Weekly Actos, Avandia, Metformin, Fortamet, Glucophage IR, Atacand/HCTZ, Avalide, Avapro, Micardis, Captopril, Captopril/HCTZ, Capozide, Lotensin, Fosinopril/HCTZ, Lisinopril, Prinivil, Prinzide, Uniretic, Lisinopril/HCTZ, Quinapril, Univasc, Vasotec, Antiemetics Ondansetron Aloxi, Anzemet, Cesamet, Emend, Kytril, Marinol, Zofran tablets, Zofran * Members currently taking excluded SSRIs, ARBs, and Antidiabetics are grandfathered indefinitely, all other classes are grandfathered for 90 days. Lipitor will be covered with Prior Authorization for members who are on a Protease Inhibitor and have tried Pravastatin. Lipitor will be excluded for all other members. Prior Authorization may be requested for coverage of an excluded drug for members who have tried and failed all covered products in the same category as described above.

Drugs Requiring Prior Authorization
Prior authorization is required for the following drugs:
Weight-Loss medication, Retinoids (for members older than 26), Oral Anti-Fungal Agents, Lotronex, Xolair, Provigil and Revatio
Drugs With Quantity Limits
MetroPlus is implementing quantity limits on the following medications: Omeprazole, Prevacid, Prilosec OTC, Protonix
New Step Therapies
MetroPlus is implementing the following Step Therapies:
Must try and fail on 2 Topical Steroids within the past 120 days Must try and fail a covered ACE Inhibitor within the past 180 days. Covered ACE Inhibitors include: Benazepril, Benazepril/HCTZ, Captopril, Captopril/HCTZ, Enalapril, Enalapril/HCTZ, Fosinopril, Fosinopril/HCTZ, Lisinopril, Lisinopril/HCTZ, Quinapril, Quinapril/HCTZ, and Trandolapril. Must try and fail a 30 day supply of Prilosec OTC or Omeprazole 10mg before filling Prevacid, Protonix, Nexium, or Aciphex. Prilosec OTC pays at the generic copay. Must try and fail generic albuterol inhalation solution within Must try and fail one Steroidal Inhalant agent within the past 180 days. Must try and fail Claritin OTC before any of the following agents will pay: Allegra, Allegra-D, Clarinex, Clarinex-D, Zyrtec, or Zyrtec-D. Claritin OTC pays at the generic copay. Must try and fail generic metformin within the past 180 days before filling Actos, Avandia, Actoplus Met, Avandamet,

Source: http://www.metroplus.org/docs/CHP-FHP%20formulary%20summary10-22-07.pdf