Bulletin


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Bulletin Health Partners Formulary Changes BIN: 600428 PCN: 02530000 Communication #108MG12 Date: December 18, 2012 What You Need to Know In an effort to promote quality, cost-effective health care, Health Partners has made some formulary changes for all members enrolled in the state of Pennsylvania. Additions to the Formulary – Effective Immediately Addition to Formulary Ulesfia Muro-128 2% Eye Drops Permethrin 1% liquid Isentress chewable tablets 25mg and 100mg Escitalopram Baraclude •

Formulary Notes Step therapy with 1 day supply in previous 14 day supply of permethrin N/A at this time. N/A at this time. N/A at this time. N/A at this time. Preferred with PA for Hepatitis B

Medications available at the pharmacy with a valid prescription. A copy of the full 2012 formulary and Prior Authorization Forms are available at http://www.healthpart.com/provider_formulary.asp.

©2012 by Argus Health Systems, Inc. All Rights Reserved. The computer systems, procedures, databases, software programs, documentation and other materials (collectively "Information") created, maintained or provided by Argus Health Systems, Inc. ("Argus"), are proprietary to Argus and are confidential. 108MG12

Argus Health Systems, Inc. 1300 Washington St. Kansas City, MO 64105-1433 www.argushealth.com

Deletions from Formulary REMOVALS – Effective January 14, 2013 BRAND NAME

GENERIC NAME

Citranatal Rx, Prenatal Vitamin Completenate, Complete-Rf Prenatal, Co-Natal Fa, EngranHp, Inatal Ultra, Kpn, Maternal Vitamin & Mineral, Maternity, MVit, Mynatal, Mynatal Plus, Mynatal-Z, Mynate 90 Plus, Natalins, O-Cal Prenatal, P-D Natal Plus with Folic, Prenatabs Fa, Prenatal Z, Tri Rx, Trinatal Gt, Trinatal Ultra, Venatal-Fa, Vinacal, Vinate Calcium, Vinate Care, Vinate Gt, Vinate Ultra, Vinate-M, Vynatal-Fa Ovide Malathion

FORMULARY ALTERNATIVE(S) Prenaplus, Prenatal 19 Chewable, Prenatal Ad, Prenatal Low Iron, Prenatal Plus, Prenate Plus, Prenavite, Right Step Prenatal Vitamins, Se-Natal 19 Chewable, Stuart Prenatal, Triadvance, Trinatal Rx 1, Vinate One, Vol-Plus, Vol-Tab Rx, Mynatal Advance, Inatal Advance, Prenatal AD, Prenatatabs Rx

Permethrin Ulesfia (step edit)

Effexor Xr Tablets

Venlafaxine Xr Tablets

Venlafaxine XR Capsules

Zetia

Ezetimibe

Lovastatin, Pravastatin, Simvastatin, Atrorvastatin, Fenofibrate, Gemfibrozil, Tricor, Cholestyramine, Niacin

• • •

Members currently receiving these medications will receive a disruption letter giving them 30-days notice of the change and listing the formulary alternatives available. The member’s pharmacy will be notified that the above prescriptions are no longer on our list. If the physician thinks the member is still in need of the medicine, he/she should contact Health Partners to request a medical exception. Forms may be downloaded at http://www.healthpart.com/provider_formulary.asp and faxed to 866-240-3712.

Argus bulletin – 2012

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QUANTITY LIMITS/EDITS – Effective December 17, 2012 (unless otherwise noted) o

Quantity Limits • Prenatal Vitamins – 1 per day

o

DUR Edits and Age Edits • Prenatal Vitamins – Gender Edit • Isentress chewable tablets 25mg and 100mg – ages 2 through up to 12 • Viread (step therapy for HIV) (preferred with PA for Hepatitis B) – Effective date is TBD

Action Required Argus truly appreciates your cooperation and assistance in working with us as we make this change to the Health Partners formulary. If you have any questions or concerns about the requirements established for Health Partners, please contact Health Partners Pharmacy Services at 215-991-4300.

Argus bulletin – 2012

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