New drug Products

Zelboraf (vemurafenib)

    Zelboraf is a chemotherapy agent used to treat certain skin cancers. It is an oral tablet that is given twice daily.

  • Zelboraf will be added to the formulary as a non-preferred drug.
  • Prior authorization is required with a quantity limit of 240 tablets per 30 days.

Xgeva (denosumab)

    Xgeva is an intravenous medication to prevent bone degradation in patients diagnosed with certain cancers.

  • Xgeva will be added to the formulary as a non-preferred drug.
  • Prior authorization is required.

Xalkori (crizotinib)

    Xalkori is a chemotherapy agent used to treat certain kinds of lung cancer. It is an oral medication that is given twice daily.

  • Xalkori will be added to the formulary as a Specialty Tier drug.
  • Prior authorization is required and a quantity limit of 60 capsules per 30 days.

Viramune XR (nevirapine extended release)

    Viramune XR is an antiretroviral that is used in combination with other medications to treat HIV-1 infected patients. It is an oral tablet that is taken once daily.

  • Viramune XR will be added to the formulary as a preferred drug.
  • Quantity limits of 30 tablets per 30 days.

Safyral (drospirenone, ethinyl estradiol, and levomefolate calcium)

    Safyral is an estrogen/progestin combination oral contraceptive approved for the use of pregnancy prevention in women. It also treats low folate levels in the blood.

  • Safyral will be added to the formulary as a non-preferred drug.
  • Quantity limits of 28 tablets per 28 days.

Sorilux (calcipotriene)

    Sorilux (calcipotriene) is a topical foam used to treat patients with plaque-type psoriasis.

  • Sorilux will be added to the formulary as a non-preferred drug.
  • Quantity limit of 120gm per 30 days.

Potiga (ezogabine)

    Potiga is used with other medications to treat patients with seizure disorder. It is an oral tablet to be taken three times daily.

  • Potiga will be added to the formulary as a non-preferred drug.
  • Quantity limit of 120 tablets per 30 days.

Phoslyra (calcium acetate)

    Phoslyra is a phosphate binder to treat high phosphate levels in patients with end-stage kidney disease. It is available only as a liquid.

  • Phoslyra will be added to the formulary as a non-preferred drug.
  • Quantity limit of 1800ml per 30 days.

Lo Loestrin Fe (Norethindrone acetate/ethinyl estradiol and ferrous fumarate)

    Lo Loestrin Fe is an estrogen/progestin combination oral contraceptive approved for the use of pregnancy prevention in women.

  • Lo Loestrin Fe will be added to the formulary as a non-preferred drug.
  • Quantity limits are 28 tablets per 28 days.

Horizant (gabapentin enacarbil)

    Horizant (gabapentin enacarbil) is a once-daily tablet to treat moderate to severe Restless Legs Syndrome.

  • Horizant will be added to the formulary as a non-preferred drug.
  • Quantity limit of 30 tablets per 30 days.

Incivek (telaprevir)

    Incivek is an antiviral medication for patients with chronic hepatitis C that are newly diagnosed or have previously taken interferon-based therapy.

  • Incivek will be added to the formulary as a non-preferred drug.
  • Prior authorization is required with a quantity limit of 180 tablets per 30 days for 12 weeks.

Gralise (gabapentin, extended release)

    Gralise is used in patients that have nerve pain that was a complication following a shingles occurrence. It is a once-daily tablet.

  • Gralise will be added to the formulary as a non-preferred drug.
  • Prior authorization is required with quantity limits per 30 days.

Duexis (ibuprofen/famotidine)

    Duexis is approved for the treatment of rheumatoid arthritis and osteoarthritis in patients who also have an increased risk for gastric ulcer. It is an oral tablet given three times daily.

  • Duexis will be added to the formulary as a non-preferred drug.
  • Quantity limits of 90 tablets per 30 days.

Docefrex (docetaxel)

    Docefrex (docetaxel) is a chemotherapy agent used in patients that have certain kinds of breast, lung and prostate cancer. It is given by intravenous injection.

  • Docefrex will be added to the formulary as a non-preferred drug.
  • Prior authorization is required.

Dificid (fidaxomicin)

    Dificid (fidaxomicin) is a macrolide antibiotic to treat patients with Clostridium dificile- associated diarrhea in adults. It is an oral tablet given twice daily.

  • Dificid will be added to the formulary as a non-preferred drug.
  • Prior authorization is required.

Complera (emtricitabine/rilpivirine/tenofovir)

    Complera (emtricitabine/rilpivirine/tenofovir) is a combination antiretroviral to treat HIV patients that are new to antiviral therapy. It is given once daily.

  • Complera will be added to the formulary as a preferred drug.
  • Prior authorization is required with quantity limits of 30 tablets per 30 days.

Bromday (bromfenac)

    Bromday (bromfenac) is an NSAID ophthalmic drop used in patients undergoing cataract surgery to reduce inflammation and pain.

  • Bromday will be added to the formulary as a non-preferred drug.
  • Quantity limits of 2 bottles per 30 days.

Brilinta (ticagrelor)

    Brilinta is indicated for patients diagnosed with acute coronary syndrome and patients with stents to prevent blood clotting. It is an oral tablet to be taken twice daily with a low-dose aspirin.

  • Brilinta will be added to the formulary as a preferred drug.
  • Quantity limits of 60 tablets per 30 days.

Alsuma (sumatriptan succinate)

    Alsuma (sumatriptan succinate) is indicated for acute migraine attacks and acute cluster headaches. It is only available as a subcutaneous injection, in a pre-filled auto-injector.

  • Alsuma will be added to the formulary as a non-preferred drug.
  • Prior authorization is required with quantity limits of 6 injections per 30 days.

Arcapta (indacaterol maleate)

    Arcapta (indacaterol maleate) is a long-acting bronchodilator indicated only in patients with COPD. The dose is one capsule inhaled once daily.

  • Arcapta will be added to the formulary as a preferred drug.
  • Quantity limits of one inhaler (30 capsules) per 30 days.

Adcetris (brentuximab vedotin)

    Adcetris (brentuximab vedotin) is an intravenous chemotherapy agent to treat patients with Hodgkin’s Lymphoma after failure of other chemotherapy or stem cell transplant. It is given every 3 weeks for a maximum of 16 cycles.

  • Adcetris will be added to the formulary as a non-preferred drug.
  • Prior authorization is required for each cycle.