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Paramount Advantage™ Preferred Drug List

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Paramount Advantage™ Preferred Drug List Paramount Advantage™ Preferred Drug List (11/01/2019) INTRODUCTION ........................................................................................................................................................................................................................4 NOTICE OF NONDISCRIMINATION AND ACCESSIBILITY: DISCRIMINATION IS AGAINST THE LAW ............................................................................ 4 HOW TO SEARCH THIS DOCUMENT ...................................................................................................................................................................................... 6 PREFACE ...................................................................................................................................................................................................................................6 PHARMACY AND THERAPEUTICS COMMITTEE .................................................................................................................................................................. 6 DRUG LIST PRODUCT DESCRIPTIONS.................................................................................................................................................................................. 6 GENERIC SUBSTITUTION ........................................................................................................................................................................................................ 6 PLAN DESIGN ...........................................................................................................................................................................................................................7 PRIOR AUTHORIZATION ..........................................................................................................................................................................................................7 QUANTITY LIMITATIONS ......................................................................................................................................................................................................... 7 STEP THERAPY ........................................................................................................................................................................................................................7 LEGEND .....................................................................................................................................................................................................................................7 NOTICE ......................................................................................................................................................................................................................................8 ANALGESICS ............................................................................................................................................................................................................................9 NSAIDs .............................................................................................................................................................................................................................9 NSAIDs, TOPICAL ...........................................................................................................................................................................................................9 COX-2 INHIBITORS ......................................................................................................................................................................................................... 9 GOUT ...............................................................................................................................................................................................................................9 OPIOID ANALGESICS ..................................................................................................................................................................................................... 9 NON-OPIOID ANALGESICS ......................................................................................................................................................................................... 10 ANTI-INFECTIVES ...................................................................................................................................................................................................................10 ANTIBACTERIALS ......................................................................................................................................................................................................... 11 ANTIFUNGALS ..............................................................................................................................................................................................................12 ANTIMALARIALS ...........................................................................................................................................................................................................12 ANTIRETROVIRAL AGENTS ........................................................................................................................................................................................ 12 ANTITUBERCULAR AGENTS ....................................................................................................................................................................................... 13 ANTIVIRALS ..................................................................................................................................................................................................................13 MISCELLANEOUS ......................................................................................................................................................................................................... 13 ANTINEOPLASTIC AGENTS .................................................................................................................................................................................................. 14 ALKYLATING AGENTS ................................................................................................................................................................................................. 14 ANTIMETABOLITES ...................................................................................................................................................................................................... 14 HORMONAL ANTINEOPLASTIC AGENTS................................................................................................................................................................... 14 IMMUNOMODULATORS ............................................................................................................................................................................................... 14 KINASE INHIBITORS .................................................................................................................................................................................................... 15 TOPOISOMERASE INHIBITORS .................................................................................................................................................................................. 15 MISCELLANEOUS ......................................................................................................................................................................................................... 15 CARDIOVASCULAR ................................................................................................................................................................................................................15 ACE INHIBITORS ..........................................................................................................................................................................................................15 ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS .......................................................................................................................... 16 ACE INHIBITOR/DIURETIC COMBINATIONS .............................................................................................................................................................. 16 ADRENOLYTICS, CENTRAL ........................................................................................................................................................................................ 16 ALDOSTERONE RECEPTOR ANTAGONISTS ............................................................................................................................................................ 16 ALPHA BLOCKERS ....................................................................................................................................................................................................... 16 ANGIOTENSIN II RECEPTOR ANTAGONISTS/DIURETIC COMBINATIONS ............................................................................................................ 16 ANTIARRHYTHMICS ....................................................................................................................................................................................................
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