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Optumrx Step Therapy

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Optumrx Step Therapy Utilization management updates - July 1, 2019 Step therapy — Select Most medical conditions have many medication options. Although their clinical effectiveness may be the same, the cost can be very different. The Step Therapy program gives you the treatment you need, usually at a lower cost. Here’s how it works: With this program, you must try a Step 1 medication first, before a Step 2 medication may be covered. When you bring a prescription to your pharmacy, our system will check the medication for step therapy requirements. If your old pharmacy claims show you have tried a Step 1 medication in the recent past, the Step 2 medication may be filled. If not, the pharmacist will contact your doctor to explain next steps. We encourage you to talk about your treatment and medication options with your doctor. If you have questions about the Step Therapy program, call the phone number on your member ID card. In this drug list, brand-name medications are shown in UPPERCASE (for example, CLOBEX) and generic medications in lowercase (for example, clobetasol). 1 Select Formularies Step therapy medications If you have a prescription for any of the Step 2 medications below, you are required to first try a Step 1 medication(s) for benefit coverage. Condition Step 1 Step 2 Anti-infectives HIV3 Any one of the following brands: ATRIPLA JULUCA, SYMFI, SYMFI LO, TRIUMEQ OR CIMDUO AND Any one of the following preferred brands: ISENTRESS, TIVICAY Oral Brand Any one of the following generics: ACTICLATE, ADOXA, DORYX, DORYX Tetracyclines doxycycline, minocycline MPC, MINOLIRA, MONODOX, SEYSARA, TARGADOX, VIBRAMYCIN Otic Agents ofloxacin CETRAXAL, ciprofloxacin Cardiovascular Beta-Blockers Any two of the following generics: KAPSPARGO metoprolol tartrate, metoprolol succinate ER, bisoprolol, betaxolol, carvedilol IR or ER, labetalol, atenolol, acebutolol, propranolol IR or ER, pindolol, nadolol Renin- Any one of the following generics: EDARBI, EDARBYCLOR, TEKTURNA, Angiotensin amlodipine-benazepril, amlodipine- TEKTURNA HCT System Agents olmesartan, benazepril, benazepril- HCTZ, candesartan, candesartan-HCTZ, captopril, captopril-HCTZ, enalapril, enalapril-HCTZ, fosinopril, fosinopril- HCTZ, irbesartan, irbesartan-HCTZ, lisinopril, lisinopril-HCTZ, losartan, losartan-HCTZ, moexipril, moexipril- HCTZ, olmesartan, olmesartan- HCTZ, olmesartan-amlodipine-HCTZ, perindopril, quinapril, quinapril-HCTZ, ramipril, telmisartan, telmisartan-HCTZ, trandolapril, trandolapril-verapamil Statins Any one of the following generics: ALTOPREV, FLOLIPID2, LIPITOR, LIVALO atorvastatin, fluvastatin, fluvastatin ER, lovastatin, pravastatin, rosuvastatin, simvastatin Statins Any one of the following generics: ZYPITAMAG atorvastatin, fluvastatin, fluvastatin ER, lovastatin, pravastatin, rosuvastatin, simvastatin AND LIVALO1 Fibric Acid Any one of the following generics: FENOGLIDE, FIBRICOR, LOFIBRA, Derivatives fenofibric cap, fenofibrate tab, TRIGLIDE fenofibrate micronized cap, fenofibric acid tab AND LIPOFEN 2 Condition Step 1 Step 2 Antianginals Any one of the following generics or RANEXA preferred brands: acebutolol, amlodipine, amlodipine- benazepril, amlodipine-telmisartan, amlodipine-valsartan, atenolol, bextaxolol, bisoprolol, carvedilol, diltiazem, diltiazem ER, felodipine ER, isosorbide dinitrate ER, isosorbide mononitrate ER, isradipine, metoprolol, metoprolol ER, nadolol, nicardipine, nifedipine, nisoldipine SR, nitroglycerin ER, pindolol, propranolol, propranolol SR, timolol, trandolapril-verapamil, verapamil, verapamil ER BYSTOLIC, DILATRATE SR, INDERAL XL, INNOPRAN XL Central Nervous System ADHD Agents Any two of the following generics or ADDERALL XR2, ADZENYS ER2, preferred brands: ADZENYS XR ODT2, amphetamine-dextroamphetamine APTENSIO XR2, CONCERTA2, IR or ER, dexmethylphenidate IR or COTEMPLA XR-ODT2, DAYTRANA2, ER, dextroamphetamine IR or SR, DESOXYN2, DYANAVEL XR2, methylphenidate IR or ER, EVEKEO2, FOCALIN XR2, VYVANSE KAPVAY, METADATE CD2, METHYLIN2 SOLUTION, METHYLIN CHEW2, MYDAYIS2, PROCENTRA2, QUILLICHEW ER2, QUILLIVANT2, RITALIN LA2, ZENZEDI2 Anticonvulsants3 Any one of the following generics BRIVIACT lamotrigine IR, levetiracetam IR or ER, oxcarbazepine IR, topiramate IR Anticonvulsants3 topiramate IR QUDEXY XR, TROKENDI XR, topiramate ER Anticonvulsants3 oxcarbazepine IR OXTELLAR XR Antidepressants3 bupropion ER APLENZIN2 Antidepressants3 Any two of the following generics: FETZIMA2 desvenlafaxine succinate ER, duloxetine, venlafaxine, venlafaxine ER Antidepressants3 Any two of the following generics: DESVENLAFAXINE ER/KHEDEZLA2, bupropion, citalopram, desvenlafaxine PAXIL SUSPENSION, TRINTELLIX2 succinate ER, duloxetine, escitalopram, fluoxetine, mirtazapine, paroxetine, paroxetine ER, sertraline, venlafaxine, venlafaxine ER 3 Condition Step 1 Step 2 Antipsychotics3 Any one of the following generics FANAPT2, VRAYLAR2 or preferred brands: aripiprazole, olanzapine, quetiapine IR or ER, risperidone, SAPHRIS Insomnia Agents Any one of the following generics: BELSOMRA2 eszopiclone, temazepam, zaleplon, zolpidem, zolpidem CR Insomnia Agents Any one of the following generics: EDLUAR2, ZOLPIMIST2 zolpidem, zolpidem CR Migraine Agents Any one of the following generics: TREXIMET2, ZOMIG NASAL2 naratriptan, rizatriptan, sumatriptan, zolmitriptan Migraine Agents Any two of the following generics: ONZETRA XSAIL2 naratriptan, rizatriptan, sumatriptan, zolmitriptan Neurologic gabapentin GRALISE2 Agents Neurologic Any one of the following generics or LYRICA CR2, SAVELLA2 Agents preferred brands: amitriptyline, cyclobenzaprine, duloxetine, gabapentin LYRICA Non-Narcotic Any two of the following generics: CAMBIA, INDOCIN SUPPOSITORY, Analgesics diclofenac, diclofenac CR, diflunisal, INDOCIN SUSPENSION, TIVORBEX, etodolac, fenoprofen, flurbiprofen, VIVLODEX, ZORVOLEX ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamate, meloxicam, nabumetone, naproxen, oxaprozin, piroxicam, sulindac, tolmetin Opioid NARCAN EVZIO Antagonists Opioid clonidine LUCEMYRA2 Withdrawal Parkinson’s Any one of the following generics: NEUPRO Disease pramipexole IR or ER, ropinirole IR or ER Parkinson’s Any one of the following generics: RYTARY Disease carbidopa-levodopa, carbidopa-levodopa CR Parkinson’s Both of the following generics: rasagiline, XADAGO2 Disease selegiline Dermatology Rosacea SOOLANTRA FINACEA Rosacea MIRVASO RHOFADE 4 Condition Step 1 Step 2 Skin Cancer Any one of the following generics: diclofenac gel 3%2, PICATO, Agents fluorouracil, imiquimod SOLARAZE2 Topical Acne Any one of the following preferred brands: ACANYA, AKTIPAK, BENZACLIN, Treatments EPIDUO/EPIDUO FORTE, ONEXTON BENZAMYCIN, clindamycin-benzoyl peroxide, DUAC, VELTIN, ZIANA Topical Acne Any two generic single-agent topical CLINDAGEL Treatments clindamycin products Topical Psoriasis calcipotriene SORILUX Agents Topical Immuno- Any one of the following generics: EUCRISA modulators alclometasone, amcinonide, betamethasone, calcipotriene- betamethasone, clobetasol, clocortolone, desonide, desoximetasone, diflorasone, fluocinolone, fluocinonide, fluticasone, halobetasol, hydrocortisone, mometasone, pramoxine-HC, prednicarbate, triamcinolone Endocrinology Basal Insulin Any two of the following BASAGLAR preferred brands: LANTUS, LEVEMIR, TOUJEO, TRESIBA Diabetic Agents Any one of the following generics: ACTOPLUS MET XR, AVANDIA, metformin, metformin ER, glipizide- CYCLOSET, METFORMIN ORAL metformin, glyburide-metformin, SOLUTION, RIOMET pioglitazone-metformin Blood Glucose Both of the following preferred brands: ABBOTT2, ACON2, AT LAST2, BAYER2, Meters and ACCU-CHECK, ONETOUCH EMBRACE2, EPS2, FORA CARE2, Strips GLUCOCARD2, GMATE2, LIBERTY2, NEUTEK2, QUINTET2, RELION2, REVEAL2, SUPREME2, TRUE METRIX2, TRUETEST2, TRUETRACK2, ULTIMA2, UNISTRIP2 DPP4 Inhibitors Any one of the following generics: JANUMET, JANUMET XR, JANUVIA, metformin, metformin ER, glipizide- JENTADUETO, JENTADUETO XR, metformin, glyburide-metformin, TRADJENTA pioglitazone-metformin DPP4 Inhibitors Any one of the following preferred brands: alogliptin, alogliptin-metformin, JANUMET1, JANUMET XR1, JANUVIA1 alogliptin-pioglitazone, KAZANO, KOMBIGLYZE XR, NESINA, ONGLYZA, AND any one of the following OSENI preferred brands: JENTADUETO1, JENTADUETO XR1, TRADJENTA1 5 Condition Step 1 Step 2 GLP-1 Agonists Any one of the following generics: BYDUREON2, BYUREON BCISE2, metformin, metformin ER, glipizide- BYETTA2, OZEMPIC2, TRULICITY2, metformin, glyburide-metformin, VICTOZA2 pioglitazone-metformin GLP-1 Agonists Any one of the following preferred brands: ADLYXIN2, TANZEUM2 BYDUREON1, BYDUREON BCISE1, BYETTA1 AND any one of the following preferred brands: OZEMPIC1, TRULICITY1, VICTOZA1 GLP-1 Agonist Any one of the following brands: SOLIQUA2 Combinations ADLYXIN1, BYDUREON1, BYDUREON BCISE1, BYETTA1, OZEMPIC1, TANZEUM1, TRULICITY1, VICTOZA1, BASAGLAR1, LANTUS, LEVEMIR, TRESIBA, TOUJEO Any one of the following XULTOPHY2 preferred brands : BYDUREON1, BYDUREON BCISE1, BYETTA1, OZEMPIC1, TRULICITY1, VICTOZA1, LANTUS, LEVEMIR, TOUJEO, TRESIBA SGLT2 Inhibitors Any one of the following generics: GLYXAMBI, INVOKAMET, metformin, metformin ER, glipizide- INVOKAMET XR, INVOKANA, metformin, glyburide-metformin, JARDIANCE, SYNJARDY, SYNJARDY pioglitazone-metformin XR SGLT2 Inhibitors Any one of the following preferred brands: FARXIGA, QTERN, SEGLUROMET, INVOKANA1, INVOKAMET1, STEGLATRO, STEGLUJAN, INVOKAMET XR1 XIGDUO XR AND any one of the following preferred brands: GLYXAMBI1, JARDIANCE1, SYNJARDY1, SYNJARDY XR1 Short-Acting Any one of the following preferred
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