A List of Medications That May Lower Your Patients' Costs
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A list of medications that may lower your patients’ costs INTRODUCTION Catamaran utilizes a Pharmacy and Therapeutics Committee (P & T Committee), made up of practicing physicians, pharmacists, and nurses to help ensure that our formulary is medically sound and that it supports patient health. This committee reviews and evaluates medications on the formulary based on safety and efficacy to help maintain clinical integrity in all therapeutic categories. FORMULARY DESIGN There are numerous formulary designs that can be used by a pharmacy benefits administrator. Catamaran has chosen a formulary structure which is open and incentive based. Open Formulary: features co‐payments for medications that are preferred and non‐ preferred brands, plus lower co‐payments for generic drugs. Incentive Based: features different co‐payments for medications that are on or off the formulary. In this type of formulary, the patient cost structure may be two‐tier, three‐ tier, or four‐tier design. USING THIS FORMULARY REFERENCE GUIDE TO HELP CONTAIN COSTS Many benefit sponsors use the Catamaran formulary to help manage the overall cost of providing prescription drug benefits. This formulary offers a wide range of medications from which to choose. We realize that this formulary reference guide may not include every drug from every manufacturer. However, choosing a preferred drug when it is appropriate can provide access to the necessary medications to stay healthy, at a cost that is more affordable. KNOWING HOW THE FORMULARY INFORMATION IS ORGANIZED The following formulary reference guide is designed so that generic products are listed first in each drug category. The preferred brand name products are listed next, and non‐preferred brand products are listed last. The Generic category is related to Tier 1 medications, Preferred category is related to Tier 2 medications, Non‐Preferred is related to Tier 3 medications, Specialty medications are related to Tier 4 medications, and Tier 00 medications are related to the preventative services covered under the Affordable Care Act. PLEASE NOTE: If a generic product is listed in the “generics” section and its corresponding brand‐name product is not listed in the “preferred brand‐name” section, then only the generic product is on the formulary. If a brand name product is listed in the “preferred brand‐ name” section and its corresponding generic product is not listed in the “generics” section, then a generic version of the medication is not available. Formulary Drug Edits Below is a list of the various edits associated with some drugs on the formulary as well as a brief definition. PA (Prior Authorization)‐ requires review and approval prior to filling QL (Quantity Limit)‐ limit on the quantity dispensed for that drug ST (Step Therapy)‐ approval subject to trial of preferred alternatives first AL (Age Limit)‐ approval of the drug is specific to a certain age range GL (Gender Limit)‐ approval of the drug is gender specific Mandatory Generic The Prescription Drug benefit is a “Mandatory Generic” program. Each Prescription will be filled as a Generic when available. If the Physician or the Covered Person requests a Brand Name Medication when there is an FDA “AB” rated Generic available, the Covered Person will be charged the applicable Deductible/ Co‐insurance/ Co‐payments plus the difference in the price of the Brand Name Medication and the available Generic. CONSIDERING PREFERRED ALTERNATIVES Catamaran realizes that the medications on the formulary may not always be appropriate for all patients. However, by referring to this formulary reference guide, one can help ensure the full advantage of the coverage provided by the prescription drug plan. Possible preferred alternatives are listed for commonly prescribed non‐preferred medications. Pharmacies cannot substitute a preferred brand‐name drug without the prescriber’s approval. Therefore, a pharmacist may contact the prescriber to obtain authorization to dispense an alternative preferred product when a non‐preferred product is prescribed. SAVING ON OUT‐OF‐POCKET COSTS The prescription drug plan determines the cost for generic, preferred brand‐name, and on‐ preferred brand‐name medications. Benefit providers often design prescription drug plans to encourage the use of generic and preferred brand‐name drugs. Choosing non‐preferred drugs may mean paying higher out‐of‐pocket expenses (such as coinsurance, co‐payments, and deductible amounts) or not receiving coverage at all. Patients may also pay less for generic drugs, or they may be asked to pay the cost difference between brand‐name drugs and their generic alternatives, which are preferred by the plan. CONSULTING THE PRESCRIBER’S OFFICE WHEN APPROPRIATE When employers and other benefit sponsors design their prescription drug plans, they may choose to provide coverage only for certain medications or for particular uses, time periods, doses, or quantities (e.g. they may exclude coverage for medications for unapproved, unproven, or cosmetic indications, as well as over‐the‐counter medications). When coverage for medications is provided based on use or quantity, Catamaran may contact your prescriber’s office for additional information to determine whether coverage is available under your plan. Patients who are unsure whether these coverage rules apply for a particular medication can consult their prescription drug benefit manual or contact a Catamaran Member Services representative to determine specific coverage requirements. *Formulary Disclaimer: Coverage for some drugs may be limited to specific dosage forms and/or strengths. The benefit design determines what is covered and the applicable co‐payment. The medications listed on this formulary are subject to change pursuant to the formulary management activities of catamaran. The presence of a medication on this formulary list does not guarantee coverage. To see the most up‐to‐date formulary, please visit your member website. You may also call Member Services at the number listed on your ID card to request a copy be mailed to you. Table of Contents ANTI-INFECTIVES . 1 PENICILLINS . 1 CEPHALOSPORIN . 1 FIRST GENERATION . 1 SECOND GENERATION . 1 THIRD GENERATION . 1 MACROLIDES . 1 TETRACYCLINES . 1 QUINOLONES . 1 AMINOGLYCOSIDES . 1 SULFONAMIDES . 1 ANTIMYCOBACTERIAL AGENTS . 2 ANTIFUNGALS . 2 ANTIVIRALS . 2 ANTIMALARIALS . 3 AMEBICIDES . 3 ANTHELMINTICS . 3 MISC. ANTI-INFECTIVES . 3 ANTINEOPLASTICS, ETC . 3 ALKYLATING AGENTS . 3 ANTIBIOTICS . 3 ANTINEOPLASTIC ENZYMES . 3 ANTIMETABOLITES . 3 ANGIOGENESIS INHIBITORS . 4 ANTIBODIES . 4 HORMONAL AGENTS . 4 IMMUNOMODULATORS . 4 MITOTIC INHIBITORS . 4 ENZYME INHIBITORS . 4 TOPOISOMERASE I INHIBITOR . 5 RADIOPHARMACEUTICALS . 5 CELLULAR IMMUNOTHERAPY . 5 ANTINEOPLASTICS MISC. 5 CHEMOTHERAPY RESCUE . 5 CHEMOTHERAPY ADJUNCTS . 5 CARDIOVASCULAR DRUGS . 5 CARDIAC GLYCOSIDES . 5 ANTIANGINAL AGENTS . 5 BETA BLOCKERS . ..