FEP® Blue Focus Formulary (907) Effective January 1, 2022 The FEP formulary includes a preferred drug list which is comprised of Tier 1, generics and Tier 2, preferred brand-name drugs, preferred generic specialty drugs, and preferred brand-name specialty drugs. Ask your physician if there is a generic drug available to treat your condition. If there is no generic drug available, ask your physician to prescribe a preferred brand-name drug. The preferred brand-name drugs within our formulary are listed to identify medicines that are clinically appropriate and cost-effective. Click on the category name in the Table of Contents below to go directly to that page INTRODUCTION ........................................................................................................................................................................................................................ 5 PREFACE ................................................................................................................................................................................................................................... 5 PRIOR APPROVAL ................................................................................................................................................................................................................... 5 QUANTITY LIMITATIONS ......................................................................................................................................................................................................... 5 PHARMACY AND MEDICAL POLICY COMMITTEE ................................................................................................................................................................ 5 PRODUCT SELECTION CRITERIA .......................................................................................................................................................................................... 6 FORMULARY PRODUCT DESCRIPTIONS .............................................................................................................................................................................. 6 GENERIC SUBSTITUTION ........................................................................................................................................................................................................ 7 DRUG EFFICACY STUDY IMPLEMENTATION DRUGS ......................................................................................................................................................... 7 EDITOR ...................................................................................................................................................................................................................................... 7 NOTICE ...................................................................................................................................................................................................................................... 7 LEGEND ..................................................................................................................................................................................................................................... 7 ANALGESICS ............................................................................................................................................................................................................................ 9 NSAIDs ............................................................................................................................................................................................................................. 9 NSAIDs, COMBINATIONS ............................................................................................................................................................................................... 9 NSAIDs, TOPICAL ........................................................................................................................................................................................................... 9 COX-2 INHIBITORS ......................................................................................................................................................................................................... 9 GOUT ............................................................................................................................................................................................................................... 9 OPIOID ANALGESICS ..................................................................................................................................................................................................... 9 NON-OPIOID ANALGESICS ......................................................................................................................................................................................... 10 VISCOSUPPLEMENTS ................................................................................................................................................................................................. 10 ANTI-INFECTIVES ................................................................................................................................................................................................................... 10 ANTIBACTERIALS ......................................................................................................................................................................................................... 11 ANTIFUNGALS .............................................................................................................................................................................................................. 12 ANTIMALARIALS ........................................................................................................................................................................................................... 12 ANTIRETROVIRAL AGENTS ........................................................................................................................................................................................ 12 ANTITUBERCULAR AGENTS ....................................................................................................................................................................................... 13 ANTIVIRALS .................................................................................................................................................................................................................. 14 MISCELLANEOUS ......................................................................................................................................................................................................... 14 ANTINEOPLASTIC AGENTS .................................................................................................................................................................................................. 15 ALKYLATING AGENTS ................................................................................................................................................................................................. 15 ANTIMETABOLITES ...................................................................................................................................................................................................... 15 HORMONAL ANTINEOPLASTIC AGENTS .................................................................................................................................................................. 16 IMMUNOMODULATORS ............................................................................................................................................................................................... 16 KINASE INHIBITORS .................................................................................................................................................................................................... 16 MULTIPLE MYELOMA ................................................................................................................................................................................................... 17 TOPOISOMERASE INHIBITORS .................................................................................................................................................................................. 17 MISCELLANEOUS ......................................................................................................................................................................................................... 17 CARDIOVASCULAR ................................................................................................................................................................................................................ 19 ACE INHIBITORS .......................................................................................................................................................................................................... 19 ACE INHIBITOR/CALCIUM CHANNEL BLOCKER COMBINATIONS .........................................................................................................................