STANDARD Stepped Therapy Agents ~ 2011 The following drugs will require prior authorization if the condition is not met when the pharmacist would attempt to transmit a prescription claim. Your doctor will coordinate this approval for you. If the prescription is approved, Coventry Health Care will cover the cost. You will be responsible for the copayment. If the request is not approved, it does not mean your doctor cannot prescribe the medicine for you. It means that you are responsible for paying the prescription in full. Self- administered injectable agents also require prior authorization and can be found on a separate list. Drug Condition
Trial & failure of Risperdal* or Seroquel
Trial & failure of metformin/ER (at least 1500mg/d)
Trial & failure of metformin/ER (at least 1500mg/d)
ActoPLUS Met XR (pioglitazone / metformin ext rel)
Trial & failure of metformin/ER (at least 1500mg/d)
Ambien CR (zolpidem extended release)
Trial & failure of Ambien* or Sonata*, AND Lunesta
Trial & failure of Lactulose* or Miralax*
Trial of Aricept 10mg QD for at least 3 months
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of 2: Claritin OTC*, Zyrtec OTC*, Allegra OTC
Coreg CR (carvedilol extended rel)
Trial & failure of Mevacor*, Pravachol* or Zocor*
Detrol / Detrol LA (tolterodine / extended release)
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Trial & failure of metformin/ER (at least 1500mg/d)
Effexor XR* capsules (venlafaxine extended rel)
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Trial & failure of Risperdal* or Seroquel
Trial & failure of metformin/ER (at least 1500mg/d)
Gelnique (oxybutynin topical gel)
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Trial & failure of Risperdal* or Seroquel
Trial & failure of metformin/ER (at least 1500mg/d)
Trial & failure of Neurontin* and Lidoderm
Trial & failure of Tenex* or Catapres*, AND a stimulant
Trial & failure of Risperdal* or Seroquel
Janumet (sitagliptin / metformin)
Trial & failure of metformin/ER (at least 1500mg/d)
Trial & failure of metformin/ER (at least 1500mg/d)
Trial & failure of Tenex* or Catapres*, AND a stimulant
Trial & failure of metformin/ER (at least 1500mg/d)
Trial & failure of Risperdal* or Seroquel
Trial & failure of Mevacor*, Pravachol* or Zocor*, AND Crestor
Trial & failure of Apriso, Asacol or Asacol HD
Trial & failure of Mevacor*, Pravachol* or Zocor*, AND Crestor
This is the most current list at the time of printing and is subject to change. Last update November 1, 2011
Trial & failure of Ambien* or Sonata*
Luvox CR (fluvoxamine extended release)
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of metformin/ER (at least 1500mg/d)
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Paxil CR* (paroxetine extended release)
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of Ambien* or Sonata*, AND Lunesta
Trial & failure of Risperdal* or Seroquel
Trial & failure of oral Toradol* AND one additional NSAID
Symbyax (olanzapine / fluoxetine)
Trial & failure of Risperdal* or Seroquel
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Trial & failure of metformin/ER (at least 1500mg/d), AND Actos or
Duetact, AND Januvia/Janumet or Onglyza/Kombiglyze
Ultram ER (tramadol extended release)
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Vytorin (simvastatin/ezetimibe) 10/10 only
Trial & failure of Mevacor*, Pravachol* or Zocor*
Trial & failure of 2: Claritin OTC*, Zyrtec OTC*, Allegra OTC
Trial & failure of Risperdal* or Seroquel
*indicates generic available Italics indicate non-formulary agents # indicates Step Therapy required for age 18yr and under; Prior Auth required for age 19yr and over
This is the most current list at the time of printing and is subject to change. Last update November 1, 2011
Information for Childhood Cancer Survivors Non-Hodgkin Lymphoma Fact sheet #21 Supportive care for childhood non-Hodgkin lymphoma Supportive care helps children and their families meet the physical, practical, emotional and spiritual challenges of childhood non-Hodgkin lymphoma. It is an important part of cancer care. There are many programs and services available to help me
2. Neue Links bei 3. Bitte um Teilnahme an Online-Befragung zum Thema Gewalt4. Praxiswerkstatt Kommunikation 1. Eigene Ideen oder Aspirin? Eigene Ideen können sich in der Tat wie Kopfschmerzen auswirken: irgendwo da oben ist der Kopfschmerz zu spüren. Er weitet sich Stück für Stück aus und zunehmend konzentriert sich alle Aufmerksamkeit auf den Kopfschmerz. Kopfschmerzmittel (es muss
STANDARD Stepped Therapy Agents ~ 2011 
Trial & failure of Ambien* or Sonata*
Luvox CR (fluvoxamine extended release)
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of metformin/ER (at least 1500mg/d)
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Paxil CR* (paroxetine extended release)
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of Ambien* or Sonata*, AND Lunesta
Trial & failure of Risperdal* or Seroquel
Trial & failure of oral Toradol* AND one additional NSAID
Symbyax (olanzapine / fluoxetine)
Trial & failure of Risperdal* or Seroquel
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Trial & failure of metformin/ER (at least 1500mg/d), AND Actos or
Duetact, AND Januvia/Janumet or Onglyza/Kombiglyze
Ultram ER (tramadol extended release)
Trial & failure of Flonase* or Nasalide*, AND Nasonex
Trial & failure of Ditropan* or Sanctura/Sanctura XL
Vytorin (simvastatin/ezetimibe) 10/10 only
Trial & failure of Mevacor*, Pravachol* or Zocor*
Trial & failure of 2: Claritin OTC*, Zyrtec OTC*, Allegra OTC
Trial & failure of Risperdal* or Seroquel
* indicates generic available
Italics indicate non-formulary agents # indicates Step Therapy required for age 18yr and under; Prior Auth required for age 19yr and over
This is the most current list at the time of printing and is subject to change. Last update November 1, 2011