Bardzo tanie apteki z dostawą w całej Polsce kupic viagra i ogromny wybór pigułek.

Condition

PEEHIP Step Therapy List
he following Step Therapy programs to ensure that prescription use by PEEHIP members is safe and affordable. As a PEEHIP member, you should be aware of the following Step Therapy programs when considering new prescription therapy for any of the conditions listed below. PEEHIP members are required to try a 1st Step Drug before PEEHIP will pay for a 2nd Step Drug. If after trying a 1st Step Drug your physician decides to prescribe a different HIP will cover the 2nd Step Drug listed below. A Prior Authorization (PA) is not needed as long as there is a presence of the 1st Step Drug in your claims history within the past 130 days. If your doctor by-passes the 1st Step Drug and prescribes a 2nd Step Drug, a Prior Authorization (PA) must be completed and s ubmitted by your doctor’s office. MedImpact, administrator of PEEHIP’s prescription drug benefit, may approve the PA if your doctor provides on that warrants the use of the 2nd Step Drug. Without an approved PA, the claim will be rejected and the member will be required to pay the full price of the medication. Your doctor can call MedImpact at the PEEHIP-exclusive Prior Authorization Department at 1-800-347-5841 to complete the PA review by phone, or to request a PA form. The completed PA form can be faxed to MedImpact at 1-877-606-0728. MedImpact will automatically notify the PEEHIP members who are currently taking a 2nd step drug, and have had a prescription claim processed for that 2nd Step Drug through the PEEHIP prescription dr ug benefit within the prior 130 days, will not be subject to Step Therapy for that 2nd Step Drug, i.e. can be grandfathered in from the Step Therapy requirem ents. NOTE: Samples are not considered processed claims for purposes of Step Therapy. You can ask your doctor if a generic
medication is appropriate for you, and share the PEEHIP Formulary (Preferred Drugs) List with your doctor. Keep the prescription drug program safe and affordable by bei ng familiar with the Step Therapy programs. Please Note: Thi s list is subject to change. Generics may be subject to step therapy. In addition, select brands may move to tier 3 status if a generic equivalent becomes available.
KEY: Generics ar
e listed in bold lower case; Formulary Brands are listed in bold upper case; Nonformulary brands are listed in regular upper case; Multi- source brands (M SBs) with an exact generic equivalent are listed in italics (MSBs are not covered unless the physician indicates in longhand writing on the prescription “medically necessary” or “dispense as written” or “do not substitute”). Condition
Drug Category
1st Step Drug
2nd Step Drug
3rd Step Drug
montelukast
zafirlukast
flunisolide
fluticasone
NASACORT, NASACORT AQ
triamcinolone acetonide
- AND- Brand or Generic Antihistamine or Antihistamine/Decongestant tablets or nasal sprays: ALLEGRA, ALLEGRA D ASTELIN ASTEPRO CLARINEX, CLARINEX D PATANASE XYZAL flunisolide
fluticasone
triamcinolone acetonide
NASAREL OMNARIS RHINOCORT AQ VERAMYST PEEHIP Step Therapy List – October 1, 2013

Condition
Drug Category
1st Step Drug
2nd Step Drug
3rd Step Drug
(Members must have tried a generic within the past 365 days before a 2nd step drug will be flunisolide
fluticasone

levocetirizine
desloratadine
donepezil
galantamine, galantamine er
rivastigmine cap
EXELON cap EXELON soln, patch RAZADYNE, RAZADYNE ER (Members must try two first-line generics before a diclofenac potassium
diclofenac sodium
etodolac
fenoprofen
flurbiprofen
ibuprofen
indomethacin
ketoprofen
ketoralac
meclofenamate
mefenamic acid
meloxicam
nabumetone
naproxen
naproxen sodium
oxaprozin
piroxicam
sulindac
tolmetin sodium
(Members must try two first-line generics before a diclofenac potassium
diclofenac sodium
etodolac
EC naproxen
fenoprofen
flurbiprofen
ibuprofen
Indomethacin
ketoprofen
ketoralac
meclofenamate
mefenamic acid
meloxicam
nabumetone
naproxen
naproxen sodium
oxaprozin
piroxicam
sulindac
tolmetin sodium
RELAFEN TORADOL VOLTAREN, VOLTAREN XR, VOLTAREN GEL ZIPSOR PEEHIP Step Therapy List – October 1, 2013

Condition
Drug Category
1st Step Drug
2nd Step Drug
3rd Step Drug
diclofenac
etodolac
fenoprofen
flurbiprofen
ibuprofen
indomethacin
ketoprofen
ketorolac
meclofenamate
meloxicam
nabumetone
naproxen
oxaprozin
piroxicam
sulindac
tolmetin

tramadol extended release

doxycycline
Requires a trial of any two generics shown below. olanzapine
quetiapine IR
risperidone
risperidone ODT
ziprasidone
Requires a trial of any two generics shown below. olanzapine
quetiapine IR
risperidone
risperidone ODT
ziprasidone
venlafaxine
citalopram
fluoxetine
paroxetine
sertraline

SEROQUEL XR
Requires a trial of any two generics shown below.
olanzapine
quetiapine IR
risperidone
risperidone ODT
ziprasidone
venlafaxine
citalopram
fluoxetine
paroxetine
sertraline

PEEHIP Step Therapy List – October 1, 2013

Condition
Drug Category
1st Step Drug
2nd Step Drug
3rd Step Drug
alfuzosin
doxazosin
prazosin
tamsulosin
terazosin
finasteride
alfuzosin
doxazosin
prazosin
tamsulosin
terazosin

Brands:
RAPAFLO
finasteride
alfuzosin
doxazosin
prazosin
tamsulosin
terazosin

Brands:
AVODART
RAPAFLO
alendronate
ACTONEL, ACTONEL W/CALCIUM
ibandronate
Authorization will be required for a 2nd step drug. alendronate
ibandronate

methylphenidate CD
methylphenidate LA
lamotrigine
topiramate
valproic acid
lamotrigine immediate release
divalproex
valproic acid
PEEHIP Step Therapy List – October 1, 2013

Condition
Drug Category
1st Step Drug
2nd Step Drug
3rd Step Drug
ondansetron tablet or ODT
carbamazepine
gabapentin
lamotrigine
levetiracetam
oxcarbazepine
topiramate
zonisamide
valproic acid
divalproex
COMBIVENT
DALIRESP
(Must try one first line generic or brand citalopram
escitalopram
fluoxetine
fluvoxamine
CYMBALTA
paroxetine
sertraline
venlafaxine
PEEHIP Step Therapy List – October 1, 2013

Condition
Drug Category
1st Step Drug
2nd Step Drug
3rd Step Drug
budeprion, budeprion sr, budeprion xl
bupropion, bupropion sr, bupropion xl
bupropion
citalopram
escitalopram
CYMBALTA
fluoxetine
fluvoxamine
paroxetine
sertraline
venlafaxine
PRISTIQ
PROZAC
SARAFEM

VENLAFAXINE ER
ZOLOFT

citalopram
escitalopram
DESVENLAFAXINE
fluoxetine
paroxetine
sertraline
mirtazapine
bupropion ir
bupropion sr
bupropion xl

citalopram
escitalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
paroxetine
trazodone
PEEHIP Step Therapy List – October 1, 2013

Condition
Drug Category
1st Step Drug
2nd Step Drug
h-cortisone-iodoquinol
hydrocortisone
h-cortisone-iodoquinol
PROTOPIC
hydrocortisone
alclometasone
amcinonide
lidazone
betamethasone
betanate
lidocaine-hc
beta-val
clobetasol
mometasone
del-beta
dermazene
prednicarbate
desonide
desoximetasone
diflorasone
triamcinolone
embeline
fluocinolone
fluocinonide
fluticasone
halobetasol
h-cortisone-iodoquinol
PEEHIP Step Therapy List – October 1, 2013

Condition
Drug Category
1st Step Drugs
2nd Step Drugs
3rd Step Drugs
DRITHOCREME HP
clobetasol
fluticasone
fluocinonide
triamcinolone
VECTICAL
metformin er
metformin, metformin er
metformin/glipizide
metformin/glyburide
JUVISYNC
TRADJENTA
JENTADUETO
BYDUREON
metformin, metformin er
metformin/glipizide
metformin/glyburide
chlorpropamide
glimepiride
glipizide
glyburide
tolazamide
tolbutamide

BYDUREON
AND
One of the following generics:
metformin, metformin er
metformin/glipizide
metformin/glyburide
chlorpropamide
glimepiride
glipizide
glyburide
tolazamide
tolbutamide

metformin, metformin er
metformin/glipizide
metformin/glyburide
chlorpropamide
glimepiride
glipizide
glyburide
tolazamide
tolbutamide
pioglitazone
prednisone
balsalazide
PEEHIP Step Therapy List – October 1, 2013

Condition
Drug Category
1st Step Drug
2nd Step Drug
3rd Step Drug
dorzolamide/timolol

abacavir
didanosine
lamivudine
lamivudine/zidovudine
nevirapine
stavudine
zidovudine
Brands:
ATRIPLA
APTIVUS
COMBIVIR
COMPLERA
CRIXIVAN
EDURANT
EMTRIVA
EPIVIR
EPZICOM
FUZEON
INTELENCE
INVIRASE
ISENTRESS
KALETRA
LEXIVA
NORVIR
PREZISTA
RESCRIPTOR
RETROVIR
REYATAZ
SELZENTRY
STRIBILD
SUSTIVA
TRIZIVIR
TRUVADA
VIDEX/EC
VIRACEPT
VIRAMUNE/XR
VIREAD
ZERIT
ZIAGEN
ASACOL HD
lansoprazole
omeprazole
omeprazole/sodium bicarbonate
pantoprazole
PREVACID (NON-OTC) PRILOSEC (NON-OTC) PROTONIX ZEGERID (NON-OTC) ribavirin 200mg
ribavirin 400mg, 600mg
Riba-Pak 400-400mg, 400-600mg,
600-600mg

PEEHIP Step Therapy List – October 1, 2013

Condition
Drug Category
1st Step Drug
2nd Step Drug
3rd Step Drug
benazepril
captopri
lenalapril
fosinopril
lisinopril
moexipril
perindopril
quinapril
ramipril
trandolapril
benazepril/amlodipine
benazepril/hctz
captopril/hctz
enalapril/hctz
fosinopril/hctz
lisinopril/hctz
moexipril/hctz
quinapril/hctz
losartan +/- hctz
valsartan hctz
irbesartan +/- hctz
EXFORGE, HCT
acebutolol
BYSTOLIC
atenolol
atenolol-
chlorthalidone
betaxolol
bisoprolol, -hctz
carvedilol, er
labetalol
metoprolol, -hctz
metoprolol
succinate er
nadolol,
bendroflumethiazide
pindolol
propranolol, LA, -hctz
PEEHIP Step Therapy List – October 1, 2013

Condition
Drug Category
1st Step Drug
2nd Step Drug
3rd Step Drug
verapamil er
verapamil ir
verapamil sr
COVERA-HS ISOPTIN SR VERELAN, PM amlodipine
amlodipine/benazepril
felodipine
DYNACIRC CR
isradipine
nicardipine ir
nifedipine
nisoldipine
Must try a generic ACE, ACE combination product, lovastatin
CRESTOR*
pravastatin
simvastatin
fenofibrate
FENOGLIDE
LIPOFEN
LOFIBRA
TRICOR (fenofibrate)
TRIGLIDE
TRILIPIX

Requires a trial of any two generics below. atorvastatin
lovastatin
pravastatin
simvastatin
the past 365 days or a Prior Authorization will be required. Requires a trial of any two generics below. atorvastatin
lovastatin
pravastatin
simvastatin
Requires a trial of any two generics below. atorvastatin
lovastatin
pravastatin
simvastatin
atorvastatin 40mg or 80mg
PEEHIP Step Therapy List – October 1, 2013

Condition
Drug Category
1st Step Drug
2nd Step Drug
3rd Step Drug
zaleplon
zolpidem
AMBIEN CR
EDLUAR
INTERMEZZO
LUNESTA
ROZEREM
SONATA
ZOLPIMIST

Members must try both first line agents before a COPAXONE
entacapone
ropinirole
pramipexole
NEUPRO
REQUIP, XL
gabapentin
pramipexole
ropinirole IR

gabapentin IR
gabapentin
oxybutynin ir, xl
GELNIQUE
OXYTROL
SANCTURA
SANCTURA XR
TOVIAZ
VESICARE

PEEHIP Step Therapy List – October 1, 2013

Source: http://dev-rsa.com.s158285.gridserver.com/uploads/files/Step_Therapy_List.pdf

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