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Step therapy criteria

Step Therapy Criteria 2013 Fidelis Formulary Last Updated: 10/01/2013 ALPHA GLUCOSIDASE INHIBITOR THERAPY - PS PART D
Products Affected

Criteria
Step 1: Any two of the following: Metformin, Sulfonylurea, Thiazolidinedione (TZD), Insulin, Byetta, any generic Tier 1 combination antidiabetic agent(s). Step 2: Glyset ANTIDEPRESSANT THERAPY - FIDELIS
Products Affected

Criteria
Step 1: One of the following Tier 1 or Tier 2 antidepressants: SSRI, SNRI, bupropion, mirtazepine. Step 2: Emsam or Pexeva ARCAPTA THERAPY - PS PART D
Products Affected

Criteria
Step 1: Inhaled corticosteroids or Inhaled anticholinergics or Advair or Symbicort. Step 2: Arcapta ARICEPT THERAPY - PS PART D
Products Affected

Criteria
Step 1: Aricept/donpezil 10 mg or Aricept/donpezil 10 mg ODT. Step 2: Aricept/donpezil 23mg BISPHOSPHONATE THERAPY - PS PART D
Products Affected

Criteria
Step 1: Alendronate. Step 2: Atelvia or Actonel BYDUREON THERAPY - FIDELIS
Products Affected

Criteria
Step 1: Any one of the following: 1. Metformin, 2. sulfonylurea, 3. thiazolidinedione (TZD), 4. Insulin, 5. any generic Tier 1 combination antidiabetic agent. Step 2: Bydureon CHOLINERGIC AGONIST THERAPY - PS PART D
Products Affected

Criteria
CNS STIMULANT THERAPY - PS PART D
Products Affected

Criteria
Step 1: Amphetamine/Dextroamphetamine combinations or Dextroamphetamine, or Dexmethylphenidate or Methylphenidate or a long acting methylphenidate. Step 2: Strattera DIPEPTIDYL PEPTIDASE-4 INHIBITOR THERAPY - PS
PART D

Products Affected

Criteria
Step 1: Any ONE of the following: 1. Metformin, 2. Sulfonylurea, 3. Thiazolidinedione (TZD), 4. Insulin, 5. Byetta, 6. any generic Tier 1 combination antidiabetic agent. Step 2: Januvia or Onglyza. DIPEPTIDYL PEPTIDASE-4 INHIBITOR/ METFORMIN
COMBINATION THERAPY - PS PART D

Products Affected

Criteria
Step 1: Any ONE of the following: 1. Metformin, 2. Sulfonylurea, 3. Thiazolidinedione (TZD), 4. Insulin, 5. Byetta, 6. any generic Tier 1 combination antidiabetic agent. Step 2: Janumet or Kombiglyze XR DIPEPTIDYL PEPTIDASE-4 INHIBITOR/OTHER
COMBINATION - PS PART D

Products Affected

Criteria
Step 1: Any ONE of the following: 1)Januvia or 2)Onglyza or 3)Janumet or 4)Janumet XR or 5)Kombiglyze XR. Step 2: Tradjenta or Jentadueto DUETACT THERAPY - PS PART D
Products Affected

Criteria
Step 1: Sulfonylurea or Actos. Step 2: Duetact/Pioglitazone HCl - Glimepiride FANAPT THERAPY - PS PART D
Products Affected

Criteria
Step 1: One of the following atypical antipsychotics: Risperidone or Seroquel (quetiapine)/ Seroquel XR or olanzapine or olanzapine ODT. Step 2: Fanapt INCRETIN MIMETIC THERAPY - PS PART D
Products Affected

Criteria
Step 1: Any one of the following: 1. Metformin, 2. sulfonylurea, 3. thiazolidinedione (TZD), 4. Insulin, 5. any generic Tier 1 combination antidiabetic agent. Step 2: Byetta or Victoza. INHALED CORTICOSTEROID THERAPY - PS PART D
Products Affected

Criteria
Step 1: Any ONE preferred formulary non-nebulized inhaled corticosteroid. Step 2: Alvesco INTUNIV THERAPY - FIDELIS
Products Affected

Criteria
Step 1: Any ONE formulary ADHD stimulant. Step 2: Intuniv JANUMET XR THERAPY - FIDELIS
Products Affected

Criteria
Step 1: Any ONE of the following: 1. Metformin, 2. Sulfonylurea, 3. Thiazolidinedione (TZD), 4. Insulin, 5. Byetta, 6. any generic Tier 1 combination antidiabetic agent Step 2: Janumet XR LEUKOTRIENE MODIFIER ASTHMA THERAPY - PS PART
D

Products Affected

Criteria
Step 1: Formulary Beta-agonist or Formulary Inhaled corticosteroid or Formulary Inhaled Beta-agonist/Corticosteroid combination or Formulary Oral Corticosteroid. Step 2: Zyflo CR LONG ACTING BETA AGONIST THERAPY - PS PART D
Products Affected

Criteria
Step 1: Inhaled corticosteroids or Inhaled anticholinergics. Step 2: Foradil or Serevent MEGLITINIDE THERAPY - PS PART D
Products Affected

Criteria
Step 1: Any two of the following: 1. Metformin, 2. Sulfonylurea, 3. Thiazolidinedione (TZD), 4. Insulin, 5. Byetta, 6. any generic Tier 1 combination antidiabetic agent. Step 2: Prandin/Repaglinide OPHTHALMIC ANTIHISTAMINE THERAPY - PS PART D
Products Affected

Criteria
Step 1: Azelastine, Pataday, or Patanol. Step 2: Emadine OPHTHALMIC STEROID THERAPY - PS PART D
Products Affected

Criteria
Step 1: Ophthalmic prednisolone acetate. Step 2: FML Forte or Vexol OXYCONTIN THERAPY - PS PART D
Products Affected

Criteria
Step 1: Generic morphine sulfate ER. Step 2: Oxycontin. RANEXA THERAPY - PS PART D
Products Affected

Criteria
Step 1: Long-acting nitrate, Beta-blocker, or Calcium-channel blocker. Step 2: Ranexa RENAGEL THERAPY - PS PART D
Products Affected

Criteria
SKELETAL MUSCLE RELAXANTS - PS PART D
Products Affected

Criteria
Step 1: Cyclobenzaprine (immediate-release). Step 2: Cyclobenzaprine (extended-release) or generic Cyclobenzaprine IR (generic Fexmid) STALEVO THERAPY - PS PART D
Products Affected

Criteria
Step 1: Carbidopa/Levodopa (immediate release) AND Comtan. Step 2: Stalevo STATIN THERAPY: GROUP 1 - PS PART D
Products Affected

Criteria
Step 1: Simvastatin or Lovastatin or Pravastatin or Atorvastatin or Fluvastatin or Crestor. Step 2: Altoprev STATIN THERAPY: GROUP 2 - PS PART D
Products Affected

Criteria
Step 1: Atorvastatin or Crestor. Step 2: Vytorin TOPICAL IMMUNOMODULATOR THERAPY - PS PART D
Products Affected

Criteria
Step 1: Topical Corticosteroid. Step 2: Elidel or Protopic TRIPTAN THERAPY - PS PART D
Products Affected

Criteria
Step 1: Naratriptan and Sumatriptan. Step 2: Axert or Frova or Relpax ULORIC THERAPY - PS PART D
Products Affected

Criteria
VIIBRYD THERAPY - PS PART D
Products Affected

Criteria
Step 1: One Tier 1 or Tier 2 SSRI or SNRI. Step 2: Viibryd XOPENEX NEBULIZER THERAPY - PS PART D
Products Affected

Criteria
Step 1: Albuterol (Nebulizer) Step 2: Xopenex Nebulizer or Generic Levalbuterol Nebulizer. XYZAL SUSPENSION THERAPY - PS PART D
Products Affected

Criteria
Step 1: cetirizine syrup. Step 2. levocetirizine syrup ZELAPAR THERAPY - PS PART D
Products Affected

Criteria
Step 1: Formulary Selegiline. Step 2: Zelapar ZYFLO THERAPY - FIDELIS
Products Affected

Criteria
Step 1: Formulary Beta-agonist or Formulary Inhaled corticosteroid or Formulary Inhaled Beta-agonist/Corticosteroid combination or Formulary Oral Corticosteroid. Step 2: Zyflo A coordinated care plan with a Medicare Advantage contract and a contract with Michigan Medicaid
program.
Formulary ID# 00013383
MCE 12_117 H2323, H5575, H5980
File & Use 04/18/2012

Source: http://www.fidelissc.com/wordpress/wp-content/uploads/2013/10/2013-Fidelis-Formulary-Web-ST-File-2013_GOLDF.pdf

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UKPMC Funders Group Author Manuscript Mol Psychiatry . Author manuscript; available in PMC 2009 January 22. Mol Psychiatry . 2008 July ; 13(7): 658–660. doi:10.1038/mp.2008.47. D-Amino acid oxidase (DAO) activity and expression are increased in schizophrenia PWJ Burnet , SL Eastwood , GC Bristow , BR Godlewska , P Sikka , M Walker , and PJ Harrison Department of Psychiatry

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Experience with passive monitoring deploymentSven Ubik, Aleˇs Friedl, CESNET, Czech Republic Keywords: passive network monitoring 10 Gb/s monitoring. There are several models, which differin type of PCI bus (PCI-X, PCI-E), link technology (Ether-net, PoS) and ability to split packets into multiple buffersPassive network monitoring, which observes directly realnetwork traffic, can provide n

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