This report highlights all changes (additions and deletions) to the cvs caremark prescribing guide

Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)

This report highlights all changes (additions and deletions) to the CVS Caremark Performance Drug List.

ADDITIONS:
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
Brand Agents:
Abilify
To provide an oral atypical antipsychotic therapy option with minimal risk of extrapyramidal symptoms, hyperprolactinemia, weight gain, and glucose and as an adjunct to lithium or valproate. • Maintenance treatment of bipolar I disorder, both as monotherapy and as an adjunct to lithium or valproate. • Adjunctive treatment of major depressive disorder (MDD). • Treatment of irritability associated with autistic disorder. Abilify injection is indicated for acute treatment of agitation associated with schizophrenia or bipolar I disorder. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
To provide an oral therapy option for the treatment of • Treatment of irritable bowel syndrome (IBS) with constipation in women ≥ 18 years of age. Azilect Central Nervous System/
To provide an oral therapy option for the treatment of Parkinson’s disease as initial monotherapy and as adjunct therapy to levodopa. To provide a fixed-dose combination therapy option for blood pressure. • As initial therapy in patients likely to need multiple anti-hypertensive agents to achieve their blood pressure goals. To provide a therapy option for the prevention and This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
(FMF) in adults and children 4 years of age or older. To provide a pancrelipase agent therapy option for the treatment of exocrine pancreatic insufficiency. insufficiency due to cystic fibrosis, chronic pancreatitis, pancreatectomy, or other conditions. To provide a fixed-dose combination therapy option for controlled on monotherapy. • As initial therapy in patients likely to need multiple drugs to achieve their blood pressure goals. Exforge HCT
To provide a fixed-dose combination therapy option for This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
To provide a fast-acting transmucosal fentanyl management of breakthrough pain formulation therapy option for breakthrough cancer pain. and older who are already receiving and who are tolerant to around-the-clock opioid therapy for their underlying persistent cancer pain. To provide an injectable therapy option for the treatment have failed to respond adequately to non-pharmacologic therapy, non-steroidal antiinflammatory drugs or simple analgesics, e.g., acetaminophen. To provide an injectable therapy option for the treatment to respond adequately to conservative non-pharmacologic therapy and simple analgesics, e.g., acetaminophen. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
To provide an oral atypical antipsychotic therapy option To provide a fast-acting fentanyl nasal spray for management of breakthrough pain breakthrough cancer pain. in cancer patients 18 years of age
and older who are already
receiving and who are tolerant to
opioid therapy for their underlying
persistent cancer pain.

Letairis
To provide an endothelin receptor antagonist therapy option for the treatment of pulmonary hypertension. Lotronex Gastrointestinal/
To provide the only FDA-approved oral therapy option for syndrome (IBS) who have: • Chronic IBS symptoms (generally lasting six months or longer), • Had anatomic or biochemical This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
abnormalities of the gastrointestinal tract excluded, and • Not responded adequately to conventional therapy. To provide an omega-3 fatty acid therapy option for the Moviprep Gastrointestinal/
To provide a low-volume therapy option for bowel preparation for colonoscopy in adults 18 years or older. Neupro Central Nervous System/
To provide a transdermal patch therapy option for the Syndrome (RLS). • The treatment of the signs and symptoms of idiopathic Parkinson’s disease. Orthovisc
To provide an injectable therapy option for the treatment This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
to respond adequately to conservative non-pharmacologic therapy and simple analgesics, e.g., acetaminophen. To provide a transdermal patch antiemetic therapy option prevention of nausea and vomiting for the treatment of nausea and vomiting associated with and/or highly emetogenic chemotherapy for up to five consecutive days. Seroquel XR
To provide an oral atypical antipsychotic therapy option with minimal risk for treatment-emergent mania in bipolar bipolar I disorder, both as monotherapy and as an adjunct to lithium or divalproex. • Acute treatment of depressive episodes associated with bipolar disorder. • Maintenance treatment of bipolar I disorder as an adjunct to lithium or divalproex. • Adjunctive treatment of MDD. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
To provide a low-volume therapy option for bowel
Tracleer
To provide an endothelin receptor antagonist therapy option for the treatment of pulmonary hypertension. Tribenzor
To provide a fixed-dose combination therapy option for Uloric Analgesics/
To provide a therapy option for management of To provide a pancrelipase agent therapy option for the treatment of exocrine pancreatic insufficiency. insufficiency due to cystic fibrosis, or other conditions. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
To provide a pancrelipase agent therapy option for the treatment of exocrine pancreatic insufficiency. in adults for the treatment of exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatectomy. To provide a pancrelipase agent therapy option for the treatment of exocrine pancreatic insufficiency. insufficiency due to cystic fibrosis, or other conditions. To provide an oral soluble film formulation antiemetic therapy option for the treatment of nausea and vomiting. vomiting associated with highly emetogenic cancer chemotherapy. • Prevention of nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy. • Prevention of nausea and vomiting associated with radiotherapy in patients receiving total body irradiation, single high-dose fraction to abdomen, or daily This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
fractions to the abdomen.
• Prevention of postoperative
nausea and/or vomiting.

Generic Agents:
allopurinol
To provide an additional generic therapy option. primary or secondary gout (acute attacks, tophi, joint destruction, uric acid lithiasis, and/or nephropathy). • The management of patients with leukemia, lymphoma and malignancies who are receiving cancer therapy which causes elevations of serum and urinary uric acid levels. • The management of patients with recurrent calcium oxalate calculi whose daily uric acid excretion exceeds 800 mg/day in male patients and 750 mg/day in female patients. carbidopa/levodopa Central Nervous System/
Carbidopa/levodopa is indicated in To provide an additional generic therapy option. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
idiopathic Parkinson's disease (paralysis agitans), post-encephalitic parkinsonism, and symptomatic parkinsonism which may follow injury to the nervous system by carbon monoxide intoxication and/or manganese intoxication. carbidopa/levodopa Central Nervous System/
To provide an additional generic therapy option. extended-release
treatment of the symptoms of idiopathic Parkinson's disease (paralysis agitans), post-encephalitic parkinsonism, and symptomatic parkinsonism which may follow injury to the nervous system by carbon monoxide intoxication and/or manganese intoxication. carbidopa/
To provide an additional generic therapy option. levodopa/
entacapone
idiopathic Parkinson's disease: • To substitute (with equivalent This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
strength of each of the three components) for immediate-release carbidopa/levodopa and entacapone previously administered as individual products. • To replace immediate-release carbidopa/levodopa therapy (without entacapone) when patients experience the signs and symptoms of end-of-dose “wearing-off.” clozapine
To provide an additional generic therapy option. schizophrenic patients who fail to respond adequately to standard drug treatment for schizophrenia. • Reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder who are judged to be at chronic risk for re-experiencing suicidal behavior, based on history and recent clinical state. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
dronabinol
To provide an additional generic therapy option. • Anorexia associated with weight loss in patients with acquired immunodeficiency syndrome (AIDS). • Nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatments. entacapone
To provide an additional generic therapy option. treat patients with idiopathic Parkinson’s disease who experience the signs and symptoms of end-of-dose "wearing-off.” fentanyl
To provide an additional generic therapy option. transmucosal
management of breakthrough pain in cancer patients 16 years of age and older who are already receiving and who are tolerant to This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
around-the-clock opioid therapy for their underlying persistent cancer pain. granisetron
To provide an additional generic therapy option. • Nausea and vomiting associated with initial and repeat courses of emetogenic cancer therapy, including high-dose cisplatin. • Nausea and vomiting associated with radiation, including total body irradiation and fractionated abdominal radiation. meclizine
To provide an additional generic therapy option. nausea, vomiting, or dizziness associated with motion sickness. metoclopramide
To provide an additional generic therapy option. weeks) therapy for adults with symptomatic, documented gastroesophageal reflux who fail to respond to conventional therapy. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
• For the relief of symptoms associated with acute and recurrent diabetic gastric stasis. olanzapine
To provide an additional generic therapy option. • The acute treatment of manic or mixed episodes associated with bipolar I disorder and maintenance treatment of bipolar I disorder. • The treatment of manic or mixed episodes associated with bipolar I disorder as an adjunct to lithium or valproate. ondansetron
To provide an additional generic therapy option. vomiting associated with highly emetogenic cancer chemotherapy, including cisplatin ≥ 50 mg/m2. • Prevention of nausea and vomiting associated with initial and repeat courses of moderately emetogenic cancer chemotherapy. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
• Prevention of nausea and vomiting associated with radiotherapy in patients receiving either total body irradiation, single high-dose fraction to the abdomen, or daily fractions to the abdomen. • Prevention of postoperative nausea and/or vomiting. polyethylene glycol
PEG 3350 and electrolytes for oral To provide an additional generic therapy option. (PEG) 3350/
electrolytes
cleansing prior to colonoscopy and barium enema X-ray examination. pioglitazone/
The “A”-rated generic pioglitazone/glimepiride will replace glimepiride
the branded agent Duetact (pioglitazone/glimepiride) on diabetes mellitus who are already treated with a thiazolidinedione and a sulfonylurea or who have inadequate glycemic control on a thiazolidinedione alone or a sulfonylurea alone. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
pramipexole
To provide an additional generic therapy option. symptoms of idiopathic Parkinson’s disease. probenecid
To provide an additional generic therapy option. hyperuricemia associated with gout and gouty arthritis. • As an adjuvant to therapy with penicillin or with ampicillin, methicillin, oxacillin, cloxacillin, or nafcillin, for elevation and prolongation of plasma levels by whatever route the antibiotic is given. prochlorperazine
To provide an additional generic therapy option. • For control of severe nausea and vomiting. • For the treatment of schizophrenia. Prochlorperazine suppositories are indicated for control of severe nausea and vomiting in adults. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
promethazine
To provide an additional generic therapy option. rhinitis. • Vasomotor rhinitis. • Allergic conjunctivitis due to inhalant allergens and foods. • Mild, uncomplicated allergic skin manifestations of urticaria and angioedema. • Amelioration of allergic reactions to blood or plasma. • Dermographism. • Anaphylactic reactions, as adjunctive therapy to epinephrine and other standard measures, after the acute manifestations have been controlled. • Preoperative, postoperative, or obstetric sedation. • Prevention and control of nausea and vomiting associated with certain types of anesthesia and surgery. • Therapy adjunctive to meperidine or other analgesics for control of postoperative pain. • Sedation in both children and adults, as well as relief of This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
apprehension and production of light sleep from which the patient can be easily aroused. • Active and prophylactic treatment of motion sickness. • Antiemetic therapy in postoperative patients. quetiapine
To provide an additional generic therapy option. • The acute treatment of manic episodes associated with bipolar I disorder, both as monotherapy and as an adjunct to lithium or divalproex. risperidone
To provide an additional generic therapy option. • As monotherapy or adjunctive therapy with lithium or valproate, for the treatment of acute manic or mixed episodes associated with bipolar I disorder. • Treatment of irritability associated with autistic disorder. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
ropinirole
To provide an additional generic therapy option. • The signs and symptoms of idiopathic Parkinson’s disease. • Moderate-to-severe primary RLS. ropinirole
To provide an additional generic therapy option. extended-release
signs and symptoms of idiopathic Parkinson’s disease. selegiline
To provide an additional generic therapy option. Parkinsonian patients being treated with levodopa/carbidopa who exhibit deterioration in the quality of their response to this therapy. sildenafil
To provide an additional generic therapy option. Hypertension/ in adults to improve exercise Phosphodiesterase Inhibitors trimethobenzamide
To provide an additional generic therapy option. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
nausea and vomiting and for nausea associated with gastroenteritis. ziprasidone
To provide an additional generic therapy option. for the treatment of schizophrenia.

This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
DELETIONS:
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments
Brand Agents:
Duetact
Duetact (pioglitazone/glimepiride) will be replaced on the Performance Drug List by the “A”-rated generic inadequate glycemic control on a thiazolidinedione alone or a sulfonylurea alone. Availability of injectable therapy options for the treatment Alternatives on the Performance Drug List include Gel- One (sodium hyaluronate), Hyalgan (sodium hyaluronate) Synvisc-One
Availability of injectable therapy options for the treatment Alternatives on the Performance Drug List include Gel- One (sodium hyaluronate), Hyalgan (sodium hyaluronate) This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313 Report
Effective 07-01-2013
(Standard Drug List Reflects Removals)
Therapeutic Category/
Subcategory
Indication
Alternatives/Comments

THERAPEUTIC CATEGORY MODIFICATIONS:
Therapeutic Category
Comments
OPIOID ANALGESICS
OPIOID ANALGESICS and OPIOID ANALGESICS, CII therapeutic categories will be merged to a single category, OPIOID ANALGESICS. This general category will avoid misrepresentation of state-specific controlled substance schedules The Performance Drug List will also display the following statement: The document is subject to state-specific regulations and rules, including, but not limited to, those regarding generic substitution, controlled substance schedules, preference for brands and mandatory generics whenever applicable. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not affiliated with CVS Caremark. The information contained in this document is proprietary. The information may not be copied in whole or in part without written permission. 2013 Caremark Rx, L.L.C. All rights reserved. 106-26208b 042313

Source: http://www.cmu.edu/hr/benefits/benefit_programs/forms/formulary-change-detail-report-07012013.pdf