List of covered drugs - Ohio Department of …

1 List of covered drugs INTRODUCTION Catamaran utilizes a Pharmacy and Therapeutics Committee (P & T Committee), made up of practicing physicians, pharmacists, and nurses to help ensure that our formulary is medically sound and that it supports patient health. This committee reviews and evaluates medications on the formulary based on safety and efficacy to help maintain clinical integrity in all therapeutic categories. FORMULARY DESIGN Catamaran has chosen a formulary structure which includes most prescription drugs . The formulary structure features generics (with the lowest co-payments), preferred and non-preferred brand-name drugs . Generic drugs : Most generic drugs are listed under GENERIC.

2 drugs listed under GENERIC have the same active ingredient as the brand-name versions but at a lower cost. Preferred drugs : drugs listed under PREFERRED include preferred brand name drugs that will generally have lower co-payments than non-preferred brand name drugs . Non-preferred drugs : drugs listed under NON PREFERRED generally have higher co-payments than preferred brand name drugs . USING THIS FORMULARY REFERENCE GUIDE TO HELP CONTAIN COSTS Many health plans use the Catamaran formulary to help manage the overall cost of providing prescription drug benefits. This formulary offers a wide range of medications from which to choose. We realize that this formulary reference guide may not include every drug from every manufacturer.

3 However, choosing a generic or preferred drug when it is appropriate can provide access to the necessary medications to stay healthy, at a cost that is more affordable. SAVING ON OUT-OF-POCKET COSTS Your health plan sets the co-payments for each formulary drug status which include generic, preferred brand-name, and non-preferred brand-name medications. Health plans often design prescription drug plans to encourage the use of generic and preferred brand-name drugs . Choosing non-preferred drugs may mean paying higher out-of-pocket expenses (such as coinsurance, co-payments, and deductible amounts) or not receiving coverage at all. Patients may also pay less for generic drugs , or they may be asked to pay the cost difference between brand-name drugs and their generic alternatives.

4 PLEASE NOTE: Brand-name drugs may move to non-preferred status if a generic version becomes available. CONSULTING THE PRESCRIBER S OFFICE WHEN APPROPRIATE When employers and other health plans design their prescription drug plans, they may choose to provide coverage only for certain medications, time periods, doses, quantities, or for specific indications ( they may exclude coverage for medications for unapproved, unproven, or cosmetic indications). When coverage for medications is provided based on use or quantity, Catamaran may contact your prescriber s office for additional information to determine whether coverage is available under your plan. Patients who are unsure whether these coverage rules apply for a particular medication can consult their prescription drug benefit manual or contact a Catamaran Member Services representative to determine specific coverage requirements.

5 KNOWING HOW THE FORMULARY INFORMATION IS ORGANIZED The following formulary reference guide is designed so that generic products are listed first in each drug category. The preferred brand name products are listed next, and non-preferred brand products are listed last. *Formulary Disclaimer: Coverage for some drugs may be limited to specific dosage forms and/or strengths. The benefit design determines what is covered and the applicable co-payment. The medications listed on this formulary are subject to change pursuant to the formulary management activities of Catamaran. The presence of a medication on this formulary list does not guarantee coverage. To determine the most up-to-date formulary status of your medication, please visit your member website or call member services at the number listed on your ID card.

6 Table of Contents ANTI-INFECTIVES .. 1 PENICILLINS .. 1 CEPHALOSPORIN .. 1 FIRST GENERATION .. 1 SECOND GENERATION .. 1 THIRD GENERATION .. 1 FOURTH GENERATION .. 1 MACROLIDES .. 1 TETRACYCLINES .. 2 QUINOLONES .. 2 AMINOGLYCOSIDES .. 2 SULFONAMIDES .. 2 ANTIMYCOBACTERIAL AGENTS .. 2 ANTIFUNGALS .. 2 ANTIVIRALS .. 3 ANTIMALARIALS .. 3 AMEBICIDES .. 3 ANTHELMINTICS .. 3 MISC. ANTI-INFECTIVES .. 3 ANTINEOPLASTICS, ETC .. 4 ALKYLATING AGENTS .. 4 ANTIBIOTICS .. 4 ANTINEOPLASTIC ENZYMES .. 4 ANTIMETABOLITES.

7 4 ANGIOGENESIS INHIBITORS .. 5 ANTIBODIES .. 5 HORMONAL AGENTS .. 5 IMMUNOMODULATORS .. 5 MITOTIC INHIBITORS .. 5 ENZYME INHIBITORS .. 5 TOPOISOMERASE I INHIBITOR .. 6 RADIOPHARMACEUTICALS .. 6 CELLULAR IMMUNOTHERAPY .. 6 ANTINEOPLASTICS MISC.. 6 CHEMOTHERAPY RESCUE .. 6 CHEMOTHERAPY ADJUNCTS .. 6 ANTINEOPLASTIC COMBO .. 6 CARDIOVASCULAR drugs .. 6 PHOSPHODIESTERASE INHBTR .. 6 CARDIAC GLYCOSIDES .. 6 ANTIANGINAL AGENTS .. 6 BETA BLOCKERS .. 7 CALCIUM CHANNEL BLOCKERS .. 7 ANTIARRHYTHMICS .. 7 ACE INHIBITORS .. 7 ANGIOTENSIN RCPTR BLOCKER .. 8 DIRECT RENIN INHIBITORS.

8 8 ANTIHYPERTENSIVES MISC.. 8 ANTIHYPERTENSIVE COMBO .. 8 DIURETICS .. 8 VASOPRESSORS .. 9 ANTIHYPERLIPIDEMICS .. 9 CARDIOVASCULAR - MISC.. 9 DERMATOLOGICALS .. 10 ACNE PRODUCTS .. 10 ROSACEA AGENTS .. 10 ANTIBIOTICS - TOPICAL .. 10 ANTIFUNGALS - TOPICAL .. 11 ANTIVIRALS - TOPICAL .. 11 ANTI-INFLAMMATORY AGENTS .. 11 ANTIPRURITICS .. 11 ANTIPSORIATICS .. 11 ANTISEBORRHEIC AGENTS .. 11 CORTICOSTEROIDS - TOPICAL .. 11 IMMUNOMODULATING AGENTS .. 12 DERMATOLOGICALS - MISC.. 12 ENDOCRINE AND METABOLIC .. 13 CORTICOSTEROIDS .. 13 ANDROGENS-ANABOLIC .. 14 ESTROGENS .. 14 CONTRACEPTIVES.

9 14 PROGESTINS .. 14 ANTIDIABETIC AGENTS .. 15 INSULIN .. 15 AMYLIN ANALOGS .. 15 INCRETIN MIMETIC AGENTS .. 15 SULFONYLUREAS .. 15 BIGUANIDES .. 15 MEGLITINIDE ANALOGUES .. 15 DIABETIC OTHER .. 15 ALPHA-GLUCOSIDASE INHIBIT .. 15 DPP-4 INHIBITORS .. 15 INSULIN SENSITIZING AGENT .. 15 ANTIDIABETIC COMBINATIONS .. 15 BISPHOSPHONATES .. 16 CALCITONINS .. 16 PARATHYROID HORMONE .. 16 RANK LIGAND INHIBITORS .. 16 CALCIUM REGULATORS - MISC .. 16 HORMONE RECEPTOR MDLTR .. 16 FERTILITY REGULATORS .. 16 LHRH/GNRH AGONIST.

10 16 GNRH/LHRH ANTAGONISTS .. 16 GROWTH HORMONES .. 16 GHRH .. 16 SOMATOMEDINS .. 16 SOMATOSTATIC AGENTS .. 16 GH RECEPTOR ANTAGONISTS .. 16 POSTERIOR PITUITARY .. 16 CORTICOTROPIN .. 17 PROLACTIN INHIBITORS .. 17 VASOPRESSIN ANTAGONISTS .. 17 PROGESTERONE ANTAGONISTS .. 17 METABOLIC MODIFIERS .. 17 THYROID AGENTS .. 17 GASTROINTESTINAL .. 17 LAXATIVES .. 17 ANTIDIARRHEALS .. 17 ANTACIDS .. 17 ULCER drugs .. 17 ANTIEMETICS .. 18 DIGESTIVE AIDS .. 18 GASTROINTESTINAL - MISC.. 18 GENITOURINARY .. 19 URINARY ANTI-INFECTIVES .. 19 URINARY ANTISPASMODICS .. 19 VAGINAL PRODUCTS.