2014 Formulary Update
Listed below are major updates to the formulary, including additions to Prior Authorization and Quantity Level Limits, that will be made effective January 1, 2014: Preferred Generics alendronate tabs paroxetine (non-ER) tabs baclofen tabs perindopril tabs carteolol ophthalmic sertraline tabs carvedilol tabs spironolactone tabs flurbiprofen tabs, eye drops trandolapril tabs ketoprofen (non-ER) caps verapamil ER tabs Non-Preferred Generics cephalexin susupension prochlorperazine suppository procto-pak estradiol tabs promethazine syrup, suppository estropipate propranolol solution gavilyte-c, -g propylthiouracil gentamicin cream, ointment silver sulfadiazine cream ibuprofen suspension thermazene cream thiothixene caps lithium carbonate ER tabs triamcinolone ointment 0.5% Preferred Brands Common Uses/Indications
KEY: Generic names of medications are noted in lower case print and bolded. Brand names of medications are noted in UPPER CASE PRINT. PA—Prior Authorization Required; ST—Step Therapy Required; QLL—Quantity Level Limits Apply
Non-Preferred Brands Common Uses/Indications Preferred Alternatives rabeprazole (QLL) pioglitazone (QLL), /metformin (QLL), /glimepiride (QLL) moxifloxacin valsartan/-hct (QLL) niacin ER acyclovir cream, ointment High Cost/Non-Formulary Tier NOT COVERED Preferred Alternatives
TRADJENTA/JENTADUETO JANUVIA/JANUMET/JANUMET XR,
Additions to Prior Authorization*
KEY: Generic names of medications are noted in lower case print and bolded. Brand names of medications are noted in UPPER CASE PRINT. PA—Prior Authorization Required; ST—Step Therapy Required; QLL—Quantity Level Limits Apply
Additions to Quantity Level Limits*
GLUCOVANCE (glyburide/ metformin)
(pioglitazone, -/metformin, -/glimepiride)
(QLL) AMARYL (glimepiride) (QLL)
PRANDIN (replaglinide) (QLL)
DIABETA (glyburide), GLYNASE (glyburide, PRANDIMET (QLL) micronized) (QLL) EDARBI (QLL)
SOMA (carisoprodol) (QLL)
GLUCOPHAGE (metformin)/-XR (ER),
STARLIX (nateglinide) (QLL)
FORTAMET, GLUMETZA (QLL) GLUCOTROL (glipizide)/-XL (ER) (QLL)
XANAX (alprazolam) (QLL)
Note: Quantity limits vary depending upon strengths of drugs. Please refer to the
*Physicians or pharmacists may call 1-888-486-3326 or fax prior authorization requests to 1-888-836-0730.
If you are a SecureRx PDP member and have questions concerning your prescription drug benefits, please call 1-888-486-3326 (TTY: 1-866-236-1069), 24 hours a day, seven days a week. As an added convenience, you may also visit for a listing of the formulary along with other helpful pharmacy information.
SecureRx® PDP is offered by Avalon® Insurance Company, a Federally-Qualified Medicare Contracting Prescription Drug Plan. Enrollment in SecureRx® PDP depends on contract renewal.
KEY: Generic names of medications are noted in lower case print and bolded. Brand names of medications are noted in UPPER CASE PRINT. PA—Prior Authorization Required; ST—Step Therapy Required; QLL—Quantity Level Limits Apply
Antibiotics, present and future 1 Institut Pasteur, Paris, France. 2 University of British Columbia and TerraGen Diversity, Inc., Vancouver BC, Canada ABSTRACT The problem of antibiotic resistance in bacterial pathogens is a problem in genetic ecology. For the past half century, microbes have been exposed to enormous quantities of toxicagents (antibiotics) and they have survived. The princip
2014 Formulary Update