Microsoft word - ksw2001 formulary update 071207 final.doc

UniCare Updates HealthWave Managed Medicaid Formulary
Changes do not apply to UniCare Commercial Formulary
We would like to thank you for providing quality services to our UniCare HealthWave program members. This bulletin is to inform you that our Pharmacy and Therapeutics Committee recently reviewed
several drug categories on the Formulary. The purpose of this letter is to notify you of some of
key changes to the Kansas Medicaid Formulary effective July 22, 2007. Please transition your
members to the formulary alternatives within the category if appropriate.
PDL alternative are Acular and Acular LS PDL alternative is benztropine or trihexyphenidyl PDL alternative is other anthelmintics such as mebendazole PDL alternative is AMBI 45/800/30, AMBI 80/700/40 ANEMAGENTM OB, NATELLE® PREFER, PDL alternatives are generic prenatal NUTRACARETM , PRIMACARE® ONE, PDL alternatives are clindamycin, metronidazole PDL alternative is levothyroxine or LEVOTHROID PDL alternatives are acetazolamide and methazolamide PDL alternatives are other generic antihistamine decongestant combinations such as pseudoephedrine with chlorpheniramine State Sponsored Business, UniCare Health Plan of Kansas, Inc. UniCare HealthWave Managed Medicaid Formulary Updates PDL alternatives are generic triphasic oral contraceptive products such as Aranelle, Leena, Necon 7/7/7, Enpresse, Trivora, Cesia, Velivet, Trinessa and Tri-Previfem PDL alternatives are generic multivitamins such as THERAPEUTIC HEMANTINIC, FORMULA B PLUS, VITAPLEX PDL alternative are generic ophthalmic corticosteroids such as dexamethasone, fluorometholone and prednisolone PDL alternatives are Actonel, Evista, and Fosamax PDL alternatives are generic cycloplegic mydriatics such as atropine sulfate, cyclopentolate and tropicamide PDL alternatives are generic potassium supplements such as EFFER K, K EFFERVESCENT, K-LYTE CL PDL alternatives are generic monophasic oral contraceptive products such as Aviane, Lessina, Lutera, and Sronyx PDL alternative is rifampin, pyrazinamide or isoniazid PDL alternatives are carbachol and pilocarpine PDL alternatives are pilocarpine ophthalmic drops PDL alternative is pyridostigmine bromide PDL alternative is PRILOSEC OTC, omeprazole State Sponsored Business, UniCare Health Plan of Kansas, Inc. UniCare HealthWave Managed Medicaid Formulary Updates Due to potential liver injury and contraindication during pregnancy, TRACLEER can be prescribed only through an access program If you believe that your patients need to continue on the medication that you originally
prescribed, please submit a written prior authorization request and fax the request to our prior
authorization department at 1-866-408-7108 for review.
This information is being provided to you for general information purposes only and is not intended as a substitute for the independent medical judgment of a physician. Only a treating physician can determine what medications are appropriate for a patient. Thank you again for working with us to provide our members with quality and affordable healthcare.

Source: http://www.unicare.com/provider/noapplication/plansbenefits/nosecondary/notertiary/pw_a096600.pdf