MCS Classicare Formulary II Step Therapy Requirements Effective Date: December /2012 MCS Classicare 2012 Formulary II (Step Therapy Requirements)
In some cases, MCS Classicare requires you to first try certain drugs to treat your medical condition before we will cover another drug for that condition. For example, if Drug A and Drug B both treat your medical condition, MCS Classicare may not cover Drug B (“Step 2”) unless you try Drug A first (“Step 1”). If Drug A does not work for you, MCS Classicare will then cover Drug B.
If you know the name of the medication you are looking for, please refer to the Index on page 8 which has drug names listed in alphabetical order. (Page 1 of 8) MCS Classicare Formulary II Last Update: October/2012 Formulary ID: 12310, Version 19 Effective: December /2012 Y0077_5003_E_110 File and Use 09112011 MCS Classicare Formulary II Step Therapy Requirements Effective Date: December /2012 Step Therapy Group Description Affected Drugs (“Step 2”) Step Therapy Criteria (“Step 1”)
glucosidase Inhibitors, or meglitinides,
or metformin, or insulin, or sulfonylurea
JANUVIA; JUVISYNC; KOMBIGLYZE XR; ONGLYZA; PRANDIN; SYMLIN; SYMLINPEN 120; SYMLINPEN 60; VICTOZA
Trial of any ONE generic statin first: atorvastatin, lovastatin, pravastatin, or
antihypertensives: generic ACE Inhibitor, generic ACE combination products, or generic ARB, generic ARB combination products.
(Page 2 of 8) MCS Classicare Formulary II Last Update: October/2012 Formulary ID: 12310, Version 19 Effective: December /2012 Y0077_5003_E_110 File and Use 09112011 MCS Classicare Formulary II Step Therapy Requirements Effective Date: December /2012 Step Therapy Group Description Affected Drugs (“Step 2”) Step Therapy Criteria (“Step 1”)
Trial of generic triptan first: naratriptan or sumatriptan
Trial of ONE generic bisphosphonate first: alendronate, or ibandronate
Trial and Failure of generic finasteride
Trial and failure of generic latanoprost
(Page 3 of 8) MCS Classicare Formulary II Last Update: October/2012 Formulary ID: 12310, Version 19 Effective: December /2012 Y0077_5003_E_110 File and Use 09112011 MCS Classicare Formulary II Step Therapy Requirements Effective Date: December /2012 Step Therapy Group Description Affected Drugs (“Step 2”) Step Therapy Criteria (“Step 1”)
medication: steroid inhalants or anticholinergic bronchodilator (ipratropium), or ARCAPTA, or anti-inflammatory agents (cromolyn) or beta adrenergics (albuterol) or xanthines (theophylline) or anti IgE monoclonal antibodies (Xolair) or nasal steroids or nasal antihistamines (azelastine spr) or nasal anticholinergics (ipratropium nasal), or generic zafirlukast.
Trial and Failure of at least ONE generic short acting Opioid: fentanyl, hydromorphone, oxycodone and APAP/codeine
(Page 4 of 8) MCS Classicare Formulary II Last Update: October/2012 Formulary ID: 12310, Version 19 Effective: December /2012 Y0077_5003_E_110 File and Use 09112011 MCS Classicare Formulary II Step Therapy Requirements Effective Date: December /2012 Step Therapy Group Description Affected Drugs (“Step 2”) Step Therapy Criteria (“Step 1”)
Trial of any ONE Step 1 antianginal medications: cardioselective beta blocker(atenolol; metropolol), OR calcium channel blocker (CARTIA; DILTIAZEM; DILT-XR; DILTZAC; MATZIM LA; TAZTIA XT; VERAPAMIL) OR nitrate
(Page 5 of 8) MCS Classicare Formulary II Last Update: October/2012 Formulary ID: 12310, Version 19 Effective: December /2012 Y0077_5003_E_110 File and Use 09112011 MCS Classicare Formulary II Step Therapy Requirements Effective Date: December /2012 Step Therapy Group Description Affected Drugs (“Step 2”) Step Therapy Criteria (“Step 1”)
For treatment of depression or anxiety disorder, trial of any ONE generic
SSRI/SNRI first: citalopram, or escitalopram, or fluoxetine, or fluvoxamine, or paroxetine, or paroxetine ER, or sertraline, or venlafaxine. If the patient meets these criteria, Cymbalta will be approved regardless of diagnosis. If the patient does not meet this criteria and a request is submitted, the following exceptions are routinely granted: Cymbalta will be approved first line for a diagnosis of diabetic peripheral neuropathy or fibromyalgia.
Trial of any TWO topical corticosteroids first
(Page 6 of 8) MCS Classicare Formulary II Last Update: October/2012 Formulary ID: 12310, Version 19 Effective: December /2012 Y0077_5003_E_110 File and Use 09112011 MCS Classicare Formulary II Step Therapy Requirements Effective Date: December /2012 Step Therapy Group Description Affected Drugs (“Step 2”) Step Therapy Criteria (“Step 1”) (Page 7 of 8) MCS Classicare Formulary II Last Update: October/2012 Formulary ID: 12310, Version 19 Effective: December /2012 Y0077_5003_E_110 File and Use 09112011 MCS Classicare Formulary II Step Therapy Requirements Effective Date: December /2012 (Page 8 of 8) MCS Classicare Formulary II Last Update: October/2012 Formulary ID: 12310, Version 19 Effective: December /2012 Y0077_5003_E_110 File and Use 09112011
ARPN Journal of Science and Technology Quantitative Analysis of Ciprofloxacin Sodium Chloride Pharmaceutical Infusions Using Ultraviolet-visible Spectroscopy 1Affo, W., 2 Mensah-Brown, H., 3 Awuku, J. F., 4 Markwo, A 1, 3, 4 Department of Chemistry, University of Ghana, Legon, Ghana2 Department of Food Process Engineering University of Ghana, Legon, Ghana ABSTRA
E D I T O R I A L E Strategie miliardarie per gonfiare il mercato dei farmaci, e rischio per la salute Stefano Cagliano Pronto Soccorso Ospedale San Paolo Civitavecchia (Roma) Come dimostra il caso della cosiddetta “sindrome metabolica”, la com- Disease mongering: parsa di una nuova malattia fa nascere nuove alleanze tra studiosi, curato- ovvero come ri e industria. Se e qu
MCS Classicare Formulary II