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2011 changes to aetna’s preferred drug, precertification, quantity limit and step-therapy lists

2013 Changes Aetna’s Preferred Drug, Precertification, Quantity Limit, Step-
Therapy and Specialty Care Rx Lists
Updated 9/7/12
Medications added to the Preferred Drug List
(* = may be added prior to 1/1/13)
COMBIVENT RESPIMAT*9/1/12 VIIBRYD KIT *8/1/12
DUTOPROL *8/1/12
MICARDIS *10/1/12
STRATTERA *9/1/12
EFFIENT *9/1/12
MICARDIS HCT *10/1/12
VIIBRYD *8/1/12
Medications removed from the Preferred Drug List1
(^ = generic equivalent available…….FE = formulary excluded in Closed Formulary plans NP = non-preferred in Open Formulary plans)
Medications to be removed from the Formulary Exclusions List
(covered in Closed Formulary plans, non-preferred in Open Formulary plans)
(* = may be removed prior to 1/1/13)
EFFIENT *9/1/12
MICARDIS HCT *10/1/12
VIIBRYD *8/1/12
DUTOPROL*8/1/12
MICARDIS *10/1/12
STRATTERA *9/1/12
VIIBRYD KIT *8/1/12
Medications added to the Precertification List 2,3,4
(* = prior-authorization is being added to include males)
Medications to be removed from the Precertification List (edit will no longer apply)
Medications added to the Quantity Limits List or changes to the Quantity Limit3,4
UPPER CASE = brand name medication lower case italics = generic medication
Medications to be removed from the Quantity Limit List (edit will no longer apply)
Medications added to the Step-Therapy List3,4
+
= Trial of a generic equivalent is required first ++ Step-therapy will not be implemented until sometime after generic equivalent becomes available
KEPPRA +
MAXALT MLT ++
KEPPRA XR +
MAXALT ++
New Benefit Exclusions
Bulk chemicals used for compounded medications:
Compound drug therapy using bulk chemicals wil no longer be covered as of January 1, 2013 for fully insured business only. Self-funded plans are currently exempt from this exclusion EGRIFTA Medications to be removed from the Step-Therapy List (edit will no longer apply)
(* = may be removed prior to 1/1/13)
LIVALO *8/10/12
BUTRANS*8/10/12
STRATTERA *9/1/12
Additions to Aetna Specialty Care Rx list
2013 Precertification Safety Edits and National Precert List for Self Insured plans only
ACTIQ PR and QL = 120/30 days
DURAGESIC QL = 20/30 days
NUCYNTA QL = 180/30 days
ONSOLIS PR and QL = 4/day
QL = 28/30 days
OXYCONTIN QL = 120/30 days
PR and QL = 120/30 days
fentanyl patch QL = 20/30 days
FENTORA PR and
buprenorphine PR and QL
QL = 120/30 days
2 mg = 24/30 days,
8 mg = 8/30 days
QL = 2 bot les/30 days
BUTRANS PR and QL = 4/30 days
UPPER CASE = brand name medication lower case italics = generic medication
2013 Precertification Safety Edits and National Precert List for Self Insured plans only (continued)
QL = 2 bot les/30 days
SUBOXONE PR and QL = 3/day
SUBUTEX PR and QL
2 mg = 24/30 days,
8 mg = 8/30 days
2013 Precertification Safety Edits and National Precert List for Fully Insured plans only
finasteride PR in all females
buprenorphine PR and QL
and males < 50 yrs old
2 mg = 24/30 days,
8 mg = 8/30 days
ACTIQ PR and
QL = 120/30 days
QL = 2 bot les/30 days
FLOMAX PR in females only
adapalene PR ≥ 36 yr old
BUTRANS PR and QL = 4/30 days
PR 17 yr old
CASODEX PR in females only
CELEBREX PR < 60 yrs old
alfuzosin PR in females only
PR 8 yr old
PR < 2 yr old
NUCYNTA QL = 180/30 days
DDAVP nasal PR 17 yr old
PR < 6 yr old
PR 17 yr old
DIFFERIN PR ≥ 36 yr old
DURAGESIC QL = 20/30 days
ONSOLIS PR and QL = 4/day
oxycodone/ibuprofen
QL = 28/30 days
OXYCONTIN QL = 120/30 days
EPIDUO PR ≥ 36 yr old
ATRALIN PR ≥ 36 yr old
avita PR ≥ 36 yr old
JALYN PR in females only
AVODART PR in females only
EXALGO QL
8mg, 12mg = 2/day;
16mg = 4/day
PROSCAR PR in all females
PR in females only
and males < 50 yrs old
PROTOPIC
PR and QL = 120/30 days
fentanyl patch QL = 20/30 days
FENTORA PR and
QL = 120/30 days
UPPER CASE = brand name medication lower case italics = generic medication
2013 Precertification Safety Edits and National Precert List for Fully Insured plans only (continued)
QUALAQUIN PR and
tamsulosin PR in females only
QL = 42/year
TAZORAC PR ≥ 36 yr old
RAPAFLO PR in females only
tretinoin PR ≥ 36 yr old
QL = 2 bot les/30 days
TRETIN-X PR ≥ 36 yr old
PR 17 yr old
SUBOXONE PR and QL = 3/day
PR in females only
SUBUTEX PR and QL
ZIANA PR ≥ 36 yr old
PR ≥ 36 yr old
2 mg = 24/30 days,
VELTIN PR ≥ 36 yr old
RETIN-A PR ≥ 36 yr old
8 mg = 8/30 days
1 In accordance with state law, full-risk members in Texas who are receiving coverage for medications that are removed from the Preferred Drug List during the plan year will continue to have those medications covered at the same benefit level until their plan’s renewal date. 2 The term precertification means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members. 3 In accordance with state law, California HMO members who are receiving coverage for medications that are added to the Precertification or Step-Therapy lists will continue to have those medications covered, for as long as the treating physician continues prescribing them, provided that the drug is appropriately prescribed and is considered safe and effective for treating the enrollee's medical condition. Nothing in this section shall preclude the prescribing provider from prescribing another drug covered by the plan that is medically appropriate for the enrollee, nor shall anything in this section be construed to prohibit generic drug substitutions. 4 Some programs, such precertification, quantity limits and step-therapy are not available in all service areas and are subject to change. For example, precertification and step therapy programs do not apply to fully insured members in Indiana. Step-therapy does not apply to fully insured members in New Jersey. However, these programs are available to self-insured plans. Please refer to your plan documents or call the Member Services number on your ID card. UPPER CASE = brand name medication lower case italics = generic medication

Source: http://www.epaumcbenefits.com/forms/2013%203Tier%20Open%20changes.pdf

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Journal of Asthma, Early Online, 1–7, 2010Copyright © 2010 Informa Healthcare USA, Inc. ISSN: 0277-0903 print / 1532-4303 onlineDOI: 10.3109/02770903.2010.528497 Behavioral Problems in Children and Adolescents with Difficult-To-Treat MARIEKE VERKLEIJ, M.SC.,1,2,∗ ERIK-JONAS VAN DE GRIENDT, M.D.,3,4 AD A. KAPTEIN, PH.D.,5 LIESBETH VANESSEN-ZANDVLIET, M.D., PH.D.,2 ERIC DUIVERMAN, M.D., PH.

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