2018 Formulary Notice of Change Prescription Drug Plans

Transcription

1 2018 Formulary Notice of Change Prescription Drug Plans WellCare Prescription Insurance, Inc. Plans in all states: WellCare Classic (PDP) WellCare may add or remove drugs from our formulary during the year. If we remove drugs from our formulary, or add prior authorization, quantity limits and/or step therapy restrictions on a drug and/or move a drug to a higher cost-sharing tier, we will notify you of the change at least 60 days before the date the change becomes effective. However, if the Food and Drug Administration deems a drug on our formulary to be unsafe or the drug s manufacturer removes the drug from the market, we may immediately remove the drug from our formulary and notify you as soon as possible. Y0070_WCM_10674E_V01 NM WellCare 2018 NA8PDGFOR13207E_NV01

2 Formulary ID: Effective Date: 4/1/2018 Formulary Version: 8 Aminosyn II Inj 7% Discontinuation / Alternative Drug: Aminosyn-HBC Inj 7% on Tier 4 / Effective Date: 3/1/2018 Buphenyl Tab 500mg Deletion of Drug From Formulary / Generic Available / Alternative Drug: Sodium Phenylbutyrate Tab 500mg Clindamax Gel 1% on Tier 5 / Discontinuation / Alternative Drug: Clindamycin Phosphate Gel 1% on Tier 3 / Effective Date: 3/1/2018 Copaxone Inj 40mg/mL Deletion of Drug From Formulary / Generic Available / Alternative Drug: Glatiramer Inj 40mg/mL on Tier 5 / Docefrez Inj 20mg Discontinuation / Alternative Drug: Docetaxel Inj 80mg/4mL on Tier 5 / Effective Date: 3/1/2018 Estrace Vaginal Cream 0.01% Deletion of Drug From Formulary / Generic Available / Alternative Drug: Estradiol Vaginal Cream 0.01% on Tier 4 / Gavilyte-H Kit Discontinuation / Alternative Drug: Gavilyte-G Sol on Tier 2 / Effective Date: 3/1/2018 Istalol Ophth Soln 0.5% Deletion of Drug From Formulary / Generic Available / Alternative Drug: Timolol Maleate Ophth Soln 0.5% (Once-Daily) on Tier 3 / Lortab Tab mg Lortab Tab 5-325mg Lortab Tab mg Acetaminophen Tab mg on Tier 3 / Effective Date: 3/1/2018 Acetaminophen Tab 5-325mg on Tier 3 / Effective Date: 3/1/2018 Acetaminophen Tab mg on Tier 3 / Effective Date: 3/1/2018 1

3 Menomune Inj A/C/Y/W Morphine Sulate Inj 15mg/mL Discontinuation / Alternative Drug: Menactra Inj on Tier 3 / Effective Date: 3/1/2018 Discontinuation / Alternative Drug: Morphine Sulfate IV Soln Pf 10mg/mL on Tier 4 / Effective Date: 3/1/2018 Renvela Pak Deletion of Drug From Formulary / Generic Available / Alternative Drug: Sevelamer Carbonate Packet on Tier 3 / Renvela Tab 800mg Deletion of Drug From Formulary / Generic Available / Alternative Drug: Sevelamer Carbonate Tab 800mg on Tier 3 / Reyataz Cap Deletion of Drug From Formulary / Generic Available / Alternative Drug: Atazanavir Cap on Tier 5 / Effective Date: 6/1/2018 Sabril Pack 500mg Deletion of Drug From Formulary / Generic Available / Alternative Drug: Vigabatrin Powder Pack 500mg on Tier 5 / Sustiva Cap 200mg Deletion of Drug From Formulary / Generic Available / Alternative Drug: Efavirenz Cap 200mg on Tier 5 / Sustiva Cap 50mg Deletion of Drug From Formulary / Generic Available / Alternative Drug: Efavirenz Cap 50mg on Tier 4 / Tamiflu Susp 6mg/mL Deletion of Drug From Formulary / Generic Available / Alternative Drug: Oseltamivir Phosphate Susp 6 mg/ml on Tier 3 / Transderm-Sc Patch 1.5mg Deletion of Drug From Formulary / Generic Available / Alternative Drug: Scopolamine Patch on Tier 4 / Triklo Cap 1gm Discontinuation / Alternative Drug: Omega-3-Acid Ethyl Esters Cap 1 gm on Tier 4 / Effective Date: 3/1/2018 Vigamox Drops 0.5% Deletion of Drug From Formulary / Generic Available / Alternative Drug: Moxifloxacin Hcl Ophth Soln 0.5% on Tier 3 / Zazole Cream 0.8% Discontinuation / Alternative Drug: Terconazole Vaginal Cream 0.8% on Tier 3 / Effective Date: 3/1/2018 2

4 Ziagen Soln 20mg/mL Deletion of Drug From Formulary / Generic Available / Alternative Drug: Abacavir Soln 20mg/mL on Tier 3 / Zoledronic Inj 4mg Discontinuation / Alternative Drug: Zoledronic Inj 4mg/5mL on Tier 4 / Effective Date: 3/1/2018 3

5 WellCare (PDP) is a Medicare-approved Part D sponsor. Enrollment in WellCare depends on contract renewal. This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments and restrictions may apply. Benefits, premiums and/or co-payments/ coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. WellCare uses a formulary. WellCare Prescription Insurance Inc. s pharmacy network offers limited access to pharmacies with preferred cost sharing in suburban areas of OK, OR, WA, ID, UT, AL, TN, MO, ME, NH, CO, and AK. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, please call (TTY only, call 711) or consult the online pharmacy directory at P.O. Box Tampa, FL