Microsoft word - qhp_st web file effective 6-1-2013
STEP THERAPY ALGORITHMS – QHP MAPD Formulary Treatment Group Description Step 1: One of the following:
Step 2: Actoplus Met Step 1: One of the following:
a. Metformin b. Sulfonylurea c. Insulin d. Byetta
Step 2: Formulary Actos Step 1: One of the following:
Step 2: Advair Diskus or Advair HFA 2013-0601 Treatment Group Description Step 1: Two of the following:
Step 2: Glyset or Precose (including acarbose) Step 1: One of the following:
c. ACE inhibitor/calcium channel blocker combination d. Losartan
Step 2: Micardis or Micardis HCT Step 1: One of the following:
c. ACE inhibitor/calcium channel blocker combination
Step 2: Benicar, Benicar HCT, or Diovan, Diovan HCT Step 1: One of the following Tier 1 or Tier 2 antidepressants: Step 2: Emsam or Pexeva or Fluoxetine 90 mg DR Step 1: One of the following:
Step 2: Aricept 23 mg 2013-0601 Treatment Group Description Step 1: One of the following:
c. ACE inhibitor/calcium channel blocker combination d. Angiotensin II Receptor Antagonist e. Angiotensin II Receptor Antagonist Combination
Step 2: Azor Step 1: Alendronate Step 2: Atelvia or Actonel Step 1: One of the following:
a. Metformin b. Sulfonylurea c. Thiazolidinedione d. Insulin
Step 2: Bydureon Step 1: Pilocarpine
Step 2: Evoxac Step 1: One of the following:
b. Dextroamphetamine c. Dexmethylphenidate d. Methylphenidate
Step 2: Strattera 2013-0601 Treatment Group Description
Dipeptidyl Peptidase 4 Inhibitor Therapy
Step 1: One of the following:
a. Metformin b. Sulfonylurea c. Thiazolidinedione
Step 2: Januvia or Onglyza
Janumet, Janumet Dipeptidyl Peptidase 4 Inhibitor/ Metformin
Step 1: One of the following:
Step 2: Janumet or Janumet XR or Kombiglyze XR Step 1: One of the following:
Step 2: Duetact Step 1: One of the following atypical antipsychotics: Step 2: Fanapt Step 1: Generic atypical antipsychotic Step 2: Geodon 2013-0601 Treatment Group Description Step 1: One of the following:
b. Sulfonylurea c. Insulin d. Thiazolidinedione
Step 2: Byetta or Victoza Step 1: One tier 1 or tier 2 inhaled corticosteroid
Step 2: Alvesco Step 1: Any one formulary ADHD stimulant Step 2: Intuniv Step 1: One of the following:
b. Formulary Inhaled corticosteroid c. Formulary Inhaled Beta-agonist/Corticosteroid combination d. Formulary Oral Corticosteroid
Step 2: Zyflo or Zyflo CR Step 1: One of the following:
Step 2: Foradil or Serevent Step 1: Two of the following:
a. Metformin b. Sulfonylurea c. Thiazolidinedione (TZD) d. Insulin e. Byetta.
Step 2: Prandin 2013-0601 Treatment Group Description Step 1: One of the following:
Step 2: Emadine Step 1: Ophthalmic prednisolone acetate Step 2: FML Forte or Vexol Step 1: Generic morphine sulfate ER Step 2: Oxycontin Step 1: One of the following:
b. Beta-blocker c. Calcium-channel blocker
Step 2: Ranexa Step 1: Renvela. Step 2: Renagel. Step 1: Cyclobenzaprine (immediate-release) Step 2: Cyclobenzaprine (extended-release) or generic Cyclobenzaprine IR Step 1: Carbidopa/levodopa (immediate release) AND Comtan Step 2: Stalevo 2013-0601 Treatment Group Description Step 1: One of the following:
a. Simvastatin b. Lovastatin c. Pravastatin d. Lipitor/Atorvastatin e. Crestor
Step 2: Altoprev Step 1: One of the following:
a. Lipitor/Atorvastatin b. Crestor c. Fluvastatin
Step 2: Vytorin Step 1: One of the following:
a. Inhaled corticosteroid b. Long-acting beta agonist c. Inhaled anticholinergic agent d. Theophylline
Step 2: Symbicort Step 1: Topical Corticosteroid
Step 2: Elidel or Protopic Step 1: One of the following:
a. ACE inhibitor b. ACE inhibitor combination c. Angiotensin II receptor blocker d. Angiotensin II receptor blocker combination
Step 2: Tribenzor 2013-0601 Treatment Group Description Step 1: Naratriptan or Sumatriptan
Step 2: Axert, Frova, or Relpax Step 1: One of the following:
b. ACE inhibitor combination c. Angiotensin II Receptor Blocker d. Angiotensin II Receptor Blocker Combination
Step 2: Twynsta Step 1: Allopurinol
Step 2: Uloric Step 1: One Tier 1 or Tier 2 SSRI or SNRI Step 2: Viibryd Step 1: Albuterol (nebulizer)
Office of the SheriffAnderson County, Tennessee FOR IMMEDIATE RELEASE Undercover Drug Operation Nets 163 Indictments One hundred sixty-three indictments for eighty-eight persons on drug related charges havebeen returned by an Anderson County Grand Jury after investigations by the AndersonCounty Sheriff’s Department in cooperation with the Tennessee Bureau of Investigation,the Oak Ridge, La
Voorzitter - Wijziging van de begroting - Wijziging van de begroting van de uitgaven en de ontvang- van de uitgaven en de ontvang- sten van het Ministerie van sten van het Infrastructuurfonds Financie ¨ n (IXB) voor het jaar voor het jaar 1995 (wijziging 1995 (wijziging samenhangende samenhangende met de Najaars- met de Najaarsnota) (24526); nota) (24536);
STEP THERAPY ALGORITHMS – QHP MAPD Formulary