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Std step therapy drugs 20100413.doc

STANDARD Stepped Therapy Agents ~ 2010
The following drugs will require prior authorization if the condition is not met when the pharmacist would attempt to
transmit a prescription claim.
Your doctor will coordinate this approval for you. If the prescription is approved, Coventry
Health Care will cover the cost. You will be responsible for the copayment. If the request is not approved, it does not mean
your doctor cannot prescribe the medicine for you. It means that you are responsible for paying the prescription in full. Self-
administered injectable agents also require prior authorization and can be found on a separate list.
Drug
Condition
Trial & failure of Risperdal* or Seroquel Trial & failure of two oral antibiotics for acne Trial & failure of metformin (at least 1500mg/d) ActoPLUS Met (pioglitazone / metformin) Trial & failure of metformin (at least 1500mg/d) Ambien CR (zolpidem extended release) Trial & failure of Ambien* or Sonata*, AND Lunesta Trial & failure of Lactulose* or Miralax* Trial & failure of metformin (at least 1500mg/d) Trial & failure of metformin (at least 1500mg/d) Avandaryl (rosiglitazone / glimepiride) Trial & failure of metformin (at least 1500mg/d) Trial & failure of Claritin* AND Zyrtec OTC Coreg CR (carvedilol extended rel) Detrol / Detrol LA (tolterodine / extended release) Trial & failure of Ditropan* or Sanctura/Sanctura XL Duetact (pioglitazone / glimepiride) Trial & failure of metformin (at least 1500mg/d) Effexor / Effexor XR (venlafaxine / extended rel) Trial & failure of Ditropan* or Sanctura/Sanctura XL Trial & failure of Risperdal* or Seroquel Trial & failure of Risperdal* or Seroquel Gelnique (oxybutynin topical gel) Trial & failure of Ditropan* or Sanctura/Sanctura XL Trial & failure of Risperdal* or Seroquel Janumet (sitagliptin / metformin) Trial & failure of metformin (at least 1500mg/d) Trial & failure of metformin (at least 1500mg/d) Lipitor (atorvastatin) 10mg & 20mg Lipitor (atorvastatin) 40mg & 80mg Trial & failure of Crestor or Vytorin Trial & failure of Ambien* or Sonata* Luvox CR (fluvoxamine extended release) Niravam ODT (alprazolam immediate rel) Trial & failure of metformin (at least 1500mg/d) Trial & failure of Ditropan* or Sanctura/Sanctura XL Paxil CR* (paroxetine extended release) Trial & failure of any SSRI AND Effexor This is the most current list at the time of printing and is subject to change. Last update April 13, 2010 Prozac Weekly (fluoxetine extended rel) Trial & failure of Ambien* or Sonata*, AND Lunesta Ryzolt (tramadol extended release) Trial & failure of Risperdal* or Seroquel Symbyax (olanzapine / fluoxetine) Trial & failure of Risperdal* or Seroquel Trial & failure of Ditropan* or Sanctura/Sanctura XL Ultram ER (tramadol extended release) Trial & failure of Ditropan* or Sanctura/Sanctura XL Vytorin (simvastatin/ezetimibe) 10/10 only Trial & failure of Claritin* AND Zyrtec OTC Trial & failure of Risperdal* or Seroquel Italics indicate non-formulary agents ^ indicates agent is not covered * indicates generic form available – lowest copay charged This is the most current list at the time of printing and is subject to change. Last update April 13, 2010

Source: https://secure.healthplan.com/user-docs/007070_STD_Step_Therapy_Drugs_20100413.pdf

acvd.org

Detailed Program Description for ACVD Website Clinical and Investigative Dermatology Residency Dermatology Service Veterinary Health Complex 2. Is the program currently on ACVD Probation? No If yes, please describe the reasons for probation, what is being done to correct them and when the program is scheduled to be off probation? Thierry Olivry, DrVet, PhD, DipACVD, DipECVD Petra Bizikova

Doi:10.1016/s0015-0282(02)04950-6

FERTILITY AND STERILITY ௡ Copyright ©2003 American Society for Reproductive MedicinePrinted on acid-free paper in U.S.A. Infertility drugs and the risk of breast cancer: findings from the National Institute Received July 2, 2002;revised and accepted of Child Health and Human Development September 24, 2002. Supported by contractsfrom the Contraception Women’s Contraceptive and Repro

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