Excluded Medications

We do not make the decision to exclude medications from benefit coverage lightly. A medication is only excluded when other, lower-cost alternative medications are available to treat a condition.

To help lower health care costs, we are no longer going to cover these medications. Please talk with your doctor to decide if a lower-cost alternative medication is right for you. You and your doctor make decisions about your health care, including decisions about prescription drugs.

Medications being excluded* on July 1, 2010:

Aplenzin™ — Depression

Alternatives:
bupropion hydrochloride SR (generic Wellbutrin SR®), bupropion hydrochloride XL (generic Wellbutrin XL®)

Rationale:
Aplenzin is an extended-release version of bupropion used for the treatment of major depressive disorder (MDD). Aplenzin is over four times more expensive than buproprion (generic Wellbutrin XL).


Edluar™ — Insomnia

Alternatives:
Ambien CR®, zaleplon (generic Sonata®), zolpidem (generic Ambien®)

Rationale:
Edluar contains zolpidem, the same active ingredient as generic Ambien. Edluar is about 13 times more expensive than the generic version of Ambien.


Lamictal® ODT™ and Lamictal XR™ — Seizure Disorders

Alternatives:
Lamictal®, lamotrigine (generic Lamictal)

Rationale:
Lamictal ODT (oral-disintegrating tablets) and Lamictal XR (extended release) cost hundreds of dollars more than therapeutically equivalent generic Lamictal.


NeoBenz® Micro — Acne

Alternatives:
OTC benzoyl peroxide

Rationale:
NeoBenz Micro, Neobenz Micro SD and Triaz Foaming Cloths all contain benzoyl peroxide as their active ingredient. Some of these products are 11 to 17 times more expensive than over-the-counter (OTC) benzoyl peroxide.


Neobenz Micro SD — Acne

Alternatives:
OTC benzoyl peroxide

Rationale:
NeoBenz Micro, Neobenz Micro SD and Triaz Foaming Cloths all contain benzoyl peroxide as their active ingredient. Some of these products are 11 to 17 times more expensive than over-the-counter (OTC) benzoyl peroxide.


pantoprazole (generic Protonix®) — Ulcers, Heartburn, and Reflux

Alternatives:
Aciphex®, Kapidex™ / Dexilant™**, Prevacid® 24HR, Prilosec OTC®, Protonix, Zegerid OTC™, omeprazole, Zegerid®

Rationale:
Pantoprazole (generic Protonix) is over five times more expensive than OTC therapeutic equivalents and eight times more expensive than omeprazole.


Provigil® — Excessive Daytime Drowsiness

Alternatives:
Nuvigil®

Rationale:
Nuvigil and Provigil are produced by the same manufacturer. They are used to treat excessive daytime drowsiness (EDD) for specific sleep disorders such as those with narcolepsy or sleep apnea. Provigil currently costs about 50% more than Nuvigil.

Important Note: If you received coverage approval for Provigil within the past year, that approval will automatically transfer to Nuvigil. You will not need to request approval when you switch to Nuvigil.


Ryzolt™ — Pain

Alternatives:
tramadol immediate-release (generic Ultram®), tramadol extended-release (generic Ultram ER®)

Rationale:
Ryzolt, generic Ultram and generic Ultram ER contain the same active ingredient, tramadol. Ryzolt is 20 times more expensive than generic Ultram.


Triaz® Foaming Cloths — Acne

Alternatives:
OTC benzoyl peroxide

Rationale:
NeoBenz Micro, Neobenz Micro SD and Triaz Foaming Cloths all contain benzoyl peroxide as their active ingredient. Some of these products are 11 to 17 times more expensive than over-the-counter (OTC) benzoyl peroxide.


Ziana® — Acne

Alternatives:
clindamycin gel + tretinoin gel***, Duac®, Retin-A-Micro®

Rationale:
Ziana is a topical, combination product containing an antibiotic (clindamycin phosphate) and retinoid product (tretinoin) in a gel formulation. Ziana is about four times more expensive than its individual components.



*These drugs will be excluded under most benefit plans. Call the phone number on the back of your ID card for more information about your benefit plan design.

**Kapidex changed its name to Dexilant in April, 2010.

***Ziana is a combination of two separate medications. This means that those two medications, when used together, are equivalent to Ziana.