This formulary is not inclusive nor does it guarantee coverage. It is an abbreviated list of Pharmacy and Therapeutics Committee approved drugs that may be prescribed for Navitus members. This document is subject to change. The most updated version of this document as well as a complete formulary listing is available at www.navitus.com or upon request. Drugs will be dispensed generically when acceptable generic equivalents are UA Net Plan – available. This document is copyrighted by Navitus Health Solutions® and may be reprinted for personal use only. Colorado Springs Reproduction of this document for any other reason is expressly prohibited, unless prior written consent is obtained from Navitus. Quick Reference Formulary Anti-Convulsants Reading the Drug List
Generic medications are listed in all lower
case letters; brand name medications are
listed in all upper case letters. Each drug
Other Cardiovascular Agents
product is associated with a coverage tier,
shown to the right of each drug product.
Anti-Gout Anti-Virals Anti-Depressants
PRADAXA (PA/QL=2 caps/day) 2
Cases where drug products are followed by
parentheses indicate that the entry relates to
RELENZA (QL=20 units/fill)
TAMIFLU (QL=10 cap/fill) Cholesterol Lowering Agents
(vaginal cream), or more than one form of
the drug, e.g. ZOMIG (ZMT). Quantity limits
provided are for prescriptions filled at retail
pharmacies; please consult complete version
of formulary for mail order quantity limits.
CARDIOVASCULAR
All newly approved drugs on the market will
Diuretics
initially NOT be covered, pending further
CRESTOR (QL = 30 tabs/Rx)
review by the Navitus P and T Committee.
CYMBALTA (QL=2 caps/day)2
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A complete version of the Navitus Formulary,
www.navitus.com (QL=1 tab/day) Beta Blockers Anti-Psychotic Agents ANTI-INFECTIVES Penicillins CNS & ANS AGENTS Analgesics Cephalosporins Stimulants
OXYCONTIN (QL=4 tab/day) ACE Inhibitors Migraine Agents Macrolides (QL= 9 tabs/Rx; 2 fill/30 days) (QL= 4 inj/Rx; 2 fill/30 days) Anti-Parkinson Agents (QL= 9 tabs/Rx; 2 fill/30 days) Quinolones Angiotensin Receptor Blockers (QL= 6 spr/Rx; 2 fill/30 days) (QL= 12 tabs/Rx; 3 fill/60 days) Miscellaneous Anti-infectives (QL= 6 spr/Rx; 2 fill/30 days) Miscellaneous CNS Agents
nitrofurantoin monohydrate/macrocrystals 1
(QL=1 tab/day) Calcium Channel Blockers Anti-Anxiety Agents & Sedatives
ARICEPT 23mg (ST/QL=1 tab/day) Anti-Fungals PA=Prior authorization required; criteria needs to be met for product to be covered ST=Step Therapy QL=Quantity limits apply NC=Not covered SP=Available through Navitus Specialty Pharmacy Program RS=Restricted to Specialists Printed 04/14/11 This formulary is not inclusive nor does it guarantee coverage. It is an abbreviated list of Pharmacy and Therapeutics Committee approved drugs that may be prescribed for Navitus members. This document is subject to change. The most updated version of this document as well as a complete formulary listing is available at www.navitus.com or upon request. Drugs will be dispensed generically when acceptable generic equivalents are UA Net Plan – available. This document is copyrighted by Navitus Health Solutions® and may be reprinted for personal use only. Colorado Springs Reproduction of this document for any other reason is expressly prohibited, unless prior written consent is obtained from Navitus. Quick Reference Formulary DIABETIC AGENTS OB/GYN AGENTS DERMATOLOGICALS
LUMIGAN (QL=2.5ml/fill) Topical Anti-Infectives
TRAVATAN (Z) (QL=5ml/fill) Diabetic Supplies Contraceptives
XALATAN (QL=2.5ml/fill) Miscellaneous Ophthalmic Agents Topical Anti-Fungals Estrogens/Combinations
PREMARIN/PREMPRO/PREMPHASE 2 Acne Agents Hypoglycemic Agents GASTROINTESTINAL Antiulcer Agents Osteoporosis Agents Psoriasis /Eczema Agents Miscellaneous Topical Agents (QL=1 tab/day)
DEXILANT (ST/QL=1 cap/day) 2 RESPIRATORY AGENTS Nasal Products
REGRANEX (QL=2-15gm tubes/copay) 2 Urinary Agents EYES & EARS THYROID AGENTS Leukotriene Modifiers Asthma/Pulmonary Agents Ophthalmic Anti-Infectives/Steroids MUSCULOSKELETAL Miscellaneous Gastrointestinal Agents (QL= 5 days tx) ANTINEOPLASTICS/ IMMUNOSUPPRESSANTS
anastrozole (SP) Glaucoma Agents COX-2 Inhibitors
AFINITOR (SP/PA/QL)
CELEBREX (ST/QL=2 cap/day)
latanoprost (QL=2.5ml/fill) Misc. Musculoskeletal PA=Prior authorization required; criteria needs to be met for product to be covered ST=Step Therapy QL=Quantity limits apply NC=Not covered SP=Available through Navitus Specialty Pharmacy Program RS=Restricted to Specialists Printed 04/14/11
Extract from the Compendium of Clinical and Health Indicators User Guide National Centre for Health Outcomes Development Thyroid and renal function testing in patients on lithium therapy Purpose: To help reduce the level of risk to health for NHS patients on lithium therapy and ensure high standards of primary health care and treatment delivered to them. There is a much higher than
Promoting the enjoyment, knowledge and benefits of gardens and gardening JOE!S CONNECTED GARDEN Urban farming made easy Backyards connected to the neighbours – for many, a beautiful image of our childhood, recreated here today. This is the second time we have opened our gardens – and our vision of simple community - to the public. Now that the nets are up, Joe’s Connected Gard