Download VIVA Medicare Plus Rx Formulary Changes Effective January 1, 2008

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VIVA Medicare Plus Rx Formulary Changes Effective January 1, 2008
Drugs Added to Formulary:
chorionic gonadotropin
Cyklokapron inj
Depo-Provera 400mg inj
Elaprase
EMSAM
Gammastan S/D
Gamunex
Gardasil
glycopyrrolate
Increlex
M-R-VAX II
Naglazyme
Nitrostat
oxandrolone
pentoxyphylline
Primaxin
Rituxan
Rotateq
Tyzine
Vaqta
Zostavax
Drugs No Longer Covered:
Cipro inj*
Climara*
Colestid granules*
Diprolene lotion*
Effexor*
Ketek
Klaron 10% Lotion*
Lamisil*
Omnicef 300mg*
Parnate*
Pravachol 80mg*
Vantin Susp*
Vospire ER*
Zithromax susp*
Zoloft*
*Even though the brand name drug will no longer be covered, generic equivalents for these
drugs are still available on the formulary.
Medicare no longer allows these drugs to be covered under Part D:
Accuzyme spray
antipyrine/benzocaine
ear drops
benzoyl peroxide gel/wash
Dritho-scalp cream
hyoscyamine sulfate
Levsin inj
nitroglycerin 6.5mg cap
papain/urea oint,spray
pilocarpine eye drops
potassium choloride liquid
Prostigmin tab
salsalate
scopolamine inj
Moved to a higher tier (higher copay):
Necon tab 10/11-28
Regonol inj
Prior Authorization no longer required:
Elidel
leflunomide
Protopic
Raptiva
Soriatane
testosterone cypionate inj
Duoneb
Xopenex solution
Quantity Limits added:
Accuneb
Step Therapy added:
Elidel
Protopic
H0154_mcdoc629A 10_07
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