Download 2010_DLC_Commerical_Grid_Rx4 Movement

HUMANA 2010 DRUG LIST CHANGES
Rx4 DRUG MOVEMENT
Rx4 Drug Movement - The drugs below will move from Level 1 to Level 2 effective January 1, 2010.
For copayment level information and possible lower cost alternatives, visit Humana.com.
DRUG NAME
AMLODIPINE-BENAZEPRIL
BENZONATATE CAPSULE
BETAMETHASONE DP CREAM
CODEINE-GUAIFEN LIQUID
ETODOLAC TABLET SA
FLAGYL TABLET
HYDROCORTISONE TABLET
INDOMETHACIN ER CAPSULE
METHADONE TABLET
METHADONE HCL TABLET
METHADONE INTENSOL
METHADONE SOLUTION
METRONIDAZOLE TABLET
MINITRAN PATCH
NEOMYCIN-POLYMIXIN-HC EAR SUSP
NEOMY-POLYMYXIN B AMP
NEOMY-POLYMYXIN B VIAL
NITROGLYCERIN PATCH
NYSTATIN CREAM
NYSTATIN OINTMENT
PRENATE ELITE
TRIAMCINOLONE CREAM
ZALEPLON CAPSULE
Rx4 Drug Movement - The drugs below will move from Level 1 to Level 3 effective January 1, 2010.
For copayment level information and possible lower cost alternatives, visit Humana.com.
DRUG NAME
CYCLOGYL EYE DROPS
E.E.S. FILMTAB
ERYPED GRANULES
ERY-TAB EC TABLET
GENTAK EYE OINTMENT
GENTAK EYE DROPS
INDOCIN SUSPENSION
INDOCIN SUPPOSITORY
ISOPTIN SR TABLET
KEFLEX CAPSULE
MEBARAL TABLET
MICRO-K EXTENCAPS
NAPRELAN SA TABLET
NORINYL 1+50-28 TABLET
NOVA MAX GLUCOSE TEST STRIP
ORAPRED SOLUTION
PRECARE CHEWABLE TABLET
PRECARE CONCEIVE TABLET
PRECARE PREMIER CAPLETS
PREMESIS TABLET
PRIMACARE ADVANTAGE COMBO PACK
PRIMACARE COMBO PACK
PRIMACARE ONE SOFTGEL
Rx4 Drug Movement - The drugs below will move from Level 2 to Level 3 effective January 1, 2010.
For copayment level information and possible lower cost alternatives, visit Humana.com.
DRUG NAME
8-MOP CAPSULE
ACLOVATE CREAM
ACUFLEX CAPLET
ADVICOR TABLET
AHIST TABLET
ALBENZA TABLET
ALOMIDE EYE DROPS
ALUPENT INHALER
AMPHETAMINE SALTS TABLET
ANALPRAM HC CREAM
ANALPRAM HC LOTION
ANCOBON CAPSULE
ATABEX PRENATAL TABLET
ATROVENT HFA INHALER
AVC CREAM
GCA FMHHH 07/08
AZMACORT INHALER
BACTROBAN CREAM
BACTROBAN NASAL OINTMENT
BETOPTIC S EYE DROPS
BLEPHAMIDE EYE DROPS
BROMHIST PEDIATRIC DROPS
BRONTUSS SF SYRUP
CARBAPHEN 12 SUSPENSION
CARBATUSS-CL LIQUID
CARDIZEM LA TABLET
CARENATAL DHA
CASODEX TABLET
CATAPRES-TTS PATCH
CEENU CAPSULE
CELLCEPT ORAL SUSPENSION
Page 1 of 3
This list is subject to change.
Rx4 Drug Movement - The drugs below will move from Level 2 to Level 3 effective January 1, 2010.
For copayment level information and possible lower cost alternatives, visit Humana.com.
DRUG NAME
CELLCEPT CAPSULE
CELLCEPT TABLET
CELONTIN KAPSEAL
CENESTIN TABLET
CHEMET CAPSULE
CHROMAGEN CAPLET
CHROMAGEN FA CAPLET
CHROMAGEN FORTE CAPLET
CIPRO HC OTIC SUSPENSION
CLEOCIN VAGINAL OVULE
CLINDESSE VAGINAL CREAM
CLODERM CREAM
COLY-MYCIN S EAR DROPS
COMBIVENT INHALER
COMTAN TABLET
CORDRAN CM TAPE
CORMAX OINTMENT
CORMAX SOLUTION
CORTIFOAM AEROSOL
CORTISPORIN OINTMENT
CORTISPORIN-TC EAR SUSPENSION
COSOPT EYE DROPS
COUMADIN TABLET
CRINONE GEL
DARAPRIM TABLET
DELTUSS DMX LIQUID
DERMA-SMOOTHE-FS BODY OIL
DERMA-SMOOTHE-FS SCALP OIL
DESOXYN TABLET
DESPEC DM SYRUP
DEXTROAMP-AMPHET ER CAPSULE
DIASTAT PEDI SYSTEM
DIFFERIN CREAM
DIFFERIN GEL
DILANTIN INFATAB
DIURIL ORAL SUSPENSION
DRITHO-SCALP CREAM
DROXIA CAPSULE
DUETACT TABLET
DYRENIUM CAPSULE
EDECRIN TABLET
EMLA CREAM
ENCORA COMBO PACK
EPIFOAM FOAM
EPIVIR HBV TABLET
EPIVIR HBV SOLUTION
ERGOMAR SL TABLET
EVAMIST SPRAY
EXELDERM CREAM
EXELDERM SOLUTION
FARESTON TABLET
FELBATOL TABLET
FELBATOL SUSPENSION
GCA FMHHH 07/08
FEMHRT TABLET
FERREX FORTE PLUS CAPSULE
FLOMAX SA CAPSULE
FOLGARD OS TABLET
FOLTRATE TABLET
FURDANTIN SUSPENSION
GILTUSS PED-C LIQUID
GYNAZOLE-1 CREAM
HALOG CREAM
HALOG OINTMENT
HYCET SOLUTION
INDERAL LA CAPSULE
INDOCIN SUSPENSION
INNOPRAN XL CAPSULE
IOPIDINE EYE DROPS
J-MAX SYRUP
KADIAN SR CAPSULE
KENALOG AEROSOL SPRAY
LEVATOL TABLET
LIDODERM PATCH
LOCOID CREAM
LOCOID LOTION
LODOSYN TABLET
LODRANE D SUSPENSION
LUFYLLIN TABLET
LUSONAL LIQUID
MACRODANTIN CAPSULE
MATULANE CAPSULE
MAXIDEX EYE DROPS
MENOSTAR PATCH
MESNEX TABLET
METANX TABLET
MOBAN TABLET
MYCOBUTIN CAPSULE
NARDIL TABLET
NATELLE C TABLET
NAVANE CAPSULE
NEBUPENT POWDER
NEOTUSS-D LIQUID
NILANDRON TABLET
NITRO-DUR PATCH
NORINYL 1+35-28 TABLET
OMNIHIST II LA TABLET
OPTINATE COMBO PACK
ORAP TABLET
OXISTAT CREAM
OXISTAT LOTION
OXSORALEN LOTION
PANATUSS DXP LIQUID
PANATUSS DXP PEDIATRIC DROPS
PANTOPRAZOLE SOD DR TABLET
PCE DISPERTAB
PERCOCET TABLET
Page 2 of 3
This list is subject to change.
Rx4 Drug Movement - The drugs below will move from Level 2 to Level 3 effective January 1, 2010.
For copayment level information and possible lower cost alternatives, visit Humana.com.
DRUG NAME
PHISOHEX CLEANSER
PHOSLO GELCAP
PHOSPHOLINE IODIDE
PILOPINE HS EYE GEL
POLY-PRED EYE DROPS
PRECOSE TABLET
PRED MILD EYE DROPS
PRED-G EYE DROPS
PRED-G S.O.P. EYE OINTMENT
PREZISTA TABLET
PROCHIEVE GEL
PROGLYCEM ORAL SUSPENSION
PROTONIX DR TABLET
PULMICORT RESPULE
RAZADYNE TABLET
RAZADYNE ORAL SOLUTION
RAZADYNE ER CAPSULE
REPLIVA TABLET
REPREXAIN TABLET
RIDAURA CAPSULE
RIFAMATE CAPSULE
RISPERDAL M TABLET
ROCALTROL CAPSULE
SANTYL OINTMENT
SEMPREX-D CAPSULE
SINA-12X ORAL SUSPENSION
SINA-12X TABLET
STROMECTOL TABLET
SUDAL-12 CHEWABLE TABLET
SULFAMYLON CREAM
SULFAMYLON POWDER PACKET
SYNALGOS-DC CAPSULE
TAMBOCOR TABLET
TASMAR TABLET
TEMOVATE EMOLLIENT CREAM
TENEX TABLET
THEO-24 SA CAPSULE
TILADE INHALER
TOBRADEX EYE DROPS
TOBRADEX EYE OINTMENT
TOBREX EYE OINTMENT
TRANSDERM-SCOP
TRANXENE SD TABLET
TREXALL TABLET
TRI-NORINYL 28 TABLET
TRISPEC DMX LIQUID
TRISPEC DMX PEDIATRIC DROPS
TRUSOPT EYE DROPS
TRUVADA TABLET
TUSSI-12D TABLET
TUSSI-PRES LIQUID
TUSSI-PRES PEDIATRIC LIQUID
VALTREX CAPLET
VAZOBID SUSPENSION
VEXOL EYE DROPS
VIGAMOX EYE DROPS
VIVACTIL TABLET
YAZ 28 TABLET
ZERIT SOLUTION
ZYDONE TABLET
Rx4 Drug Movement - The drugs below will move from Level 3 to Level 4 effective January 1, 2010.
For copayment level information and possible lower cost alternatives, visit Humana.com.
DRUG NAME
DECLOMYCIN TABLET
DEMECLOCYCLINE TABLET
DURAGESIC PATCH
FLUTAMIDE CAPSULE
NIMODIPINE CAPSULE
GCA FMHHH 07/08
PHLEXY-10 BAR
PHLEXY-10 DRINK MIX POWDER
PHLEXY-10 TABLET
RILUTEK TABLET
SUPPRELIN LA KIT
Page 3 of 3
This list is subject to change.