The top 25 Medicare Part D formulary changes for 2009-2010
The 2010 BCBSNM Medicare Part D formulary, which has been approved by the Centers for Medicare & Medicaid Services (CMS), will be included in the Annual Notice of Change sent to our Medicare Part D plan members. Members also received letters in late November about the formulary changes. You can find a comprehensive 2010 formulary on our website.
 
Following are the top 25 formulary changes for 2010. Coverage determinations for changes can be submitted by the prescribing physician after December 17, 2009, with an effective date of January 1, 2010. 

Formulary change

2009 Tier

2010 Tier

Description of change

Alternative, if applicable

Omeprazole capsules
20 mg

1

1

On our formulary; however, quantity limits may apply

On formulary, quantity limits may apply

FLOMAX® capsules
0.4 mg

2

3

On our formulary, but will be covered in higher-cost tier

On formulary, higher tier

TOPROL XL® tablets 25, 50, 100, 200 mg

3

Not on formulary

Not covered on 2010 formulary as generic equivalents and/or generic alternatives are available. Generics are FDA-approved and regulated, equal to brand-name drugs in safety and effectiveness, and less expensive

Not on formulary, generic(s) available

Propoxyphene N-APAP tablets 50/325, 100/500, 100/650 mg

1

Not on formulary

 

Not covered on our 2010 formulary

COZAAR® tablets
25, 50, 100 mg

2

3

On our formulary, but will be covered in higher-cost tier

On formulary, higher tier

COMBIVENT® AER

2

Not on formulary

Not covered on our 2010 formulary

Check with your doctor

COSOPT® SOL
2-0.5%OP

3

Not on formulary

Not covered on 2010 formulary as generic equivalents and/or generic alternatives are available. Generics are FDA-approved and regulated, equal to brand-name drugs in safety and effectiveness, and less expensive

Not on formulary, generic(s) available

HYZAAR® tablets
50-12.5, 100-12.5,
100-25 mg

2

3

On our formulary, but will be covered in higher-cost tier

On formulary, higher tier

Carisprodol tablets
350 mg, ASA/COD tablets

1

Not on formulary

Not covered on our 2010 formulary

CMS – High-risk medication

Cyclobenzaprine, methocarbamol, tizanidine

LUMIGAN® solution 0.03%

3

Not on formulary

Not covered on our 2010 formulary

TRAVATAN®, TRAVATAN Z®, XALATAN®

Colchicine tablets
0.6 mg

1

Not on formulary

Not covered on our 2010 formulary

COLCRYSTM

ARIMIDEX® tablets
1 mg

2

3

On our formulary, but will be covered in higher-cost tier

On formulary, higher tier

DEPAKOTE® tablets 125, 250, 500 mg DR; SPR capsules 125 mg

3

Not on formulary

Not covered on 2010 formulary as generic equivalents and/or generic alternatives are available. Generics are FDA-approved and regulated, equal to brand-name drugs in safety and effectiveness, and less expensive

Not on formulary, generic(s) available

KEPPRA® tablets

250, 500, 750, 1000 mg; solution 100 mg/ml

2

Not on formulary

Not covered on 2010 formulary as generic equivalents and/or generic alternatives are available. Generics are FDA-approved and regulated, equal to brand-name drugs in safety and effectiveness, and less expensive

Not on formulary, generic(s) available

TOPAMAX® tablets
25, 50, 100, 200 mg

3

Not on formulary

Not covered on 2010 formulary as generic equivalents and/or generic alternatives are available. Generics are FDA-approved and regulated, equal to brand-name drugs in safety and effectiveness, and less expensive

Not on formulary, generic(s) available

ALPHAGAN® P solution 0.15%

3

Not on formulary

Not covered on our 2010 formulary

Brimonidine 0.2% ophthalmic

NULYTELY® solution

2

Not on formulary

Not covered on 2010 formulary as generic equivalents and/or generic alternatives are available. Generics are FDA-approved and regulated, equal to brand-name drugs in safety and effectiveness, and less expensive

Not on formulary, generic(s) available

FEMARA® tablets
2.5 mg

2

3

On our formulary, but will be covered in higher-cost tier

On formulary, higher tier

Dicyclomine tablets
20 mg; capsules 10 mg; solution 10 mg/5 ml

1

Not on formulary

Not covered on our 2010 formulary

CMS – High-risk medication

Check with your doctor

XOPENEX® HFA AER

2

Not on formulary

Not covered on our 2010 formulary

PROAIR® HFA, VENTOLIN® HFA

ACULAR® LS solution 0.4%; solution 0.5% OP

2

3

On our formulary, but will be covered in higher-cost tier

On formulary, higher tier

TOBRADEX® SUS OP

2

Not on formulary

Not covered on 2010 formulary as generic equivalents and/or generic alternatives are available. Generics are FDA-approved and regulated, equal to brand-name drugs in safety and effectiveness, and less expensive

Not on formulary, generic(s) available

VALTREX® tablets
500 mg, 1gm

2

3

On our formulary, but will be covered in higher-cost tier

On formulary, higher tier

TRUSOPT® solution 2% OP

2

Not on formulary

Not covered on 2010 formulary as generic equivalents and/or generic alternatives are available. Generics are FDA-approved and regulated, equal to brand-name drugs in safety and effectiveness, and less expensive

Not on formulary, generic(s) available

ASMANEX® 30 AER 110 mcg, 120 AER 220 mcg

2

Not on formulary

Not covered on our 2010 formulary

FLOVENT® HFA, PULMICORT FLEXHALERTM, QVAR®

 

 

Issue 12, 2009 • Blue Review • www.bcbsnm.com