Benefits Plans - Prescription Drug Plan: Drug Plan Updates and New Drug Releases - Drug Reviews

Page last updated: Wednesday, 26-May-2010 20:51:28 EDT

June 2004

The following drug considerations were reviewed and determined for formulary inclusion and tier placement by the U-M Pharmaceutical Benefits Advisory Committee in April - May 2004.

Drug Name Indication PDL Class
Yes/No
Action
Rythmol SR Arrhythmias No Tier 3
Rebetol Solution Hepatitis No Tier 2
Symbyax Bipolar disorder No Tier 3
Benicar HCT Hypertension Yes Tier 2, non-pref
Wellbutrin SR Depression Yes Tier 3, generic is available at Tier 1
Cleocin T Topical, Acne No Tier 3, generic is available at Tier 1
Desowen Topical steroid No Tier 3, generic is available at Tier 1
Accutane Acne No Tier 3, generic is available at Tier 1
Lotensin/Lotensin HCT Hypertension Yes Tier 3, generic is available at Tier 1
Elestat Ophthalmic, allergic conjunctivitis Yes Tier 3
Zorbtive Short Bowel Syndrome No Prior Authorization Required
Somavert Acromegaly No Prior Authorization Required
Actiq Pain No Prior Authorization Required
Spiriva Chronic Obstructive Pulmonary Disease No QL - 30 at retail, or 90 at Mail
Nicotrol NS Smoking Cessation No QL - 280ml per year
Limitations
The University of Michigan in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their dependents. Although the university has elected to provide these benefits this year, no individual has a vested right to any of the benefits provided. Nothing in these materials gives any individual the right to continued benefits beyond the time the university modifies, amends, or terminates the benefit. Anyone seeking or accepting any of the benefits provided will be deemed to have accepted the terms of the benefits programs and the university's right to modify, amend or terminate them.