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

Page last updated: Wednesday, 26-May-2010 20:51:31 EDT

January - September, 2003

Following are the drug considerations that were reviewed and determined for formulary inclusion and tier placement by the U-M Pharmaceutical Benefits Advisory Committee from January through September, 2003.

Drug Name Indication PDL Class
Yes/No
Action
Cardizem LA Angina Yes Tier 3
RelPax Migraine Yes Tier 2
Alinia Diarrhea No Tier 2, ages 1-11yrs only
Emend Nausea No Tier 2, prior authorization
Restasis Tear Production No Tier 2
Ciprofloxacin Antibiotic Yes Tier 3
Altocor For Lipids Yes Tier 3
Augmentin XR Antibiotic Yes Tier 3
Depo-Testosterone Hormone replacement No Tier 3, quantity limit
Hepsera Hepatitis B No Tier 2, PA
Lexapro Anti-Depressant Yes Tier 3, review data in 6 months
Omnicef Antibiotic Yes Tier 2
Suprax Antibiotic Yes Remove from formulary - product discontinued
Vfend Anti-fungal No Tier 2, monitor utilization
Xyrem Narcolepsy No Tier 2
Zelnorm IBS No Tier 2, monitor utilization
Femring Hormone replacement No Tier 2
Finacea Rosacea No Tier 2
Innopran XL Hypertension Yes Tier 2
Vigamox Opthalmic AB No Tier 2
Xanax XR Anti-anxiety No Tier 3
Xolair Mod to severe asthma No Tier 2, PA
Zymar Opthalmic AB No Tier 3
Levitra Erectile Dysfunction No Tier 3, quantity limit
Crestor Lipids No Tier 3, pending data and additional review
Paroxetine (generic Paxil) Anti-depressant No Tier 1
Mirtazapine (generic Remeron) Anti-depressant No Tier 1
Amoxicillin/Clavulanate (generic Augmentin) Antibiotic No Tier 1
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.