Benefits Plans - Prescription Drug Plan: Drug Plan Updates and New Drug Releases -
Drug Tier Changes

Page last updated: Wednesday, 26-May-2010 20:51:35 EDT

Effective April 1, 2005

Non-Preferred Brand Name Drug Non-Preferred Brand Tier
(4-1-05)
Alternative
Drug Name(s)
Alternative Drug Tier
Augmentin ES-600 suspension 3 amoxicillin/clavulanate (generic equivalent) 1
Bactroban 3 mupirocin (generic equivalent) 1
Depo-Provera injection 2 medroxyprogesterone acetate injection (generic equivalent) 1
Diflucan 3 fluconazole(generic equivalent) 1
Eskalith CR 3 lithium carbonate extended-release(generic equivalent) 1
Halcion 3 triazolam(generic equivalent) 1
Lasix 3 furosemide(generic equivalent) 1
Lescol 3 lovastatin, 1
Crestor, Lipitor, Pravachol 2
Lescol XL 3 lovastatin, 1
Crestor, Lipitor, Pravachol 2
Lexapro 3 citalopram, fluoxetine, paroxetine 1
Zoloft 2
Lithobid 3 lithium carbonate extended-release 1
MiraLax 3 polyethylene glycol 3350(generic equivalent) 1
Neurontin 3 gabapentin(generic equivalent) 1
Nizoral 2% shampoo & cream 3 ketoconazole 2% shampoo(generic equivalent) 1
NuLytely solution 3 peg 3350/sodium bicarbonate/sodium chloride/potassium chloride(generic equivalent) 1
Provera 3 medroxyprogesterone acetate(generic equivalent) 1
Rowasa enema 3 mesalamine enema(generic equivalent) 1
Sulfacet-R 3 sulfacetamide/sulfur(generic equivalent) 1
Temovate 3 clobetasol(generic equivalent) 1
Tridesilon 3 desonide(generic equivalent) 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.