Munroe Regional Medical Center Effective October 1, 2012 Munroe Choice, Munroe Advantage, Network Choice and Network Advantage
1-34 Day Supply 90 Day Supply At a retail pharmacy Through Mail Generic Drugs/Tier 1 Formulary Brand/Tier 2 Non-Formulary Brand/Tier 3 Generic Policy: If your doctor writes a prescription stating that a Generic may be dispensed, your coverage will only pay for the generic drug. If you choose to buy the Brand name drug in this situation, you will be required to pay the Generic co-pay plus the difference in cost between the Generic and Brand name drug. The Generic Policy does not apply if your doctor requires a brand name medication.
Specialty medications are limited to a 30 day supply and must be ordered through Caremark Specialty Pharmacy at 1-800-237-2767. Performance Generic Step Therapy: Your employer has implemented performance generic step therapy that promotes the use of generic medications first before non-preferred brand medications. If you choose to use certain non-preferred brand-name drugs before trying a generic medication or a preferred brand medication, your prescription may not be covered and you may need to pay the full cost. Enclosed you’ll find a list of non-preferred brand-name drugs that require you try a generic first. This list can change quarterly. DRUGS COVERED*
Legend Drugs (drugs that require a prescription) Exceptions: See Exclusion list below. Acne agents (prior authorization required for age >34) ADD/ADHD medications (prior auth required for age >18)
Narcolepsy medications (prior auth required) Impotence agents (quantity limits of 6 per 25 days) Migraine Meds (FDA quantity limits apply)
Compounded medication of which at least one ingredient is a legend drug at a participating pharmacy Contraceptives: Oral, injectable, diaphragm, transdermal & intravaginal, extended cycle products Diabetic Care: Insulin/Insulin pre-filled syringes, Agents/Strips, Disposable insulin needles/syringes/lancets Prescription vitamins
Antifungals (prior authorization required) Oral Fentanyl Products (prior authorization required) Prescription and OTC smoking cessation (two 12 week programs per calendar year) OTC requires prescription EXCLUSIONS*
Biological, blood products, serums and immunization agents Fertility medications IUD and Implantable devices for contraception (may be covered under Medical) Cosmetic agents (Anti-wrinkle agents, Depigmenting agents, Hair growth stimulants and removal products)
Nutritional Supplements Anti-obesity/Appetite suppression medications Medication which is to be taken by or administered to an individual, in whole or in part, while he or she is a patient in a licensed
hospital, rest home, sanitarium, extended care facility, convalescent hospital, nursing home or similar institution which operates on its premises, or allows to be operated on its premises, a facility for dispensing pharmaceuticals.
*This is not an inclusive list but is a representation of the most commonly used medications. Contact customer service for specific drug coverage information. Your employer’s plan is subject to the Affordable Care Act (ACA) which requires the coverage of a number of preventive items and services at 100% and ensures these items and services are not subject to deductibles or other limitations such as annual caps or limits. You can contact Customer Service if you have specific drug questions or register to check drug costs and coverage.
For Prescription Drug Card Customer Service Call 1-800-334-8134 NG Munroe Regional Medical Center October 2012 Brand Medications Requiring Use of a Generic First You can save money by using safe, effective generic medications when possible. According to your prescription benefit plan, in order for certain brand-name medications to be covered, you will have to try a generic medication first. The chart below tells you which kinds of drugs require you to use a generic first. This chart only provides a sample list of generic drug options and may not include all drugs available. Drug Class Step 1: You wil have to try one of Step 2: Before you can try one of ACE Inhibitors/Angiotensin II Receptor Antagonists (ARBs)/ Direct Renin Inhibitors/ Combinations
irbesartan/irbesartan HCTZ lisinopril/lisinopril HCTZ
losartan/losartan HCTZ moexipril/moexipril HCTZ quinapril/quinapril HCTZ
ramipril trandolapril trandolapril-verapamil ext-rel
Antihistamines/Combinations Bisphosphonates/Combinations COX-2 Inhibitors/Nonsteroidal Anti-Inflammatory (NSAIDs)/ Combinations Fibrates HMG-CoA Reductase Inhibitors (HMGs or Statins)/Combinations Nasal Steroids For Prescription Drug Card Customer Service Call 1-800-334-8134 NG Drug Class Step 1: You wil have to try one of Step 2: Before you can try one of Proton Pump Inhibitors (PPIs)
omeprazole-sodium bicarbonate Zegerid Powder for Oral Susp pantoprazole
Selective Serotonin Agonists/ Combinations Selective Serotonin Reuptake Inhibitors (SSRIs) Sleeping Agents Urinary Antispasmodics
*This list indicates the common uses for which the drug is prescribed. Some medicines are prescribed for more than one condition. Brand-name drugs not listed here may be covered by your plan without the use of a generic first. Information provided here is not a substitute for medical advice or treatment.
Discuss this information with your doctor or health care provider. CVS Caremark assumes no liability for the information provided or for any diagnosis or treatment made in reliance thereon, nor is it responsible for the reliability of the content.
Subject to state law restrictions. This document contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical
manufacturers that are not af iliated with CVS Caremark. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber. Targeted therapeutic classes and specific drug targets are subject to change based on new generic drug launches, product approvals, drug withdrawals, and
other market changes. 2012 Caremark. All rights reserved. 5295-24684c v1 1012 PGST FE
For Prescription Drug Card Customer Service Call 1-800-334-8134 NG
Evolutionary Ecology Research , 2002, 4 : 1017–1032 Generations of the polyphenic butterfly Araschnia levana differ in body design 1Department of Zoology, School of Biological Sciences, University of Southern Bohemia and 2Institute of Entomology, Czech Academy of Sciences, Branisˇovská 31, CZ-370 05 Cˇeské Budeˇjovice, Czech Republic ABSTRACT The European Map Butterfly
El Carvedilol reduce la morbilidad y la mortalidad en pacientes con insuficiencia cardíaca severa. Packer M, Coats AJS, Fowler MB, Katus HA, Krum H, Mohacsi P et al for the Carvedilol Prospective Randomized Cumulative Survival Study Group. Effect of carvedilol on survival in severe chronic heart failure N Engl J Med 2001; 344: 1651-1658. Objetivo: Valorar el efecto sobre la mortalid