May 2009


	Standard Plan	Select Plan	Closed Plan

► BENEFIT DESIGN OPTIONS	A benefit plan with a one or two-tier structure that includes generic and brands. There is no difference between preferred and nonpreferred brands.	A benefit plan with a three-tier structure that includes generics, preferred brands and nonpreferred brands.	A benefit plan with a two-tier structure that includes generics and preferred brands. Nonpreferred brands are not covered.

► NEW DRUGS	Standard Plan	Select Plan	Closed Plan
Aplenzin (bupropion hydrobromide)
An antidepressant indicated for the treatment of Major Depressive Disorder. Non-preferred status DACON edit applies In a limited category (Antidepressants-Other)	Brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Third tier, non-preferred brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Not covered.
Degarelix
A subcutaneously administered injectable medication indicated for treatment of patients with advanced prostate cancer. Not added to the pharmacy benefit	Not covered.	Not covered.	Not covered.
Vimpat (lacosamide tablets)
Indicated as adjunctive therapy in the treatment of partial-onset seizures in patients with epilepsy aged 17 years and older. Nonpreferred status In a limited category (Anticonvulsants)	Brand copay.	Third tier, non-preferred brand copay.	Not covered.
Rapaflo (silodosin)
Indicated for the treatment of the signs and symptoms of benign prostatic hyperplasia (BPH). Nonpreferred status DACON edit applies In a limited category (Prostate-enlarged)	Brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Third tier, non-preferred brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Not covered.

► LINE EXTENSIONS	Standard Plan	Select Plan	Closed Plan
No line extentions reviewed at April meetings

► DRUG CLASS REVIEW	Standard Plan	Select Plan	Closed Plan
No changes from the April meetings

► PPL UPDATES	Standard Plan	Select Plan	Closed Plan
Alrex (loteprednol etabonate 0.2%)
An ophthalmic steroid suspension used for seasonal allergic conjunctivitis. Alrex is being removed from preferred status. Quantity Limit applies In a limited category (Ophthalmic-Steroids)	Brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Third tier, non-preferred brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Not covered.
Lotemax (loteprednol etabonate 0.5%)
An ophthalmic steroid suspension used for the treatment of steroid responsive inflammatory conditions of the eye. Lotemax is being removed from preferred status. In a limited category (Ophthalmic-Steroids)	Brand copay.	Third tier, non-preferred brand copay.	Not covered.
Orth Evra (norelgestromin / ethinyl estradiol transdermal system)
Indicated for the prevention of pregnancy in women who elect to use a transdermal patch as a method of contraception. Ortho Evra is being removed from preferred status. In a limited category (Contraceptives)	Brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Third tier, non-preferred brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Not covered.
Ortho Tri-Cyclen Lo (norgestimate/ethinyl estradiol)
indicated for the prevention of pregnancy in women who elect to use oral contraceptives as their method of contraception. Ortho Tri-Cyclen lo is being removed from preferred status. In a limited category (Contraceptives)	Brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Third tier, non-preferred brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Not covered.
Symbyax (olanzapine/fluoxetine)
A combination of an atypical antipsychotic and an SSRI antidepressant which is indicated for acute treatment of depressive episodes associated with bipolar I disorder in adults, and treatment resistant depression in adults. Symbyax is being removed form preferred status. In a limited category (Antidepressants-Bipolar Disorder)	Brand copay.	Third tier, non-preferred brand copay.	Not covered.
Zylet (loteprednol etabonate 0.5% and tobramycin 0.3%)
An ophthalmic suspension that combines a steroid with an anti-infective agent. Zylet is indicated for steroid-responsive inflammatory conditions of the eye where risk for bacterial ocular infection exists. Zylet is being removed from preferred status. In a limited category (Ophthalmic-Steroids)	Brand copay.	Third tier, non-preferred brand copay.	Not covered.

► BRANDS WITH GENERICS AVAILABLE	Standard Plan	Select Plan	Closed Plan
Depakote (divalproex sodium delayed release tablets)
Used in the treatment of seizure disorder in adults and children age 10 and older, for the treatment of manic episodes associated with bipolar disorder, and for prophylaxis of migraine headaches. Depakote is removed from preferred status because the generic equivalent divalproex sodium delayed release tablet is available at the generic copay. In a limited category (Anticonvulsants)	Brand copay.	Third tier, non-preferred brand copay.	Not covered.
Lamictal & Lamictal Chewable Dispersible (lamotrigine)
Used in the treatment of seizure disorder in adults and children age 2 and above, and for the maintenance treatment of Bipolar I Disorder to delay the time to occurrence of mood episodes. Lamictal is being removed from preferred status because generic equivalents, lamotrigine tablet and lamotrigine dispersible tablets, are available at the generic copay. In a limited category (Anticonvulsants)	Brand copay.	Third tier, non-preferred brand copay.	Not covered.

► Clinical Programs	Standard Plan	Select Plan	Closed Plan
No additional changes made to Clinical Programs as a result of the April meetings

	May 2009



Innoviant's Business Committee meets monthly to evaluate product status (tier placements) and new prescription products approved by the Food and Drug Administration (FDA). Decisions made by the Innoviant Business Committee are based on information and recommendations provided by Prescription Solutions' National Pharmacy & Therapeutics Committee (NPTC). The P&T is comprised of independent physician providers, affiliated plan physicians and pharmacists. The following table summarizes the decisions made at the April committee meetings. All changes are effective July 1, 2009 unless otherwise noted. Current information related to Innoviant and its offerings is available at www.innoviant.com. A copy of this newsletter can also be found on the website (http://www.innoviant.com/customers/publications/default.asp).