April 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
Promacta (eltrombopag)
A thrombopoietin receptor agonist indicated for the treatment of thrombocytopenia in patients with chronic immune (idiopathic) thrombocytopenic purpura who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy. Prior Authorization applies	Brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Second tier, preferred brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Second tier, preferred brand copay. Coverage determined by the benefit design chosen by the plan sponsor.
Nplate (romiplostim)
A thrombopoietin receptor agonist indicated for the treatment of thrombocytopenia in patients with chronic immune (idiopathic) thrombocytopenic purpura (ITP) who have had an insufficient response to corticosteroids, immunoglobulins, or splenectomy. Prior Authorization applies Specialty Pharmacy Program	If the customer has the Specialty Pharmacy Program (SPP), this product may be obtained through the specialty pharmacy network at the brand copay. If the customer does not have the SPP it may be considered under the medical benefit. Coverage and pharmacy provider(s) determined by the benefit design selected by the plan sponsor.	If the customer has the Specialty Pharmacy Program (SPP), this product may be obtained through the specialty pharmacy network at the preferred brand copay. If the customer does not have the SPP it may be considered under the medical benefit. Coverage and pharmacy provider(s) determined by the benefit design selected by the plan sponsor.	If the customer has the Specialty Pharmacy Program (SPP), this product may be obtained through the specialty pharmacy network at the preferred brand copay. If the customer does not have the SPP it may be considered under the medical benefit. Coverage and pharmacy provider(s) determined by the benefit design selected by the plan sponsor.

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

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

► PPL UPDATES	Standard Plan	Select Plan	Closed Plan
Concerta (methylphenidate ER tablet)
A CNS stimulant indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children 6 years of age and older, adolescents, and adults up to the age of 65. Concerta is being removed from preferred status. DACON edit applies In a limited category (ADHD)	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.
Avonex (Interferon beta-1a)
indicated for the treatment of patients with relapsing forms of multiple sclerosis to slow the accumulation of physical disability and decrease the frequency of clinical exacerbations. Avonex is being added to preferred status. Prior Authorization applies Specialty Pharmacy Program In a limited category (Multiple Sclerosis)	If the customer has the Specialty Pharmacy Program (SPP), this product may be obtained through the specialty pharmacy network at the brand copay. If the customer does not have the SPP it may be considered under the pharmacy benefit. Coverage and pharmacy provider(s) determined by the benefit design selected by the plan sponsor.	If the customer has the Specialty Pharmacy Program (SPP), this product may be obtained through the specialty pharmacy network at the preferred brand copay. If the customer does not have the SPP it may be considered under the pharmacy benefit. Coverage and pharmacy provider(s) determined by the benefit design selected by the plan sponsor.	If the customer has the Specialty Pharmacy Program (SPP), this product may be obtained through the specialty pharmacy network at the preferred brand copay. If the customer does not have the SPP it may be considered under the pharmacy benefit. Coverage and pharmacy provider(s) determined by the benefit design selected by the plan sponsor.
Rebif (interferon beta-1a)
Indicated for the treatment of patients with relapsing forms of multiple sclerosis to decrease the frequency of clinical exacerbations and delay the accumulation of physical disability. Rebif is being removed from preferred status. Prior Authorization applies Specialty Pharmacy Program In a limited category (Multiple Sclerosis)	If the customer has the Specialty Pharmacy Program (SPP), this product may be obtained through the specialty pharmacy network at the brand copay. If the customer does not have the SPP it may be considered under the pharmacy benefit. Coverage and pharmacy provider(s) determined by the benefit design selected by the plan sponsor.	If the customer has the Specialty Pharmacy Program (SPP), this product may be obtained through the specialty pharmacy network at the third tier, non-preferred brand copay. If the customer does not have the SPP it may be considered under the pharmacy benefit. Coverage and pharmacy provider(s) determined by the benefit design selected by the plan sponsor.	Not covered.
Simcor (niacin-simvastatin SR tab)
Indicated for the treatment of primary hypercholesterolemia, mixed dyslipidemia or hypertriglyceridemia when therapy with either agent alone is considered inadequate. Electronic step edit is being revised to review claim history for prior use of Advicor, Vytorin, or any formulary statin.	Brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Second tier, preferred brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Second tier, preferred brand copay. Coverage determined by the benefit design chosen by the plan sponsor.

► BRANDS WITH GENERICS AVAILABLE	Standard Plan	Select Plan	Closed Plan
Depakote ER (divalproex sodium ER tablet)
Used in the treatment of seizure disorder in adults, and for the prophylaxis of migraine headaches in adults. Depakote ER is removed from preferred status because the generic equivalent divalproex sodium ER tablet is available at the generic copay. In a limited category (Anticonvulsants)	Brand copay.	Third tier, non-preferred brand copay.	Not covered.
Depakote Sprinkles (divalproex sodium sprinkle capsule)
Used in the treatment of seizure disorder in adults and children age 10 and above. This medication is being removed from preferred status because the generic equivalent, divalproex sodium sprinkle capsule, is available at the generic copay. In a limited category (Anticonvulsants)	Brand copay.	Third tier, non-preferred brand copay.	Not covered.

► Clinical Programs: Prior Authorization	Standard Plan	Select Plan	Closed Plan
Leukine (sargramostim)
A colony stimulating factor, is used to promote growth and function of white blood cells to restore immune function and reduce the risk of infection following strong chemotherapy. Leukine is added to the Prior Authorization program, effective June 1, 2009. Specialty Pharmacy Program	If the customer has the Specialty Pharmacy Program (SPP), this product may be obtained through the specialty pharmacy network at the brand copay. If the customer does not have the SPP it may be considered under the pharmacy benefit. Coverage and pharmacy provider(s) determined by the benefit design selected by the plan sponsor.	If the customer has the Specialty Pharmacy Program (SPP), this product may be obtained through the specialty pharmacy network at the preferred brand copay. If the customer does not have the SPP it may be considered under the pharmacy benefit. Coverage and pharmacy provider(s) determined by the benefit design selected by the plan sponsor.	If the customer has the Specialty Pharmacy Program (SPP), this product may be obtained through the specialty pharmacy network at the preferred brand copay. If the customer does not have the SPP it may be considered under the pharmacy benefit. Coverage and pharmacy provider(s) determined by the benefit design selected by the plan sponsor.
Neulasta (pegfilgrastim) and Neupogen (filgrastim)
Colony stimulating factors used to promote growth and function of white blood cells to restore immune function and reduce the risk of infection following strong chemotherapy. Neulasta and Neupogen are added to Prior Authorization program, effective June 1, 2009. Specialty Pharmacy Program Quantity Limit applies	If the customer has the Specialty Pharmacy Program (SPP), this product may be obtained through the specialty pharmacy network at the brand copay. If the customer does not have the SPP it may be considered under the pharmacy benefit. Coverage and pharmacy provider(s) determined by the benefit design selected by the plan sponsor.	If the customer has the Specialty Pharmacy Program (SPP), this product may be obtained through the specialty pharmacy network at the preferred brand copay. If the customer does not have the SPP it may be considered under the pharmacy benefit. Coverage and pharmacy provider(s) determined by the benefit design selected by the plan sponsor.	If the customer has the Specialty Pharmacy Program (SPP), this product may be obtained through the specialty pharmacy network at the preferred brand copay. If the customer does not have the SPP it may be considered under the pharmacy benefit. Coverage and pharmacy provider(s) determined by the benefit design selected by the plan sponsor.
Amitiza (lubiprostone)
Indicated for the treatment of irritable bowel syndrome (IBS) with constipation in women 18 years of age and older. Amitiza 24 mcg is used to treat chronic idiopathic constipation (CIC) in adults. Amitiza is added to the Prior Authorization program, effective June 1, 2009. DACON edit applies	Brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Second tier, preferred brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Second tier, preferred brand copay. Coverage determined by the benefit design chosen by the plan sponsor.

► Clinical Programs: Quantity Limits	Standard Plan	Select Plan	Closed Plan
fentanyl TD patch, morphine sulfate CR/ER/SR
Listed items will be added to the Quantity Limits program, effective June 1, 2009.	Generic copay. Coverage determined by the benefit design chosen by the plan sponsor.	First tier, generic copay. Coverage determined by the benefit design chosen by the plan sponsor.	First tier, generic copay. Coverage determined by the benefit design chosen by the plan sponsor.
Avinza, Opana ER
Listed items will be added to the Quantity Limits program, effective June 1, 2009.	Brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Second tier, preferred brand copay. Coverage determined by the benefit design chosen by the plan sponsor.	Second tier, preferred brand copay. Coverage determined by the benefit design chosen by the plan sponsor.
Duragesic, Kadian, MS Contin, Opana, Oramorph SR,
Listed items will be added to the Quantity Limits program, effective June 1, 2009.	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.
fentanyl oral transmucosal
Existing Quantity Limit of 6 units per day will be changed to a limit of 4 units per day, effective June 1, 2009.	Generic copay. Coverage determined by the benefit design chosen by the plan sponsor.	First tier, generic copay. Coverage determined by the benefit design chosen by the plan sponsor.	First tier, generic copay. Coverage determined by the benefit design chosen by the plan sponsor.
Actiq, Fentora
Existing Quantity Limit of 6 units per day will be changed to a limit of 4 units per day, effective June 1, 2009.	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.
ketorolac tablet
Existing Quantity Limit of 20 tablets per dispensing will be changed to a limit of 20 tablets per month, effective June 1, 2009.	Generic copay. Coverage determined by the benefit design chosen by the plan sponsor.	First tier, generic copay. Coverage determined by the benefit design chosen by the plan sponsor.	First tier, generic copay. Coverage determined by the benefit design chosen by the plan sponsor.

► Clinical Programs: Utilization Management-- Gender Edit	Standard Plan	Select Plan	Closed Plan
Oral Estrogens, Oral Estrogen combinations, Oral contraceptives
Gender edit will be applied for all oral estrogens, oral estrogen combinations and oral contraceptives. These products will be approved for coverage for female members only.	Tier will vary for individual product used. Please consult Innoviant's Preferred Product Listing (PPL) for preferred products in the Hormone Replacement and Contraceptive categories.	Tier will vary for individual product used. Please consult Innoviant's Preferred Product Listing (PPL) for preferred products in the Hormone Replacement and Contraceptive categories.	Tier will vary for individual product used. Please consult Innoviant's Preferred Product Listing (PPL) for preferred products in the Hormone Replacement and Contraceptive categories.

	April 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 March committee meetings. All changes are effective June 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).