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Network Health


Preferred Drug List changes effective October 3, 2011

Products added:

  • Edurant
  • Flumist*
  • Halaven
  • Influenza vaccine*
  • Phoslyra
  • Rilutek
  • Sylatron**
  • Zytiga**

Products now requiring prior authorization:

  • Incivek**
  • Kapvay
  • Nexiclon XR
  • Peg-Intron**
  • Topicort LP ointment
  • Victrelis**

Products now requiring step care:

  • Avalide
  • Avapro

Products no longer requiring prior authorization:

  • Lipitor 40 mg and 80 mg
  • Opium tincture
  • Pantoprazole tablets

Products removed:

  • Ortho Tri-Cyclen Lo
  • Pegasys

Products with quantity limit changed:

  • Tamiflu suspension — 180 ml per prescription, two prescriptions per member per calendar year

*For Network Health patients at least 18 years of age, when administered by a pharmacist between September 15, 2011 and March 31, 2012, at a participating pharmacy
** Provided through Caremark

We update our Preferred Drug List quarterly. Download our Preferred Drug List and pharmacy prior authorization form.

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