Chcde physician formulary notice for pr.doc

November 2009
Dear Participating Provider:
Please find highlights of the changes made to the Coventry Commercial Formulary that will take effect for January 1, 2010.
We have also enclosed a copy of the Member/Physician Reference 2010 Prescription Drug List. In addition, our formulary is
available through Epocrates and on our website at . The formulary is viewable in the Provider Section under
Prescription Benefits. There are many other documents posted in the Prescription Benefits section that you may find helpful.
Formulary Additions
The drugs in Table 1 have been added to the formulary for 2010.
Table 1. Formulary Additions
Brand Name
Generic Name
available from multiple mfgs & reasonably priced available from multiple mfgs & reasonably priced SP – Limited to Specialty Pharmacy for supply
Formulary Deletions effective January 2010
The drugs in Table 2 will be removed from formulary effective Jan 2010. Most members have a three tier pharmacy
copay design and these drugs will be available for a Tier 3 copay.
Table 2. Formulary Deletions with Alternatives
Brand Name
Generic Name
Comment/ Formulary Alternatives
Zaditor OTC or Alaway* (with a prescription – Tier 1 copay), Crolom* Betoptic*, Timoptic*, Timoptic XE*, Betagan* Fosamax*, Fosamax Plus D, Miacalcin nasal spray* Prilosec OTC*20mg (with a prescription – Tier 1 copay) or omeprazole 20mg, + amoxicillin & clarithromycin Prilosec OTC*20mg (with a prescription – Tier 1 copay), omeprazole 20mg, Nexium Testosterone inj (Tier 1 copay), Androgel Ziagen, Epivir, and Retrovir* or Ziagen + Combivir ^ - Androgel is the only covered topical testosterone product covered on most benefits. ST = Step Therapy 2751 Centerville Road, Suite 400, Wilmington, DE 19808
Prior Authorization Additions
The drugs in Table 3 were reviewed and will require prior authorization.
Table 3. Prior Authorization Additions with Alternatives
Formulary Alternatives/Comments
Tier One ACE-Is such as Prinivil*, Accupril*, Altace*, Lotensin*, or Benicar, Tier One ACE-I combinations such as Prinizide*, Accuretic*, LotensinHCT*, or Zocor* 80mg, Crestor 20mg, Vytorin 10/40
Other Actions/Information

New Claims Administrator
Effective January 1, 2010, Coventry Health Care of Delaware and Coventry Health Care will transition claims processing,
mail order and specialty pharmacy services to Medco from Caremark. The commercial benefit conversion follows the successful conversion of Coventry’s Medicare prescription benefits in January 2009. As part of this conversion, we will transfer open prior authorization files, open mail order and self administered injectable prescriptions. General and targeted member mailings will be sent related to this conversion beginning in the Fall 2009. Coventry Health Care of Delaware and Coventry used Caremark’s services for the past 10 years. Specialty Drug Formulary
Coventry Health Care will expand the list of covered Specialty drugs to include other routes of administration besides self administered injectables. The expanded list will include drugs to treat cystic fibrosis, HIV & transplant rejection, Hepatitis B & C, PAH, cancer oral cyclical meds such as Temodar, Tarceva and fertility when covered under the rx benefit. To request a formulary exception or coverage of a prior authorization agent, please contact our Pharmacy Department via one of the following numbers. You may also access the necessary forms for completing a prior authorization and the complete list of the drugs that require Prior Authorization or Step Therapy, on our website at , Provider Section under Prescription Benefits. For additional information, please contact your Provider Relations representative or visit our website at . Thank you for your attention to this matter. 2751 Centerville Road, Suite 400, Wilmington, DE 19808

Source: http://www.metracomp.com/web/groups/public/documents/adacct/c049212.pdf