2013 Medicare formulary changes

Effective Jan. 1, 2013, certain drugs under the Humana Medicare formularies will have new limitations or will require utilization management for the 2013 plan year. These changes could mean higher costs or new requirements for Humana members who use these drugs. Humana encourages the use of generic and cost-effective brand medications whenever possible.

Below is a list of some commonly used medications that will be impacted by Humana Medicare formulary changes in 2013 [i.e., prior authorization (PA) requirements, step therapy (ST) modifications and nonformulary (NF) changes]. Humana members are asked to talk to their health care provider about possible alternatives.

Download and print a PDF file of this information.

2013 Formularies Impacted Drug
    glyburide/ metformin HCL Lexapro Avapro Patanol
Puerto Rico
Formulary		   PA NF NF ------
Preferred
Formulary		   PA NF NF NF
National-4 PDP
Complete
Formulary		   PA NF NF NF
National-4 MAPD
Formulary		   PA NF NF NF
National-5
PDP
Enhanced
Formulary		   PA NF NF NF
National-5
Formulary		   PA NF NF NF
Plus-5
Formulary		   PA NF NF

------
Select Formulary   PA PA PA ------
One Possible Alternative   glipizide/metformin escitalopram irbesartan Pataday

2013 Formularies Impacted Drug
  Plavix glyburide Aggrenox estradiol benztropine mesylate
Puerto Rico
Formulary		 NF PA ST PA PA
Preferred
Formulary		 NF PA ------ PA PA
National-4 PDP
Complete
Formulary		 NF PA ST PA PA
National-4 MAPD
Formulary		 NF PA ST PA PA
National-5
PDP
Enhanced
Formulary		 NF PA ------ PA PA
National-5
Formulary		 NF PA ST PA PA
Plus-5
Formulary		 NF PA ST PA

PA
Select Formulary PA PA ST PA PA
One Possible Alternative clopidogrel glimepiride clopidogrel Premarin Vaginal Cream pramipexole

 

Legend

PR Formulary

Humana Gold Plus, Humana Gold Plus SNP-DE

Preferred Formulary

Humana Gold Plus, Humana Gold Choice, HumanaChoice, Humana Walmart-Preferred Rx Plan

National-4 PDP Complete Formulary

Humana Complete

National-4 MAPD Formulary

Humana Gold Choice, Humana Gold Plus, Humana Gold Plus SNP-CHF/DM, Humana Gold Plus SNP-DB, Humana Gold Plus SNP-DE,
Humana Prime Choice, HumanaChoice

National-5 PDP Enhanced Formulary

Humana Enhanced

National-5 Formulary

Arcadian Community Care-Plus, Arcadian Health Plan-Plus, CareFree, CareNeeds Plus, Desert Canyon Community Care-Plus, Humana Gold Choice

Humana Gold Plus, Humana Gold Plus SNP-CHF/DM, Humana Gold Plus SNP-CVD/CHF/DM, Humana Gold Plus SNP-DB, Humana Gold Plus SNP-DE, Humana Prime Choice

Humana Reader’s Digest Healthy Living Plan, Humana Total Care Advantage, HumanaChoice, MD Care, Texas Community Care-Plus, Arkansas Community Care, Care One

Plus-5 Formulary

CareFree, CareNeeds, CareNeeds PLUS, CareOne, CareOne PLUS, Humana Gold Plus, Humana Gold Plus SNP-DB, Humana Gold Plus SNP-DE

Select Formulary

CareDirect, CareFree, CareFree PLUS, CareHeart

CareNeeds, CareNeeds PLUS, CareOne, CareOne PLUS

Humana Gold Plus, Humana Gold Plus SNP-CHF/DM, Humana Gold Plus SNP-CLD, Humana Gold Plus SNP-CVD/CHF

Humana Gold Plus SNP-CVD/CHF/DM, Humana Gold Plus SNP-DB, Humana Gold Plus SNP-DE, Humana Gold Plus SNP-I

For prescription drug information for Humana Medicare members, please visit www.Humana.com/providers/pharmacy/drug_list.aspx. Click “Drug List Search” and enter the drug name. Choose “Medicare” to see the drug’s tier placement in Medicare formularies and any restrictions that apply.

Please note: Many medications considered to be high-risk in the elderly will have a formulary status change or a utilization management requirement for 2013. View a list of high-risk medications (HRM) and possible alternatives.

If you have any questions regarding this document, please call 1-800-457-4708. This line is open from 8 a.m. to 8 p.m., local time, Monday through Friday. (In Puerto Rico, please call 1-866-773-5959.)