2013 Formularies Impacted Drug
  glyburide estradiol benztropine mesylate glyburide/metformin HCL metaxalone
Puerto Rico
Formulary		 PA PA PA PA ------
Preferred
Formulary		 PA PA PA PA PA
National-4 PDP
Complete
Formulary		 PA PA PA PA PA
National-4 MAPD
Formulary		 PA PA PA PA PA
National-5
PDP
Enhanced
Formulary		 PA PA PA PA PA
National-5
Formulary		 PA PA PA PA PA
Plus-5
Formulary		 PA PA PA PA

PA
Select Formulary PA PA PA PA PA
One Possible Alternative glimepiride Premarin Vaginal Cream pramipexole glipizide/metformin tizanidine tablets

2013 Formularies Impacted Drug
  ticlopidine HCl orphenadrine citrate ER methyldopa glyburide micronized zaleplon
Puerto Rico
Formulary		 PA PA NF PA PA
Preferred
Formulary		 PA PA NF PA PA
National-4 PDP
Complete
Formulary		 PA PA NF PA PA
National-4 MAPD
Formulary		 PA PA NF PA PA
National-5
PDP
Enhanced
Formulary		 PA PA NF PA PA
National-5
Formulary		 PA PA NF PA PA
Plus-5
Formulary		 PA PA NF PA

PA
Select Formulary PA PA PA PA PA
One Possible Alternative clopidogrel tizanidine tablets lisinopril glimepiride n/a

2013 Formularies Impacted Drug
  butalbital/ acetaminophen guanfacine HCl Lunesta estradiol/ norethindrone A Mimvey
Puerto Rico
Formulary		 NF PA NF NF PA
Preferred
Formulary		 NF PA ------ NF PA
National-4 PDP
Complete
Formulary		 NF PA PA NF PA
National-4 MAPD
Formulary		 NF PA PA NF PA
National-5
PDP
Enhanced
Formulary		 NF PA PA NF PA
National-5
Formulary		 NF PA PA NF PA
Plus-5
Formulary		 NF PA PA NF

PA
Select Formulary NF PA PA PA PA
One Possible Alternative sumatriptan lisinopril n/a Premarin Vaginal Cream Premarin Vaginal Cream

2013 Formularies Impacted Drug
  butalbital/aspirin/ caffeine Promethegan
Puerto Rico
Formulary		 NF PA
Preferred
Formulary		 NF PA
National-4 PDP
Complete
Formulary		 NF PA
National-4 MAPD
Formulary		 NF PA
National-5
PDP
Enhanced
Formulary		 NF PA
National-5
Formulary		 NF PA
Plus-5
Formulary		 NF PA
Select Formulary NF PA
One Possible Alternative sumatriptan ondansetron

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, visit our website at 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. For a more comprehensive list of high-risk medications (HRM) and possible alternatives, please go to http://apps.humana.com/marketing/documents.asp?file=1578031.

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.)