High-risk medications impacted by 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.

High-risk medications (HRM) have the potential to be problematic in those 65 years of age or older. Below is a list of some commonly used HRMs 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.

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 Premarian Vaginal Cream pramipexole glipizide/metformin tizanidine tablets

2013 Formularies Impacted Drug
  ticlopidine HCI 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 ST 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 HCI Lunesta estradiol/norethindrone A Mimvey
Puerto Rico Formulary PA PA NF NF PA
Preferred Formulary PA 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 Premarian Vaginal Cream Premarian 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 Human 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, Humana Choice
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-CVS/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.)