4/27/07

November 25, 2008
Dear Provider:
The following changes will go into effect December 1, 2008, regarding our Formulary
coverage. Please take a moment to familiarize yourself and staff to the amendments.
Additions:
none
Deletions:
Beta-blockers—Blocarden (timolol)

Alpha-blockers—Wytensin (guanabenz)

Ophthalmics—Iopidine (apraclonidine), Isopto-Carbachol (carbachol), Phospholine
Iodide (echothiophate iodide), Optpranolol (metpranolol), P-E (pilocarpine &
epinephrine),
Modifications:
Griseofulvin tablets—will no longer be Formulary, the suspension will continue to be
covered for members under the age of 12. For adults with tinea infections, we prefer
the use of Lamisil (terbinafine).
Lamisil (terbinafine)—Will be allowed up to 12 weeks therapy. Onychomycosis of the
fingers utilizes a 6 week therapy, toes is 12 week. Not approved for cosmetic purposes,
and should have KOH or positive culture.
Macrodantin—nitrofurantioin in the regular release will no longer be Formulary. The
time released version (Macrobid) will be Formulary.
Phenergan/Codeine—will be limited to 240 mls per member per month.
Diabetic guidelines update—New guidelines have been issued by the American
Diabetic Association. KHS encourages these concepts as well. Lifestyle modifications
will be the standard first step. Often medication management is needed. Metformin
would be the first pharmacological agent of choice. The ADA divides pharmaceutical
agents into tiers. The first tier is evidence supported, the second is less backed by
evidence. The KHS Formulary allows for the medications in tier one, both first and
second steps.

Modifications (continued):
Mental health—Many medications used in mental health are carved out of the plan.
However, for Healthy Families, they are still a benefit from our health plan. Some of
these medications require prior authorization or step therapy. In the past this has not
been rigorously enforced. We will implement this requirement going forward. The
following are a list of meds that will require a prior authorization: Abilify, Marplan,
Symbyax, Invega, Nardil, Orap, Parnate, Geodon, Zyprexa.
Antibiotic utilization. Please note the following state collaborative. Project AWARE
(Alliance Working for Antibiotic Resistance Education) is a statewide collaborative
project designed to promote appropriate antibiotic utilization and reduce resistance and
inappropriate use. Other provider materials and information may be accessed at
or by calling 916-551-2550.
CFC inhalers. Please note that beginning January 1, 2009 all inhalers using CFC
propellants will no longer be allowed. This is based off Federal mandates. Instead,
inhalers will need to utilize the HFA formulation. Please be sure to be ready for this
switch. The main inhaler which could be problematic is the generic albuterol. After
January 1, 2009 please consider our Formulary options, ProAir HFA and Ventolin HFA.
Other medications with CFC formulations will be affected as well.
Sincerely,
Bruce Wearda, R.Ph.
Corporate Pharmacist

Source: http://www.khs-net.com/uploads/293-Provider_Bulletin_Formulary_Updates_12-1-08_WEBSITE.pdf