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Step Therapy Requirements Effective 2/1/2014 Effective Date: 02/01/2014 STEP THERAPY GROUP DESCRIPTION ANTI-INFLAMMATORY AGENTS - GI DRUG NAME ASACOL HD | DIPENTUM STEP THERAPY CRITERIA PRIOR CLAIM FOR BALSALAZIDE OR APRISO WITHIN THE PAST 120 DAYS. Physicians United Plan Step Therapy Requirements Effective Date: 02/01/2014 STEP THERAPY GROUP DESCRIPTION ANTIDIABETIC AGENTS - INSULINS DRUG NAME LEVEMIR | LEVEMIR FLEXPEN STEP THERAPY CRITERIA PRIOR CLAIM FOR INSULIN GLARGINE (LANTUS OR LANTUS SOLOSTAR) WITHIN THE PAST 120 DAYS. Physicians United Plan Step Therapy Requirements Effective Date: 02/01/2014 STEP THERAPY GROUP DESCRIPTION ANTIDIABETIC AGENTS - MISCELLANEOUS DRUG NAME INVOKANA STEP THERAPY CRITERIA PRIOR CLAIM FOR METFORMIN, METFORMIN ER, A SULFONYLUREA, A COMBINATION OF SULFONYLUREA AND METFORMIN, PIOGLITAZONE, OR COMBINATION PIOGLITAZONE AND METFORMIN IN THE LAST 120 DAYS. Physicians United Plan Step Therapy Requirements Effective Date: 02/01/2014 STEP THERAPY GROUP DESCRIPTION ANTIPSYCHOTIC AGENTS DRUG NAME FANAPT | FAZACLO | INVEGA | LATUDA | SAPHRIS STEP THERAPY CRITERIA PRIOR CLAIM FOR FORMULARY VERSIONS OF ANTIPSYCHOTICS SUCH AS RISPERIDONE TABLET, RISPERIDONE DISINTEGRATING TABLET, CLOZAPINE TABLET, OLANZAPINE TABLET, OLANZAPINE ORAL DISINTEGRATING TABLET, IMMEDIATE RELEASE QUETIAPINE FUMARATE, OR ZIPRASIDONE, AND ABILIFY WITHIN THE PAST 365 DAYS. Physicians United Plan Step Therapy Requirements Effective Date: 02/01/2014 STEP THERAPY GROUP DESCRIPTION ANTIULCER AGENTS DRUG NAME DEXILANT STEP THERAPY CRITERIA PRIOR CLAIM FOR GENERIC FEDERAL LEGEND OMEPRAZOLE OR PANTOPRAZOLE WITHIN THE PAST 120 DAYS. 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