In an effort to promote the appropriate use of certain drugs and to help better manage the cost of expensive drugs, the ConnectiCare Pharmacy & Therapeutics Committee has developed a list of prescription drugs that require prior authorization. Prior authorization requests must be faxed to ConnectiCare’s Pharmacy Services department at 860-674-2851 or toll free 800-249-1367 by the prescribing physician’s office. POS members receiving out-of-network care are responsible for initiating this process. When submitting a request for Prior Authorization please use a Prior Authorization form which can be printed at ConnectiCare.com or obtained by calling ConnectiCare at 800-251-7722. If the prescribed drug is approved, the prescription will be filled as usual at a participating pharmacy or administered by a provider (where appropriate).
Chantix (PA not required for initial 30 day supply)
Aciphex (Use Prilosec OTC-Tier 1)
Clarinex / D (Use loratadine OTC first-Tier 1)
Contraceptives (if excluded by group)
Allegra / Allegra D (Use loratadine OTC first-Tier 1)
*Crestor (Use simva-, prava-, lovastatin first)
Altoprev (Use simva-, prava-, lovastatin first)
*Cymbalta (Use generic SSRI’s first)
*Detrol / LA (Use oxybutynin IR/XL first)
*Effexor XR (Use generic SSRI’s first)
Aranesp (PA required for pharmacy claims only)
*Enablex (Use oxybutynin IR/XL first)
*Beconase AQ (Use generic flonase first)
fexofenadine (Use loratadine OTC-Tier 1)
*Cardura XL (Use generic doxazosin first)
Fosamax plus D 5600 (Use fosamax plus D 2800)
Note: Self administeredmedications (i.e. interferons), even those not on this list, may not be dispensed for self administration and billed through the medical benefit by a provider, they must be dispensed through a participating pharmacy. (*) prior authorization is not required within the first 90 days of membership with ConnectiCare. (M) physician administered drug, usually billed under the medical benefit Rev. 12/2007
In an effort to promote the appropriate use of certain drugs and to help better manage the cost of expensive drugs, the ConnectiCare Pharmacy & Therapeutics Committee has developed a list of prescription drugs that require prior authorization. Prior authorization requests must be faxed to ConnectiCare’s Pharmacy Services department at 860-674-2851 or toll free 800-249-1367 by the prescribing physician’s office. POS members receiving out-of-network care are responsible for initiating this process. When submitting a request for Prior Authorization please use a Prior Authorization form which can be printed at ConnectiCare.com or obtained by calling ConnectiCare at 800-251-7722. If the prescribed drug is approved, the prescription will be filled as usual at a participating pharmacy or administered by a provider (where appropriate).
MMirena (levonorgestrel-releasing IUD)
Myrac (Use generics first)
*Nasacort AQ (Use fluticasone, Nasonex,or Veramyst first)
*Nasarel (Use fluticasone,Nasonex,Veramyst first)
Neulasta (PA required for pharmacy claims only)
Injectable Drugs- All (excluding insulin)
Klonopin Wafers (Use clonazepam tablets)
*Omacor (note name change to “Lovaza”)
*Omnaris (Use fluticasone, Nasonex, or Veramyst first)
*Lescol/XL (Use simva-, prava-, lovastatin first)
*Lipitor (Use simva-, prava-, lovastatin first)
*Oxytrol (Use generic oxybutynin IR/XL first)
Prevacid (Use Prilosec OTC-Tier 1)
Minocin Combo Pack (Use generics first)
Note: Self administeredmedications (i.e. interferons), even those not on this list, may not be dispensed for self administration and billed through the medical benefit by a provider, they must be dispensed through a participating pharmacy. (*) prior authorization is not required within the first 90 days of membership with ConnectiCare. (M) physician administered drug, usually billed under the medical benefit Rev. 12/2007
In an effort to promote the appropriate use of certain drugs and to help better manage the cost of expensive drugs, the ConnectiCare Pharmacy & Therapeutics Committee has developed a list of prescription drugs that require prior authorization. Prior authorization requests must be faxed to ConnectiCare’s Pharmacy Services department at 860-674-2851 or toll free 800-249-1367 by the prescribing physician’s office. POS members receiving out-of-network care are responsible for initiating this process. When submitting a request for Prior Authorization please use a Prior Authorization form which can be printed at ConnectiCare.com or obtained by calling ConnectiCare at 800-251-7722. If the prescribed drug is approved, the prescription will be filled as usual at a participating pharmacy or administered by a provider (where appropriate).
MSynvisc (hyaluronate sodium)
*Prozac Weekly (Use generics first)
Travel Medication: including Malarone,
*Rhinocort Aqua (Use fluticasone, Nasonex, Veramyst first)
*Vesicare (Use oxybutynin IR/XL first)
*Sanctura (Use oxybutynin IR/XL first)
MVivaglobulin (SQ Immuneglobulin)
Singulair (Use loratadine OTC first for allergic rhinitis)
*Vytorin (Use simva-, prava-, lovastatin first)
Weight Loss Medication (if covered by your plan);
Meridia, Xenical, Ionamin, Tenuate, etc
Xanax XR (use generic alprazolam)
Steroids, Anabolic (i.e Nandrolone)
Xyzal (Use OTC loratadine first-Tier 1)
Zegerid (PA for age > 15 y/o) (Use Prilosec OTC)
Note: Self administeredmedications (i.e. interferons), even those not on this list, may not be dispensed for self administration and billed through the medical benefit by a provider, they must be dispensed through a participating pharmacy. (*) prior authorization is not required within the first 90 days of membership with ConnectiCare. (M) physician administered drug, usually billed under the medical benefit Rev. 12/2007
In an effort to promote the appropriate use of certain drugs and to help better manage the cost of expensive drugs, the ConnectiCare Pharmacy & Therapeutics Committee has developed a list of prescription drugs that require prior authorization. Prior authorization requests must be faxed to ConnectiCare’s Pharmacy Services department at 860-674-2851 or toll free 800-249-1367 by the prescribing physician’s office. POS members receiving out-of-network care are responsible for initiating this process. When submitting a request for Prior Authorization please use a Prior Authorization form which can be printed at ConnectiCare.com or obtained by calling ConnectiCare at 800-251-7722. If the prescribed drug is approved, the prescription will be filled as usual at a participating pharmacy or administered by a provider (where appropriate).
MZevelin Zolinza Zyban Zyrtec / Zyrtec D (Use OTC)
Note: Self administeredmedications (i.e. interferons), even those not on this list, may not be dispensed for self administration and billed through the medical benefit by a provider, they must be dispensed through a participating pharmacy. (*) prior authorization is not required within the first 90 days of membership with ConnectiCare. (M) physician administered drug, usually billed under the medical benefit Rev. 12/2007
The manic highs and depressive lows of bipolar disorder can be devastating, but treatment ormal y, how happy or sad we trously in debt if they spin out of con- or delusions, or require hospitalization. feel is connected to events in trol. Mania can also lead to sexual Hypo mania may, though, have negative our lives—achievements and indiscretions and hasty, ill-advised consequences if the co
BEFORE THE ALASKA OFFICE OF ADMINISTRATIVE HEARINGS ON REFERRAL FROM THE DEPARTMENT OF ADMINISTRATION ORDER GRANTING SUMMARY ADJUDICATION S E is a retiree under the Teachers’ Retirement System (“TRS”) and is entitled to benefits of the AlaskaCare Retiree Health Plan (“Plan”). On September 26, 2007, Mr. E underwent radical retropubic prostatectomy surgery at the Mayo Clinic.