4/27/07

September 10, 2008
Dear Provider:
The following changes will go into effect September 15, 2008, regarding our formulary
coverage. Please take a moment to familiarize yourself and staff to the amendments.
Additions:
Duragesic 12.5 mcg (fentanyl) will be added with the same restrictions as the other strengths,
available to pain mgt and oncologists. All others require prior authorization.
Nevanac (nepafenac) available to plan ophthalmologists only.
Deletions:
Diuretics — Hygroton (chlorthalidone), Diuril (chlorothiazide), Lozol (indapamide), Edecrin
(ethacrynic acid), Aldactazide (spironolactone/hctz)
Tricyclic antidepressants — Anafranil (clomipramine), Nopramin (desipramine), Sinequan
(doxepin), Tofranil PM (imipramine pamoate), Vivactil (protiptyline)
Thyroid — Armour Thyroid (desiccated porcine derivative)
Statins — Mevacor (lovastatin)
Beta-blockers — Sectral (acebutolol), Zebeta (bisoprolol), Corgard (nadolol), Visken (pinolol),
Levatol (penbutolol)
Alpha-blockers — Minipress (prazosin)
Ca Channel blockers — Dynacirc (isradipine), Cardene (nicardipine)
Anticonvulsants — Celontin (methsuximide)
Narcotics — Demerol (meperidine), Percodan (oxycodone/ASA)
Ophthalmic antibiotics — Chloromycetin (chloramphenicol), Stoxil (idoxuridine), Chibroxin
(norfloxacin)
Miotics — Betagan (levobunolol), Isopto-Eserine (physostigmine)
Otic antibiotics — Colymycin HC (neomycin, colistin, & HC)
Anticholinergics — Probanthine (propantheline)
Estrogenic agents — diethylstibetrol
Modifications:
Claritin (loratadine) — tablets now available regardless of age. Best practice guidelines still
indicate nasal steroids as first line for allergic rhinitis.
Prilosec OTC (omperazole) — available for Healthy Families members now as well.
Coreg (carvedilol) — will be allowed for hypertension along with treatment for CHF. As such,
may be used as monotherapy, no prequesite therapy needed.
Nasal steroids — Will require generics first, fluticasone, flunisolide before allowing branded
Formulary meds, Nasonex, Rhinocort. Nasonex allowed first line for members age 2-4 yrs old.
Catapres TTS patches — will no longer be Formulary, the tablets will continue to be covered.
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 m or by calling 916-551-2550.
Other items to note:
When filling out the request for prior authorization, please fill it out completely. Do not leave
blanks and be sure to sign and date the document. Special note to pharmacy, please indicate
specific diagnosis. This should be the diagnosis of record at the physician’s office.
In general, when filling prescriptions for our members under the age of 21 years, certain
conditions are covered by California Children’s Services (CCS). The prescribers are to identify
these cases and forward the information to CCS and coordinate with the health plan. CCS cases
are carved out of Kern Family Health Care. Disease states such as endocrine disorders, diabetes
and thyroid for example, oncology, cardiology, and rheumatology are conditions that are
covered. There are other conditions as well, but these are common ones. If you receive a script
for one of these, check for CCS coverage. If a case is not currently open, chances are that it so
will be or is in the process. The prescribers are to share the SAR information with the
pharmacies.
Kern Health Systems is aware of the many stresses and constraints in health care today. KHS
strives to ensure best practice standards are applied in treating its membership. The health plan
appreciates your work and cooperation to work towards that common goal as well.
Sincerely,
Bruce Wearda, R.Ph.
Corporate Pharmacist

Source: http://khs-net.com/uploads/174-Provider_Bulletin_9-29-2008.pdf