The script care drug list is a guide within select therapeutic categories for clients, plan participants and health care providers

2010 Performance Drug List
Quick Reference
January 2010
The Script Care Drug List is a guide within select therapeutic categories for clients, plan participants and health care providers. Generics should be
considered the first line of prescribing. If there is no generic available, there may be more than one brand-name medicine to treat a condition. These
preferred brand-name medicines are listed to help identify products that are clinically appropriate and cost-effective. Generics listed in therapeutic
categories are for representational purposes only. This is not an all-inclusive list. This list represents brand products in CAPS, branded generics in upper-
and lowercase Italics, and generic products in lowercase italics
PLAN PARTICIPANT
HEALTH CARE PROVIDER
Your benefit plan provides you with a prescription benefit program. Ask Your patient is covered under a prescription benefit plan. As a way to help your doctor to consider prescribing, when medically appropriate, a manage health care costs, authorize generic substitution whenever preferred medicine from this list. Take this list along when you or a covered possible. If you believe a brand-name product is necessary, consider Please note:
Please note:
Your specific prescription benefit plan design may not cover certain Generics should be considered the first line of prescribing. categories, regardless of their appearance in this document. This drug list represents a summary of prescription coverage. It is not inclusive and does not guarantee coverage. Unless specifically indicated, drug list products will include all dosage forms. QUICK REFERENCE DRUG LIST
Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document.
PREFERRED ALTERNATIVE LIST
DRUG NAME
PREFERRED ALTERNATIVE(S)*
DRUG NAME
PREFERRED ALTERNATIVE(S)*
estradiol-norethindrone, PREMPHASE, estradiol, estropipate, ENJUVIA, PREMARIN estradiol, CLIMARA, ESTRADERM, pravastatin, simvastatin, CRESTOR, estradiol-norethindrone, PREMPHASE, timolol maleate solution, BETIMOL estradiol, estropipate, ENJUVIA, PREMARIN citalopram, fluoxetine, paroxetine, paroxetine clindamycin solution, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, estradiol-norethindrone, PREMPHASE, clindamycin solution, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, clindamycin solution, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, clindamycin solution, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, doxazosin, terazosin, FLOMAX estradiol, estropipate, ENJUVIA, PREMARIN clindamycin solution, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, clindamycin solution, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, doxazosin, terazosin, FLOMAX clindamycin solution, erythromycin solution, erythromycin-benzoyl peroxide, tretinoin, clindamycin solution, erythromycin solution * The preferred alternative products in this list are a broad representation within therapeutic categories of available treatment options and do not necessarily represent clinical
equivalency.
FOR YOUR INFORMATION: Generics should be considered the first line of prescribing. This Script Care Drug List represents a summary of prescription coverage. It is not inclusive
and does not guarantee coverage. Specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document. The plan participant’s
prescription benefit plan may have a different copay1 for specific products on the list. Unless specifically indicated, drug list products will include all dosage forms. This list represents
brand products in CAPS, branded generics in upper- and lowercase Italics, and generic products in lowercase italics. Generics listed in therapeutic categories are for representational
purposes only. This is not an all-inclusive list. Listed products may be available generically in certain strengths or dosage forms. Dosage forms on this list will be consistent with the
category and use where listed.
§
Generics are available in this class and should be considered the first line of prescribing. Copayment, copay or coinsurance means the amount a plan participant is required to pay for a prescription in accordance with a Plan, which may be a deductible, a percentage of the prescription price, a fixed amount or other charge, with the balance, if any, paid by a Plan. Atacand should be reserved for patients who meet CHARM (Candesartan in Heart Failure - Assessment of Reduction in Mortality and Morbidity) trial criteria. Indicates the proposed mechanism of action, based on the American Psychiatric Association Summary of Treatment Recommendations. Higher copays may apply depending on the plan participant’s specific prescription benefit plan. Log in to www.scriptcare.com to find the copay under a specific plan.
This Script Care Drug List contains references to brand-name prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the prescriber. Your specific prescription benefit plan design may not cover certain categories, regardless of their appearance in this document.

Source: http://www.mrhcok.com/userfiles/File/2010_Script_Care_Quick_Reference_PDL.pdf