Medication Therapy Management Program TML Intergovernmental Employee Benefits Pool

NEW Prescription Benefits! RESTAT is the new vendor that will manage the network of pharmacies RX Results-University of Arkansas College of Medical Services– peforms clinical evaluation, call center and physician outreach Medication Therapy Management Program expands the value tier to enhance access to the $0.00 and $9.00 generic program.  Wal-Mart  Sam’s  Dominick’s  Target  HEB  Fred Meyer  Kroger  Safeway  HealthMart Pharmacy  Randall’s  K-Mart  King Soopers  Tom Thumb  City Market Pharmacy  Ralph’s  Cub Pharmacy  Dillon Stores  Smiths  Farm Fresh  Fry’s Food & Drug  Vons Companies Inc.  Access Health  Quality Food Centers Inc  Shopko  Start Market Restat’s Align Network New Pharmacies are being added each month

Medication Therapy Management Program (MTMP) $ $$ $$$ Lowest Cost Highest Cost Mac A or C Employer Option Retail Copay Mail Order Copay Over the Counter Equivalence: Non-Sedating Antihistamines (Claritin, Alavert) Stomach and Ulcer (Prilosec) Allergy Medication (Zyrtec) Smoking Cessation (Nicorette Gum) Limit - 3 boxes $0.00N/A Value Tiered 34 day generic dispensement$0.00N/A Value Tiered day generic dispensement$9.00N/A Generic$10.00$25.00 Best Brand Price List$38.00$95.00 Non-Best Brand Price List$60.00$ Cost Share$120.00$ Specialty/Biotech Prescriptions$ for 34 day dispensement 8 ways to Purchase Prescription Drugs CVS Caremark will continue to administer mail order / Biotech.

Cost Share Drugs Evidence Based Drug Formulary Cost Share DrugsTherapeutic Equivalent / Clinical Drug Alternative Antibiotics: Anti-Infections Impacts utilization on: Doryx, Solodyn, Oracea Generic Minocycline (for Solodyn) Generic Doxycycline (for Doryx, Oracea) Cardiovascular: Antihyperlipidemic Lovastatin, Mevacor, Pravastatin Impacts utilization on: Altoprev, Advicor, Crestor 5 mg & 10mg, Lescol, Lescol XL, Lipitor 10mg, Lipitor 20mg, Lipitor 40 mg, Lovastatin, Mevacor, Pravachol, Pravastatin, Simcor, Zocor, Caduet and Vytorin Generic Simvastatin NOTE: Lipitor 80mg, Crestor 20mg, and Crestor 40mg require prior authorization – Physician may call Rx Results at for coverage criteria. Central Nervous System: Sedative Hypnotics Zaleplon Impacts utilization on: Ambien, Ambien CR, Lunesta, Rozerem, Sonata and Zaleplon Generic Zolpidem Gastrointestinal/Stomach: Proton Pump Inhibitors Lansoprazole, Pantoprazole, Impacts utilization on: Aciphex, Dexilant (formerly Kapidex), Nexium, Lansoprazole, Pantoprazole, Prevacid, Prilosec, Protonix and Zegerid OTC Prilosec (Prescription Required) Generic Omeprazole Respiratory/Allergy/Asthma: Antihistamines Fexofenadine, Impacts utilization on: Allegra, Fexofenadine, Clarinex and Xyzal OTC Claritin (Prescription Required) Generic Loratidine (Prescription Required) OTC Zyrtec (Prescription Required) OTC Cetirizine (Prescription Required) Anithistamines-Decongestant Fexofenadine-D Impacts utilizaqtion on: Allegra-D, Fexofenadine-D and Clarinex-D OTC Claritin (Prescription Required) Generic Loratidine (Prescription Required) OTC Zyrtec (Prescription Required) Generic Cetirizine (Prescription Required) Cost Share Generic Drugs

Relative Potency for Statins Atorvastatin (Lipitor) Fluvastatin (Lescol / XL) Lovastatin (Mevacor) Pravastatin (Pravachol) Rosuvastatin (Crestor) Simvastatin (Zocor) --40 mg20 mg --10 mg 80 mg40 or 80 mg40 mg--20 mg --80 mg 5 or 10 mg40 mg mg mg-- 40 mg--

Medication Therapy Management Program (MTMP) Clinically Appropriate & Cost Effective Prescriptions Prior Authorization: Growth Hormones- Botox, Myobloc Attention Deficit Disorder/Narcolepsy- medications for individual 17 years of age or older Oral Chemotherapy Antibiotic- Zyvox High Cholesterol- Crestor 20/40 mg, Lipitor 80 mg Osteoporosis- Forteo Testosterone Products- Androgel-Hormone Replacement/Erectile Dysfunction Asthma- Xolair, Advair and Symbicort (inhalers), Foradil, Perforomist, Brovana, Serevent, - individuals <40 years of age that have not utilized an inhaled steroid for at least 120 days Step Therapy: Asthma- Advair and Symbicort (inhalers), Foradil, Perforomist, Brovana, Serevent, - individuals <40 years of age that have not utilized an inhaled steroid for at least 120 days ***High Blood Pressure: Cozaar, Hyzaar, Diovan, Diovan HCT, Atacand, Atacand-HCT, Avapro, Avalide, Micardis, Micardis HCT, Teveten, Teveten HCT, Benicar, Benicar HCT, Exforge, Tekturna, Tekturna HCT and Valturna (***only applies to newly diagnosed individuals***) Concurrent Review: Hepatitus C prescriptions Current Prior Authorizations will need to be re-established

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Is Evidence Based Medicine. Converts Patients from costly drugs to therapeutically equivalent, cost effective alternatives. Ask your Dr. to contact Rx Results, ( the number is on your ID Card) Look up drug prices at Medication Therapy Mangement Program:

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