Kalispell.schoolwires.net
January 2013
Medications Requiring Prior Authorization for Medical Necessity
Below is a list of medicines by drug class that will not be covered without a prior authorization for medical necessity, effective January 1, 2013. If you continue using one of these drugs after this date without prior approval, you may be required to pay the full cost.
If you are currently using one of the drugs requiring prior authorization for medical necessity, ask your doctor to choose one of the generic or brand formulary consideration options listed below.
Bolded products represent drugs requiring prior authorization for medical necessity that are new for 2013 plan year.
Category *
Drugs Requiring
Formulary Considerations
Drug Class
Prior Authorization for
Medical Necessity 1
Allergies *
flunisolide spray, fluticasone spray, triamcinolone spray, NASONEX
Nasal Steroids
OMNARIS
QNASL
RHINOCORT AQUA
VERAMYST
Asthma *
PROAIR HFA, PROVENTIL HFA, VENTOLIN HFA
Beta Agonists, Short-Acting
Depression *
trazodone
Dermatology *
clobetasol propionate foam 0.05%
Skin Inflammation and Hives
Corticosteroids
Diabetes *
metformin, metformin ext-rel
Biguanides
Diabetes *
JANUVIA, TRADJENTA †
Dipeptidyl Peptidase-4
(DPP-4) Inhibitors
Diabetes *
KOMBIGLYZE XR
JANUMET, JANUMET XR, JENTADUETO
Dipeptidyl Peptidase-4
(DPP-4) Inhibitor /
Biguanide Combinations
Diabetes *
Insulins
HUMALOG MIX 50/50
NOVOLOG MIX 70/30
HUMALOG MIX 75/25
NOVOLOG MIX 70/30
NOTE: Humulin U-500 concentrate will not
be subject to prior authorization and will continue to be covered.
Diabetes *
FREESTYLE STRIPS AND KITS
ACCU-CHEK STRIPS AND KITS 2, ONETOUCH STRIPS AND KITS 2
Supplies 2
Erectile Dysfunction *
Phosphodiesterase Inhibitors
Glaucoma *
latanoprost, TRAVATAN Z, ZIOPTAN
Prostaglandin Analogs
Category *
Drugs Requiring
Formulary Considerations
Drug Class
Prior Authorization for
Medical Necessity 1
Growth Hormones *
GENOTROPIN
HUMATROPE, NORDITROPIN
NUTROPIN / NUTROPIN AQ
OMNITROPE
SAIZEN
TEV-TROPIN
High Blood Pressure *
eprosartan, irbesartan, losartan, BENICAR, DIOVAN, MICARDIS
Angiotensin II Receptor Antagonists EDARBI
High Blood Pressure *
irbesartan-hydrochlorothiazide, losartan-hydrochlorothiazide, BENICAR HCT,
Angiotensin II Receptor Antagonist / EDARBYCLOR
DIOVAN HCT, MICARDIS HCT
Diuretic Combinations
High Cholesterol *
atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin, CRESTOR,
HMG Co-A Reductase Inhibitors
(HMGs or Statins)
High Cholesterol *
atorvastatin, fluvastatin, lovastatin, pravastatin, simvastatin, SIMCOR
HMG Co-A Reductase Inhibitor /
Niacin Combinations
Overactive Bladder / Incontinence *
DETROL LA
oxybutynin ext-rel, tolterodine, trospium, GELNIQUE, VESICARE
Urinary Antispasmodics
OXYTROL SANCTURA XR
Pain and Inflammation *
diclofenac or meloxicam or naproxen WITH misoprostol; CELEBREX, VIMOVO
Nonsteroidal Anti-inflammatory
diclofenac, meloxicam, naproxen
(NSAIDs) / Combinations
Pain *
tramadol ext-rel
Non-opioid Analgesics
Prostate Condition *
finasteride or AVODART WITH alfuzosin ext-rel, doxazosin, tamsulosin,
Benign Prostatic Hyperplasia Agents /
terazosin or RAPAFLO
Sleep *
INTERMEZZO
zolpidem, zolpidem ext-rel
Hypnotics,
Testosterone Replacement *
ANDROGEL
ANDRODERM, AXIRON †, FORTESTA †
Androgens
Transplant *
tacrolimus
Immunosuppressants,
Calcineurin Inhibitors
The listed formulary considerations are subject to change.
† Drugs no longer requiring prior authorization for medical necessity in 2013.
List of Drugs Requiring Prior Authorization for Medical Necessity
HUMALOG MIX 50/50
HUMALOG MIX 75/25
ANDROGEL
INTERMEZZO
DETROL LA
KOMBIGLYZE XR
EDARBYCLOR
FREESTYLE STRIPS AND KITS
NUTROPIN / NUTROPIN AQ
TEV-TROPIN
GENOTROPIN
VERAMYST
OMNITROPE
List of Drugs Requiring Prior Authorization for Medical Necessity - Carryover from 2012 Plan Year
HUMALOG MIX 50/50
HUMALOG MIX 75/25
FREESTYLE STRIPS AND KITS
List of Drugs Requiring Prior Authorization for Medical Necessity - New for 2013 Plan Year
NUTROPIN / NUTROPIN AQ
Drugs no longer requiring prior authorization for medical necessity in 2013: AXIRON, FORTESTA and TRADJENTA
There may be additional drugs subject to prior authorization or other plan design restrictions. Please consult your plan for further information.
This list represents brand products in CAPS, branded generics in upper- and lowercase, and generic products in lowercase italics. This is not an all-inclusive list of available drug
alternative considerations. Log in to www.caremark.com to check coverage and copay information for a specific drug. Discuss this information with your doctor or health care provider.
This information is not a substitute for medical advice or treatment. Talk to your doctor or health care provider about this information and any health-related questions you have. CVS Caremark assumes no liability whatsoever for the information provided or for any diagnosis or treatment made as a result of this information. This list is subject to change.
Subject to applicable state law restrictions.
* This list indicates the common uses for which the drug is prescribed. Some drugs are prescribed for more than one condition.
1 If your doctor believes you have a specific clinical need for one of these products, he or she should contact the Prior Authorization department toll-free at: 1-855-240-0536.
2 An Accu-Chek or OneTouch blood glucose meter will be provided at no charge by the manufacturer to those individuals currently using a meter other than Accu-Chek or OneTouch.
For more information on how to obtain a blood glucose meter, call toll-free: 1-800-588-4456. Members must have CVS Caremark Mail Service Pharmacy benefits to qualify.
Your privacy is important to us. Our employees are trained regarding the appropriate way to handle your private health information.
This document contains confidential and proprietary information of CVS Caremark and cannot be reproduced, distributed or printed without written permission from CVS Caremark. CVS Caremark may receive rebates, discounts and service fees from pharmaceutical manufacturers for certain listed products. This document contains references to brand-name
prescription drugs that are trademarks or registered trademarks of pharmaceutical manufacturers not af iliated with CVS Caremark. Listed products are for informational purposes only and are not intended to replace the clinical judgment of the doctor.
2012 Caremark Rx, L.L.C. All rights reserved. 106-25923b 071912 www.caremark.com
Document date: July 19, 2012
Source: http://kalispell.schoolwires.net/cms/lib3/MT01001507/Centricity/Domain/26/benefits/Rx%20Requiring%20Pre-Auth%20January%202013.pdf
LOS ACTOS DE CONFUSIÓN E IMITACIÓN EN EL PROYECTO DE LEY POR EL QUE SE MODIFICA EL RÉGIMEN LEGAL DE LA COMPETENCIA DESLEAL. A. Jorge Viera González Profesor Titular de Derecho Mercantil Universidad Rey Juan Carlos 1. Introducción. El presente trabajo tiene por objetivo exponer de una forma crítica el contenido de la reforma de los actos de confusión e imitación que se contiene en el Proyecto de Ley por
Adrian Howe (Australia) Title: "Emotional Law—Provocation and the Cultural Politics of Law Reform." Abstract: "This paper analyses the cultural politics of criminal law reform, focusing on 21st century efforts to reform partial defences to murder in jurisdictions in Australia and the UK. Subjecting the case law and conventional black-letter law commentaries to critiques offered by feminist law scholarship and contemporary emotion theory, it explores deeply emotional reactions to the provocation defence—western societies' most emotional law. A comparative analysis is provided of the different options canvassed in debates that have raged in recent law commission inquiries into whether provocation is capable of reform or whether it should be abolished outright. It is argued that reforms which retain the defence but limit its use or which more ‘radically' abolish the defence but retain provocation as a sentencing discretion are destined to fail because they do not get to the heart of the problem—the deeply ingrained cultural script that men who kill in the heat of ‘passion' deserve some compassion. All contributors to the debate have emotional investments in their positions, but it is the passionate attachments of provocation's ardent apologists for this antediluvian defence that are the paper's analytical focus." Agnieszka Kubal (UK) Title: "Recognizing the Place of Legal Culture in Legal Integration Research. Polish post-2004 EU Enlargement Migrants in the United Kingdom." Abstract: "The paper is placed at the intersection of migration and legal studies. Enquiring into the study of the immigrants in the new socio-legal environment suggests existing gaps and certain shortcomings in the current knowledge on the various aspects of legal integration. This research, engaging critically with the reviewed literature, offers a new approach to studying legal integration, taking Polish post-2004 EU Enlargement migrants in the UK as a case study. It suggests a combined focus on structural factors stemming from the host country's legal environment as well as migrants' cultural background – their values, accustomed patterns of legal behaviour, attitudes to law (legal culture) – in the process of shaping – and possibly re-shaping – their relationship to law during the settlement process. This paper aims to offer an understanding of how people in their daily interactions gradually change their behaviour, views and attitudes engaging in the complex interplay between the new environment and their cultural background during the process of integration. This study makes the claim for the proper recognition of the cultural background of immigrants while investigating their modes and strategies of legal integration. It acknowledges the legal culture of immigrants as a significant factor in empirical research, accounting for nuances and bringing out the subtle differences and therefore revealing the bigger, richer picture of immigrant integration, than one solely relying on structural factors and government policies of immigrant incorporation. The approach to legal culture adopted in this research acknowledges the diversity of sub-cultures and sub-groups within it, at the same time stressing a general, distinguishable and largely shared pattern of accustomed behaviour, thinking and experience of law." Ahti Laitinen (Finland) Title: "Arson: Crime Rates, Offenders, and Prevention in Finland." Abstract: "This paper deals with arson and its prevention in Finland. Arson will first be viewed in the light of history and criminological theory. The second part of the paper contains the results of an empirical study on arson. The material has been collected from different official sources. For example, the offenses data base of the police, the so-called "Accident data base" of the Ministry of the Interior, and the data base of trials have been used. In addition, the documents of the preliminary investigations of the police have been utilized. According to the preliminary results, approximately one-third of all fires are arson. Most often the offenders are young, undereducated males. What is surprising is that arson is more common in some prosperous cities, where, for example, the unemployment rate is unusually low. During 2005-2007 many arson of historical and valuable buildings, like
