Date: Thu, 18 Dec 1997 18:27:52 GMT Server: Stronghold/1.3.4 Ben-SSL/1.3 Apache/1.1.3 Content-type: text/html Content-length: 7924 Last-modified: Tue, 09 Dec 1997 00:18:03 GMT Advance Paradigm, Inc. - Online Formulary - More Information  
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Development of the Drug Formulary 

The Advance Paradigm National Outpatient Drug Formulary is an information resource which can be a useful tool in the management of the quality and cost of drug therapy. It should be used as a guide by providers in the selection of drug therapies. 

The formulary was developed by a Pharmacy and Therapeutics Committee comprised of pharmacists and consulting physicians. The formulary development process involved evaluation of drug use throughout the Plan with selection of drug entities which reflected the prescribing patterns of Advance Paradigm providers. 

The formulary is continually changing to reflect new advances in drug treatment therapies and the current practices of Advance Paradigm providers. Therefore, input from Plan providers is encouraged. 

The value and effectiveness of the formulary depends upon the support and compliance of providers. The cooperation of all providers with the purpose of this formulary is appreciated. 

The Pharmacy and Therapeutics Committee 

The Pharmacy and Therapeutics Committee was established to develop and maintain a rational drug formulary and control pharmacy costs. It is comprised of consulting physicians, Plan physicians and pharmacists who meet quarterly to review drug use and establish guidelines for change. The Pharmacy and Therapeutics Committee utilizes the most authoritative sources of information, i.e. Food and Drug Administration (FDA), National Institutes of Health (NIH), National Center for Disease Control (CDC), and others, to select medications based on comparative efficacy, adverse effect profile and cost.

General Information 

Drugs are listed generically by therapeutic classification and alphabetically. Common brand names for generic entities appear in parentheses for informational purposes only. Providers are encouraged to prescribe generically whenever possible and to use first line lower cost options when appropriate. 

The formulary index lists drugs by both generic and brand names with references to specific formulary sections where the drug may be found. It also indicates over-the-counter (OTC) medications, non-formulary drugs, maintenance medications, schedule II narcotics, drugs which may be dispensed with the generic equivalent, dual source medications which will be dispensed with the formulary brand only, and drugs with recommended prescribing guidelines. 

All dosage forms and strengths of each drug listed are considered formulary products unless otherwise noted. 

Over-the-counter (OTC) products are listed for informational purposes only; they are not a covered benefit of Advance Paradigm unless exceptions are made by a Plan. 

Explanation of Symbols 

Cost Index $ 

One to six dollar signs precede all drugs listed in the formulary. The number of dollar signs reflects the weighted daily or unit cost of the pharmaceutical product, based upon average wholesale price less any contractual allowance. The use of these symbols cannot be translated directly into a dollar amount, instead they are intended to illustrate relative costs within a drug category. 

$ product A least expensive 
$$ product B more expensive than A 
$$$ product C more expensive than B 
$$$$ product D more expensive than C 
$$$$$ product E more expensive than D 
$$$$$$ product F more expensive than E 

[MAINT] 

Maintenance drugs may be dispensed to the Plan member in quantities up to a 34 day supply or 100 units, depending on plan parameters. 

Asterisk * 

An asterisk indicates drugs which have an FDA approved generic equivalent available. 

Pound Sign # 

A pound sign indicates dual source branded medications which will be dispensed with the formulary brand indicated. 

NON-FORM 

Non-formulary drugs 

CII 
Schedule II narcotics 

(OTC) 
Over-the-counter medications 

Generic Drug Policy 

The Advance Paradigm prescription benefit is a generic benefit. Specified drugs having FDA approved generic equivalents available will be dispensed generically, and are depicted throughout the formulary with the asterisk symbol. Members requesting a brand name product when a generic product is available must pay the difference between the brand and generic in addition to their standard copayment, unless the physician designates "Do Not Substitute (DNS)" on the prescription. 

Specific Exclusions and Limitations 

Exclusions may vary for certain groups. 

Prescription Quantity Limits 
Quantity limits may vary by plan 
Non-formulary Medications 

Providers are encouraged to comply with the drug formulary when prescribing medications for Advance Paradigm members. The Advance Paradigm national formulary is an open formulary that is designed to be comprehensive but not all inclusive1. Providers occasionally may find it necessary to prescribe drugs which are not listed on the formulary because these drugs are infrequently used or have very limited use. The Pharmacy and Therapeutics Committee will contact providers whose prescribing habits consistently vary from the formulary. 

1 Some individual Plans may choose to have a closed or partially closed formulary.

 
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