Latest Newsletters - Notables

Fall 2002

Additional Updates

Updated Drug Prior-Authorization List

The medications on this page require prior authorization by Dean Health Plan. Brand names (in capital letters) are listed for informational purposes only.

A
Adapalene (DIFFERIN) (Ages > 35)
Alglucerase (CEREDASE)
Alpha1-proteinase inhibitor (PROLASTIN)
Amlexanox (APHTHASOL)
Anakinera (KINERET)
Atorvastatin (LIPITOR)
Azelaic acid (AZELEX) (Ages > 35)

B
Becaplermin (REGRANEX gel)

C
Calcipotriene (DOVONEX)
Ciclopirox solution (PENLAC)

D
Darbepoetin (ARANESP)
Desmopressin (STIMATE)
Diazepam rectal gel (DIASTAT)
Dofetilide (TIKOSYN)
Donepezil (ARICEPT)
Dornase alfa (PULMOZYME)

E
Entacapone (COMTAN)
Epoetin alpha (EPOGEN, PROCRIT)
Epoprostenol (FLOLAN)
ESKALITH
Etanercept (ENBREL)

F
Fenofibrate (TRICOR brand only)
Filgrastim (NEUPOGEN)
Finasteride (PROSCAR)
Fluconazole (DIFLUCAN)
Fluticasone propionate/salmeterol inhalation powder (ADVAIR DISKUS)
Follitropin alfa (GONAL-F)
Fomivirsen (VITRAVENE)

G
Galatamine (REMINYL)
Ganciclovir (oral CYTOVENE)
Glatiramer (COPAXONE)
Goserelin (ZOLADEX)

H
Human growth hormone (all types)
Hyaluronan injections (SYNVISC)

I
Imatinib mesylate (GLEEVAC)
Imiglucerase (CEREZYME)
Infliximab (REMICADE)
Insulin infusion pumps (NOVOPEN or equivalent)
Interferon (all types, including BETASERON, AVONEX)
Itraconazole (SPORANOX)

L
Lansoprazole (PREVACID)
Leflunomide (ARAVA)
Leuprolide (LUPRON)
Levetiractam (KEPPRA)
Losartan (COZAAR)
Losartan/hydrochlorothiazide (HYZAAR)

M
Menotropins (HUMEGON, PERGONAL)
Modafanil (PROVIGIL)

N
Nafarelin (SYNAREL)
Naltrexone (REVIA)
Naratriptan tablets (AMERGE)
Nateglinide (STARLIX)
Norethindrone/ethinyl estradiol (ESTROSTEP, ORTHO-NOVUM 7-7-7)
Norgestimate ethinyl estradiol (ORTHO-CYCLEN, ORTHO TRI-CYCLEN)

O
Ofloxacin (FLOXIN)
Oprelvekin (NEUEMEGA)
Oseltamivir (TAMIFLU)
Oxcarbazine (TRILEPTAL)

P
Palivizumab (SYNAGIS)
Peginterferon alfa 2b (PEG-INTRON)
Pimecrolimus topical (ELIDEL)
Pioglitazone (ACTOS)
Progesterone—gel (CRINONE)—oral (PROMETRIUM),all other oral excluded

R
Raloxifene (EVISTA)
Repaglinide (PRANDIN)
Rimantadine (FLUMADINE)
Rivastigmine (EXELON)
Rizatriptan (MAXALT, MAXALT MLT)
Rofecoxib (VIOXX)
Rosiglitazone (AVANDIA)

S
Sargramostim (all types)
Sumatriptan tablets (IMITREX)

T
Tacrolimus topical (PROTOPIC)
Tamsulosin (FLOMAX)
Tazarotene (TAZORAC)
Terbinafine (oral LAMISIL)
Thyrotropin alfa (THYROGEN)
Tizanidine (ZANAFLEX)
Tolcapone (TASMAR)
Topiramate (TOPAMAX)
Trastuzumab (HERCEPTIN)
Tretinoin (AVITA, RETIN-A) (Ages > 35)

U
Urofollitropin (FERTINEX, METRODIN)

V
Valsartan (DIOVAN)
Valsartan/hydrochlorothiazide (DIOVAN HCT)
Verteporfin (VISUDYNE)

Z
Zolpidem (AMBIEN)
Zonisamide (ZONEGRAN)

As drugs are approved by the U.S. Food and Drug Administration, we may add them to this list. Your physician or your pharmacist should fill out a Drug Prior-Authorization Request Form. For urgent authorizations, your physician should call our Customer Service Department.

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