Pharmacy Benefit
Updates Since Your Last Issue

Dean Health Plan (DHP) has a PDF document that lists all the formulary medications and their corresponding tier level. You can find this list at www.deancare.com. Click on “Dean Health Plan,” then “Members,” then “Pharmacy Information,” then “Drug Formulary.” You can search the document easily by clicking the binocular icon on your toolbar. The pharmacy information Website has two additional lists that may be viewed online: the Drug Prior- Authorization List, which includes drugs restricted to certain specialists, and the Drug Exclusion List. You can also call Customer Service at 608-828-1301 or 800-279-1301 for a complete copy of either list or for more information about your prescription drug benefit.

Drug Prior-Authorization List

The medications on this list require prior authorization (PA) by DHP. Brand names are listed first, with the generic name in parentheses.

Added to PA List

Orencia (abatacept)
Rituxan (rituximab)
Rozerem (ramelteon)
Sutent (sunitinib malate)

Removed From PA List

Floxin (ofloxacin oral)
Retin-A, Avita (tretinoin)

As drugs are approved by the U.S. Food and Drug Administration (FDA), 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 Customer Service.

Drug Exclusion List

Our drug benefit does not automatically cover every new drug that the FDA approves. We have a panel of physicians from various specialties to evaluate new drugs. If an excluded drug has been prescribed for you, ask your physician or pharmacist if he or she can substitute it with one of the medications that we cover. Brand names are listed first, with the generic name in parentheses.

Recently Added

Exjade (deferasirox)
Revlimid (lenalidomide)

Recently Excluded

Ambien CR (zolpidem tartrate tab cr)
Enjuvia (estrogens, conjugated synthetic b)
LoEstrin 24 FE (norethindrome and ethinyl estradiol-fe)
Simvastatin (brand Zocor on Tier 1)
Taclonex Oint (calcipotriene-beta methasone dipropionate)
Testim Gel (testosterone td gel)
Twinject (epinephrine intramuscularsubcutaneous)

General exclusions: nonprescription overthe- counter drugs, weight-loss products, drugs for cosmetic use and oral medications for the treatment of sexual dysfunction

Please note: Some members may have coverage for one of these drugs based on an exception in their pharmacy benefit or an authorization from DHP.

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