Changes in PDL for Commonwealth Care Type I, Commonwealth Care Type II & III and Commonwealth Care Bridge

hscotti — Tue, 19 Jan 2010 14:38:52 +0000

Dear CeltiCare Community,

During the year, CeltiCare will review our pharmacy program to ensure appropriate and improved services for our members. Please note the below changes to your Preferred Drug List (PDL) that is available at www.celticarehealthplan.com under the members tab.

Commonwealth Care Type I PDL:

The following drugs have been added to list of covered drugs:

Trade Name	Dosage Form	Dosage	Message
APLENZIN	TB24	174MG	Bupropion XL preferred
CARMOL-HC	CREA	1%; 10%	Generics preferred~ Tier Change
GELNIQUE	GEL	10%
GRANISETRON HCL	TABS	1MG
LAMICTAL ODT	KIT	0
LAMICTAL ODT	KIT	0
LAMICTAL ODT	KIT	0
LAMICTAL ODT	TBDP	25MG
LAMICTAL ODT	TBDP	50MG
LAMICTAL ODT	TBDP	100MG
LAMICTAL ODT	TBDP	200MG
LOSEASONIQUE	TABS	0; 0
PROGRAF	CAPS	0.5MG	Generics preferred~ Tier Change
PROGRAF	CAPS	5MG	Generics preferred~ Tier Change
PROGRAF	CAPS	1MG	Generics preferred~ Tier Change
PROGRAF	CAPS	5MG	Generics preferred~ Tier Change
CELLCEPT	CAPS	250MG	Generics preferred~ Tier Change
CELLCEPT	TABS	500MG	Generics preferred~ Tier Change
RAPAFLO	CAPS	4MG
RAPAFLO	CAPS	8MG
RYZOLT	TB24	100MG
RYZOLT	TB24	200MG
RYZOLT	TB24	300MG
VIMPAT	SOLN	200MG/20ML
VIMPAT	TABS	50MG
VIMPAT	TABS	100MG
VIMPAT	TABS	150MG
VIMPAT	TABS	200MG
ADCIRCA	TABS	20MG	Prior authorization for review as specialty drug
AFINITOR	TABS	5MG	Prior authorization for review as specialty drug
AFINITOR	TABS	10MG	Prior authorization for review as specialty drug
ASACOL HD	TBEC	800MG
EFFIENT	TABS	5MG
EFFIENT	TABS	10MG
MULTAQ	TABS	400MG
ULESFIA	LOTN	5%

Commonwealth Care Type II & III and Commonwealth Care Bridge PDLs:

The following drugs have been added to list of covered drugs:

Tier 1:

Lansoprazole

Tier 2:

Aricept ODT

Exforge HCT

Prevacid SoluTab

Zenpep

Tier 3:

Prevacid Capsule

If you have additional questions regarding the copayment amounts please contact CeltiCare Member Services at 1-866-895-1786.

Planned System Outage

hscotti — Fri, 18 Dec 2009 18:49:11 +0000

Our provider and member portals will be going through planned system maintenance from 11 pm ET Saturday 12/19 thru 11:30 am ET Sunday 12/20. During this time, you will not be able to access your accounts via our web portals. If you have any questions, please call CeltiCare Customer Service at (866)-895-1786, Monday – Friday, 8am – 5pm.

CeltiCare Health Plan » Uncategorized

Changes in PDL for Commonwealth Care Type I, Commonwealth Care Type II & III and Commonwealth Care Bridge

Planned System Outage