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Baltimore County Public Schools Step Therapy - 2013 ***Most step therapy programs have exception criteria for members taking certain medications and/or medical
histories. Depending on a member's specific medical history, a back-up medication may be approved without a trial of
a front-line medication.***
Step Therapy
Your prescription is for one of Your program points you to one of
This program looks for
Indication
these targeted step drugs
these first step drugs
Angiotensin II
Atacand HCT, Atacand, Avalide, Avapro, Azor, Prior use of 1 first line medication in the Heart and hypertension
Receptor Antagonists
Benicar, Benicar HCT,Cozaar, Diovan HCT, captopril/HCTZ, enalapril, enalapril/HCTZ, Diovan, Edarbi, Edarbyclor, Exforge, Exforge fosinopril, fosinopril/HCTZ, lisinopril, lisinopril/HCTZ, HCT, Hyzaar, Micardis, Micardis HCT, Teveten, ramipril, quinapril, quinapril/HCTZ, Quinaretic, Teveten HCT, Twynsta, Tribenzor moexipril, trandolapril, moexipril/HCTZ, benazepril/amlodipine, perindopril, trandolapril/verapamil, enalapril/felodipine, losartan, losartan/HCTZ, eprosartan, irbesartan, irbesartan/HCTZ Antidepressants -
bupropion SR, bupropion XL, budeprion SR, Prior use of 1 first line medication in the Depression
Bupropion
Antidepressants -
Celexa, Lexapro, Luvox CR, Paxil CR, Paxil, fluoxetine/weekly, fluvoxamine, paroxetine, Prior use of 1 first line medication in the Depression
Selective Serotonin
paroxetine CR, citalopram, sertraline, escitalopram Reuptake Inhibitors
(SSRI)
Antidepressants -
fluoxetine, fluvoxamine, paroxetine, citalopram, Prior use of 1 first line medication in the Depression
Selective Serotonin
last 130 days; for Savella prior use of 2 Norepinephrine
medication (SSRI and/or SNRI) in the last Reuptake Inhibitors
(SNRI)
Avodart
Prior use of 1 first line medication in the BPH
Beta Blockers
Toprol XL, Bystolic, Coreg, Levatol, Inderal LA, acebutolol, atenolol, betaxolol, bisoprolol, carvedilol, Prior use of 1 first line medication in the Heart and hypertension
InnoPran XL, Sectral, Corzide, Tenormin, Kerlone, labetalol, metoprolol tartrate, metoprolol succinate (ER), Timolide, Zebeta, Normodyne, Trandate, Lopressor, nadolol, pindolol, propranolol, propranolol ER, timolol, Corgard, Blocadren, Inderal, Coreg CR, Ziac, atenolol/chlorthalidone, bisoprolol/hydrochlorothiazide, metoprolol/hydrochlorothiazide, propranolol/hydrochlorothiazide, nadolol/bendroflumethiazide Bisphosphonates
Step-One: alendronate, ibandronate
Os t
e
oporosi
s
Enhanced
Step-Two: Actonel, Actonel Plus Calcium, Atelvia, days for a Step-Two Product. Prior use of
Binosto
a Step-Two medication in the last 130 days for a Step-Three product. Branded NSAID
Arthrotec, Mobic, Ponstel, Cataflam, Voltaren, diclofenac, etodolac, fenoprofen, flurbiprofen, Prior use of 2 first line medications in the Arthritis/Pain
Voltaren XR, Lodine, Lodine XL, Nalfon, Ansaid, ibuprofen, indomethacin, ketoprofen, ketorolac, last 130 days; for Vimovo use of generic Motrin, Indocin, Indocin SR, Orudis, Toradol, meclofenamate, mefenamic acid, meloxicam, Relafen, Naprosyn, Naprelan, Anaprox, Anaprox nabumetone, naproxen, oxaprozin, piroxicam, DS, Daypro, Feldene, Clinoril, Flector, Voltaren sulindac, tolmetin, diclofenac sodium/misoprostol Gel, IC 400, IC 800, Zipsor, Pennsaid, Cambia, generic famotidine, cimetidine, nizatidine, or ranitidine AND prescription strength ibuprofen (brand or generic) Baltimore County Public Schools Step Therapy - 2013 Step Therapy
Your prescription is for one of Your program points you to one of
This program looks for
Indication
these targeted step drugs
these first step drugs
Calcium Channel
Adalat CC, Cardene, Cardene SR, Dynacirc, nifedipine SR, nifedipine IR, nicardipine IR, Prior use of 1 first line medication in the Heart and hypertension
Blockers -
Dynacirc CR, Norvasc, Plendil, Procardia, felodipine ER, isradipine, amlodipine, nisoldipine Dihydropyridine
Products
Calcium Channel
Covera-HS, Verelan PM, Verelan, Calan, Calan verapamil SR, verapamil IR, verapamil ER Prior use of 1 first line medication in the Heart and hypertension
Blockers - Verapamil
Products
COX-2 Inhibitors
diclofenac, etodolac, fenoprofen, flurbiprofen, Prior use of 2 first line medications in the Arthritis/Pain
ibuprofen, indomethacin, ketoprofen, ketorolac, meclofenamate, mefenamic acid, meloxicam, nabumetone, naproxen, oxaprozin, piroxicam, sulindac, tolmetin, diclofenac sodium/misoprostol Fenofibrate
Tricor, Lofibra, Antara, Triglide, Lipofen, Prior use of 1 first line medication in the Cholesterol
Hypnotics
Ambien CR, Lunesta, Rozerem, Sonata, Ambien, Prior use of 1 first line medication in the Insomnia
Gabapentin (formerly
Prior use of 1 first line medication in the Neuropathic pain
called Lyrica)
Nasal Steroids
Rhinocort Aqua, Beconase AQ, Nasacort AQ, fluticasone propionate, flunisolide, triamcinolone Prior use of 1 first line medication in the Allergies
Nasonex, Flonase, Veramyst, Omnaris, Qnasl, Preferred HMG (Statin) Altoprev, Caduet, Lescol, Lescol XL, Mevacor,
lovastatin, pravastatin, simvastatin, atorvastatin, Prior use of 1 first line medication in the Cholesterol
Pravachol, Zocor, Vytorin, Livalo, Lipitor Preferred Overactive
Oxybutynin IR/ER (generic only), Enablex, Prior use of 1 first line medication in the Overactive bladder
Bladder (OAB)
Vesicare, Sanctura/XR (generic only), Detrol/LA, Proton Pump Inhibitors Aciphex, Dexilant (formerly Kapidex), Nexium,
omeprazole (Rx or OTC), lansoprazole, omeprazole- Prior use of 1 first line medication in the Stomach acid conditions
- generic
Zegerid/OTC, First-Lansoprazole, First-Omeprazole Proton Pump Inhibitors - Step Two: Nexium, omeprazole-sodium bicarbonate, omeprazole (Rx or OTC), lansoprazole, pantoprazole
Stomach acid conditions
Enhanced
days for a Step-Two Product. Prior use of Step Three: Aciphex, Dexilant (formerly Kapidex),
Prilosec/OTC, Protonix, Zegerid/OTC, Prevacid/OTC, Does NOT target kids 2 years of age and younge r.
Tetracycline - Oral
Declomycin, Adoxa, Monodox, Avidoxy/kit, demeclocycline, doxycycline, minocycline, Prior use of 1 first line medication in the Dermatologic Conditions
Adoxa/CK/TT/Pak, Doryx, Vibramycin, Vibra- Tabs, Oraxyl, Periostat, Oracea, Dynacin, Minocin/kit/PAC, Solodyn, Sumycin, Alodox/kit, Morgidox, Ocudox Baltimore County Public Schools Step Therapy - 2013 Step Therapy
Your prescription is for one of Your program points you to one of
This program looks for
Indication
these targeted step drugs
these first step drugs
Topical Acne
Rule 1: Brand topical BPO, antibiotic, etc
Rule 1: Generic topical BPO, antibiotic, etc
Prior use of first line medication in the last Dermatologic Conditions
containing products Rule 2: 130 days for Rules 1 and 2; Prior use of
Rule 2: Brand topical cleansers
two products in the last 130 days for Rule Rule 3: Brand topical kits
Rule 3: One med from rule 1 AND one med from
****Due to the massive list of medications included in this step therapy, the 2nd line ST medications tab is not populated with these meds, please refer to the BAC for the most complete listing of targets and alternatives.*** Topical Corticosteroids Aclovate, Ala-Scalp HP, ApexiCon, Capex,
alclometasone, amcinonide, betamethasone Prior use of 2 first line medication in the Dermatologic Conditions
Clobex, Elocon, Halog, Halonate, Florone, Kenalog, Cloderm, Cordran, Locoid, Luxiq, Olux, dipropionate, fluocinonide, fluticasone, halobetasol, Pandel, Psorcon, Derma-Smooth/FS, Dermatop, Texacort, Vanos, Diprolene/AF, clobetasol, hydrocortisone butyrate, desonide, Verdeso, Desonate, Olux-Olux-E, Desowen, desoximetasone, hydrocortisone valerate, Cutivate, Zytopic, Nucort Lotion, Florone, Ultravate, Topicort/LP, Lidex, Westcort, Momexin, Pediaderm/TA, Triderm, Scalacort, Samol-HC, Pramosone, Pramosone E, Desonil/kit, Aqua Glycolic HC alclometasone, amcinonide, betamethasone Prior use of 1 first line medication in the Dermatologic Conditions
Immunomodulators
dipropionate, clobetasol, clobetasone, fluocinonide, fluticasone, halobetasol, betamethasone valerate, hydrocortisone, hydrocortisone butyrate, hydrocortisone buteprate, hydrocortisone acetate, desonide, desoximetasone, hydrocortisone valerate, mometasone, triamcinolone, diflorasone, fluocinolone, clocortolone, flurandrenolide, halocinonide, prednicarbate Actives Only
Retirees Only

Source: http://www.bcps.org/offices/benefits/pdf/Express-Scripts_Front-Line-Drugs.pdf