Wednesday, August 13, 2014

Formulary Fun

I have filled out more prior authorizations in the past few months than in the entire last year. Most insurance companies seem to be requiring them for more medicines than ever. They are often denied because people have not tried "preferred" medications first. As the physician I don't have access to the "preferred" list of medications on a patient's formulary, and I find that when I tell parents to look up alternatives on their formulary, they don't know what they're looking for. Insurance companies don't make it easy. Why should they?

Screen shot from Google Search


I decided that some of the most common medicines should be listed somewhere for easy access by patients so they can look up alternatives on their insurance websites. That way they can help themselves. This list is organized by diagnosis and then generic medicines for that diagnosis in alphabetical order with the brand names in parentheses. If you have other medicines or categories you'd like added, please comment below. This will be a work in progress! There are hyperlinks for more information for several of the topics. While it is most accurate to log into your own insurance company's formulary list, if you cannot you can try Fingertip Formulary.

Many of these are quite expensive as monthly costs despite insurance. For help, check out the drug company's website for any coupons or special offers.

Acne

Topical Medicines


  • Adapalene (Differin)
  • Adapalene + benzoyl peroxide (Epiduo)
  • Benzoil peroxide (Benzac AC, Brevoxyl, Triaz, many OTC brands)
  • Benzoil peroxide + clindamycin (Benzaclin)
  • Benzoil peroxide + erythromycin (Benzamycin)
  • Clindamycin (Cleocin T, Clinda-derm, Clindets)
  • Clindamycin phosphate and benzoyl peroxide (Duac)
  • Erythromycin (Akne-Mycin, A/T/S, Emgel, Erycette, Eryderm, Erygel, Erymax, Ery-Sol, Erythra-Derm, ETS, Staticin, Theramycin Z, T-Stat)
  • Tazarotene (Tazorac)
  • Tretinoin (Retin-A)

Oral Medicines

  • Co-trimoxazole AKA sulfamethoxazole-trimethoprim (Bactrim, Septra)
  • Doxycycline (Vibramycin)
  • Isotretinoin (Accutane)
  • Minocycline (Minocin) 
  • Progesterone/Estrogen (oral contraceptives): Ortho Tri-Cyclen, Estrostep, Yaz, many others
  • Spironolactone (Aldactone)

ADHD- pay attention to duration of action and if pill needs to be swallowed


Brand Name
Active Ingredient
Duration of Action
Time Release Pattern
Can be opened or chewed?
Adderall
d,l-Amphetamine
3-4 hrs
Immediate

Adderall XR
d,l-Amphetamine
10-12 hours
50% am, 50% pm
Beads can be sprinkled
Concerta
Methylphenidate
10-12 hours
10-15 min first effect, 30% am, 70% pm (*)
No, must swallow whole
Daytrana
Methylphenidate
2 hours after removal (**)
Up to 2 hours for first effect, then consistent release
N/A: patch
Dexadrine spansule
Amphetamine
6-8 hours
initial immediate release/ then gradual release over prolonged time

Focalin
DexMethylphenidate
4-6 hours
Immediate

Focalin XR
DexMethylphenidate XR
6-10 hours
50% am, 50% pm
May be sprinkled
Metadate CD
Methylphenidate
6-10 hours
30% am, 70% pm
Beads can be sprinkled
Metadate ER
Methylphenidate
6-8 hours
Gradual decrease after 3 hours, may need to be given more than once/day

Methylin
Methylphenidate
3-4 hours
Immediate

Quillivant XR
Methylphenidate
8-12 hours

N/A: liquid
Ritalin
Methylphenidate
3-4hours
Immediate

Ritalin LA
Methlyphenidate
6-10 hours
50% am, 50% pm
May be sprinkled
Lisdexamphetamine
10-12 hours
Onset in 30-45 min, then slow release

Quillivant XR
methylphenidate hydrochloride
8-12 hours
20% immediate/ 80% delayed
Liquid


*Concerta is unique: it has a coating of medicine on the outside, so within 10 or 15 minutes you'll be getting some effects of the medication. On the inside, there's a push compartment filled with a polymer fiber that expands like a sponge as it gets wet, and pushes out the medicine through a laser hole on one end. The capsule itself doesn't get absorbed. Concerta has two compartments of the drug, 30% in the first, and 70% in the second. This is called an "ascending dose," and it is designed to offset a decline in the impact of the medication that can occur the second half of the day. Some of the generics for Concerta do not use this technology.


**Daytrana is a patch. It is recommended to leave it on up to 9 hours, and the medicine effect wears off about 2 hours after the patch is removed. If it is needed for less time, it can be removed earlier. Some teens with long days note benefit if they leave it on longer, though it is not tested beyond the 9 hours.

Allergies

Antihistamines and other oral formulations

  • Cetirizine (Zyrtec) (OTC)
  • Fexofenadine (Allegra) (OTC)
  • Levocetirizine (Xyzal)
  • Loratidine (Claritin) (OTC)
  • Monoleukast (Singulair) - not an antihistamine, also sometimes used for asthma prevention

Eye drops

  • Azelastine (Optivar)
  • Ketotifen (Zaditor)
  • Olopatadine (Patanol)
  • OTC decongestant eye drops (phenylephrine, naphazoline, or tetrahydrozoline) 
  • OTC antihistamine eye drops (pheniramine or antazoline) 

Inhaled nasal corticosteroids (nose sprays)

  • Beclomethasone (Qnasl, Beconase, Vancenase)
  • Budesonide (Rhinocort)
  • Ciclesonide(Omnaris, Zetonna)
  • Flunisolide (Nasalide, Nasarel)
  • Fluticasone (Flonase) (OTC)
  • Fluticasone furoate (Veramyst)
  • Mometasone (Nasonex)
  • Triamcinolone (Nasacort) (OTC)

Asthma

Bronchodilators (quick relief medicines)

  • Albuterol (Proair, Proventil, Ventolin, Ventolin HFA)
  • Levalbuterol (Xopenex)

Inhaled Corticosteroids (prevention medicines) - many come in various strengths, be sure to check that too!

  • Beclomethasone (QVAR)
  • Budesonide (Pulmicort Flexhaler, Pulmicort Respules)
  • Ciclesonide (Alvesco)
  • Flunisolide (Aerobid)
  • Fluticasone (Flovent HFA, Flovent Discus)
  • Mometasone (Asmanex Twisthaler)
  • Triamcinolone (Azmacort)

Inhaled Corticosteroid + Bronchodilator combination medicines

  • Budesonide + Formoterol (Symbicort)
  • Fluticasone + salmeterol (Advair Discus, Advair HFA)
  • Mometasone + Formoterol (Dulera)