What is the Central Ohio Medical Directors Coalition?
The Central Ohio Medical Directors Coalition is a partnership of medical directors from prominent Central Ohio health plans and the Columbus Health Department dedicated to promoting innovative initiatives that improve health and healthcare.

NOTE: Each participating HMO makes its own independent decision as to which drugs to include or exclude from its own formulary without consulting any other HMO. The formularies are reproduced here only for your ease of reference and there is no understanding or agreement among the listed HMOs as to what drugs will or will not be included in each separate formulary.
 
 
 
 
 
 
240 Parsons Avenue  ~  Columbus, OH 43215
Phone: (614) 645-0871  ~  E-mail: comdc@cmhhealth.org		  
 
                               
                               
Central Ohio Formulary Guide - 2003
The following guide will provide easy access to preferred agents for the major categories of drugs for your patients covered by Ohio health plans. It will be updated every January.
This does not represent an exhaustive list and is subject to change. If you have any questions, please call the appropriate health plan listed to below.

This guide is only a partial list of formulary, prior authorization or step-therapy drugs and is current as of January 2003. Under some benefit plans, coverage is not limited to drugs included in the formulary. While this information is believed to be accurate as of the print date, it is subject to change without notice. As always, decisions regarding the treatment of members are at the sole discretion of physicians, and these materials do not dictate or control decisions regarding appropriate care of members.
Health Plan Preferred Brands*
(Listed alphabetically. Please use generics when clinically appropriate.)
*Some drugs may require pre-certificatioN(PR), step-therapy(ST) or have specific quantity limitations(QL).
LEGEND
(QL) : Quantity Limit
(PR) : Precertification Required
(ST) : Step-Therapy		 Generics
(common to most plans)
For items marked with an *
see individual plan.		 Aetna Health, Inc.
Drug Prior Authorization
1-800-414-2386		 Anthem BCBS
Customer Service
1-800-338-6180		 Nationwide
Health Plans
Triage
1-800-548-3112		 OSU Managed
Health Care System
Customer Service
1-800-447-5836		 United Healthcare
Customer Service
1-800-212-4776
Ace Inhibitors analapril, captopril, captopril/HCTZ, enalapril, enalapril/HCTZ, lisinopril
lisinopril/HCTZ		 Accupril, Accuretic, Altace, Mavik Accupril, Accuretic, Lotensin, Lotensin HCT, Uniretic, Univasc Accupril, Accuretic, Altace, Lotensin, Prinivil, Prinizide Accupril, Accuretic, Altace, Lotensin, Lotensin HCT Accupril, Altace
Antibacterials
(oral)		 amoxicillin, amoxicillin/clavulanate, ampicillin, cefaclor, cefaclor SR, cefadroxil, cefuroxime, cephalexin, cephradine, clindamycin, cloxacillin, dicloxacillin, doxycycline, EES/sulfisoxazole, erythromycin, metronidazole, minocycline, nitrofurantoin, SMZ/TMP, sulfisoxazole, sulfasalazine, penicillin VK, tetracycline Augmentin ES, Augmentin XR, Avelox, Biaxin, Biaxin XL, Cedax, Cipro, Lorabid, Omnicef, PCE, Zithromax, Zyvox (PR) Augmentin, Ceftin, Cefzil, Cipro, Omnicef, Tequin, Zithromax Augmentin, Biaxin, Biaxin XL, Cipro, Levaquin, Omnicef, Zithromax Augmentin, Avelox, Biaxin, Biaxin XL, Ceftin, Cipro, Levaquin, Lorabid, Macrobid, Noroxin, Omnicef, Suprax, Tequin, Zithromax Amoxil, Augmentin, Biaxin, Biaxin XL, Cefzil, Cipro, Floxin, Furadantin, Levaquin, Macrobid, Velosef, Zithromax
Anti-depressants amitriptyline, amoxapine, bupropion clomipramine, doxepin, desipramine, fluoxamine, fluoxetine, imipramine, maprotiline, nortriptyline, protriptyline, trazodonene Paxil, Paxil CR, Welbutrin SR, Zoloft Celexa, Effexor, Effexor XR, Lexapro, Paxil, Paxil CR, Remeron, Welbutrin SR, Zoloft Effexor XR, Parnate, Paxil, Prozac, Nardil, Remeron, Welbutrin SR, Zoloft Celexa, Effexor XR, Paxil, Remeron, Welbutrin SR, Zoloft Celexa, Effexor, Effexor XR, Parnate, Paxil, Paxil CR, Nardil, Serzone, Surmontil, Vivactil, Welbutrin SR, Zoloft
Antihistamines clemastine, cyproheptadine, diphenhydramine (50mg)*, hydroxyzine Astelin, Semprex D GENERICS ONLY Allegra, Clarinex, Zyrtec Allegra, Allegra D, Astelin, Optimine, Zyrtec, Zyrtec-D Clarinex, Zyrtec, Zyrtec-D
Anti-psychotics amitriptyline, chlorpromazine, clozapine, fluphenazine, fluvoxamine, haloperidol, lithium carbonate loxapine, perphenazine, prochlorperazine, thioridazine, thiothixene, trifluoperazine Lithobid, Serentil, Risperdal (QL), Zyprexa (QL), Zyprexa-Zydis (QL) Geodon, Lithobid, Moban, Risperdal, Seroquel, Zyprexa Clozaril, Moban, Orap, Risperdal, Seroquel, Zyprexa Moban, Orap, Risperdal, Serentil, Seroquel, Zyprexa Clozaril, Loxitane C, Moban, Orap, Risperdal, Serentil, Seroquel, Zyprexa
Angiotensin II
Receptor Blockers		 No generics available Cozaar, Diovan, Diovan HCT, Hyzaar Avapro, Avalide, Diovan, Diovan HCT Cozaar, Diovan, Diovan HCT, Hyzaar, Micardis, Micardis HCT Atacand, Atacand HCT, Cozaar, Diovan, Diovan HCT, Hyzaar Cozaar Diovan, Diovan HCT, Hyzaar
Antimigraines /
Triptans		 No generics available Amerge (QL), DHE-45, Imitrex (QL), Maxalt, Maxalt MLT (QL) Cafergot, Imitrex (QL), Migranal (QL), Zomig (QL) Amerge, DHE-45, Imitrex, Maxalt, Maxalt MLT Amerge, Imitrex, Maxalt, Maxalt MLT, Zomig Axert, DHE-45, Ergomar, Imitrex, Maxalt, Maxalt MLT, Migranal, Sansert, Zomig, Zomig ZMT
Beta Blockers acebutolol, nadolol, atenolol, bisoprolol, bisoprolol HCTZ, pindolol, labetalol, metoprolol, propranolol, sotalol, timolol Coreg Coreg, Toprol-XL Coreg Coreg, Toprol-XL Coreg, Toprol-XL
Calcium Channel
Blockers		 diltiazem, diltiazem long-acting felodipine, nicardipine, nifedipine, verapamil, verapamil SR Norvasc Norvasc Norvasc Covera HS, Norvasc, Verelan PM Cardiazem CD, Norvasc
Contraceptives
(oral, injectable, transdermal)		 ethinyl estradiol/levonorgestrel
(all AB rated generics)*

*Not all generic OC’s are on formulary for Aetna. Contact the health plan for further information.		 Micronor, Modicon, Ortho-Cept, Ortho-Evra, Ortho-Novum: (10/11, 1/35,
1/50, 7/7/7), Ortho-Cyclen, Ortho Tri-Cyclen, Nuvaring		 Depo-Provera, Ortho-Evra, Ortho Tri-Cyclen, Yasmin Estrostep FE, LoEstrin, Lo/Ovral, Mircette, Modicon, Ortho (all products), Triphasil Alesse, Demulen, Estrostep FE, LoEstrin, LoEstrin FE, Lo/Ovral, Mircette, Modicon, Nordette, Ortho (all products), Triphasil Alesse, Cyclessa, Estrostep, LoEstrin, LoEstrin FE, Lo/Ovral, Mircette, Microgestin FE, Modicon, Nordette, Ortho-Cept, Ortho-Cyclen, Ortho-Evra, Ortho-Micronor, Ortho-Novum, OrthoTri-Cyclen, Ovrette, Plan B, Triphasil, Yasmin
H2 Antagonists cimetidine, famotidine, nizatidine, ranitidine Zantac Syrup GENERICS ONLY GENERICS ONLY GENERICS ONLY GENERICS ONLY
Hypoglycemics acetohexamide, chlorpropamide, glyburide, glipizide, metformin, tolazamide, tolbutamide Actos, Amaryl, Avandia, Glucophage XR, Glucotrol XL, Glucovance, Prandin, Precose, Starlix Actos, Amaryl, Avandia, Glucophage XR, Glucotrol XL, Glucovance, Precose Actos, Amaryl, Avandia, Glucophage, Glucotrol XL, Prandin, Precose Actos, Amaryl, Avandia, Glucophage XR, Glucotrol XL, Glucovance, Prandin, Precose Actos, Amaryl, Avandia, Glucophage, Glucophage XR, Glucotrol XL, Glucovance, Glyset, Prandin, Precose
Inhaled Steroids No generics available Advair Diskus, Azmacort, Flovent, Flovent Rotadisk, Pulmicort Respules Azmacort, Flovent, Flovent Rotadisk, Pulmicort Advair, Flovent, Pulmicort Azmacort, Flovent, Flovent Rotadisk, Pulmicort Azmacort, Flovent, Flovent Rotadisk, Pulmicort, Pulmicort Respules, Vanceril, Vanceril DS
Lipid-lowering
Agents		 cholestyramine, clofibrate, gemfibrozil, lovastatin Lescol (QL), Lescol XL, Niaspan, Tricor, Welchol, Zocor (QL) Lipitor, Pravachol Lipitor, Tricor, Welchol, Zetia, Zocor Lipitor, Niaspan, Tricor, Welchol, Zocor Colestid, Lipitor, Niaspan, Pravachol, Tricor, Welchol, Zocor
Nasal Steroids flunisolide Flonase, Nasacort, Nasacort AQ, Nasonex Flonase, Nasacort, Nasacort AQ, Nasonex Flonase, Nasacort, Nasacort AQ, Nasonex, Rhinocort AQUA Flonase, Nasacort, Nasacort AQ, Nasonex, Rhinocort, Rhinocort AQUA, Vancenase, Vancenase AQ Beconase, Beconase AQ, Flonase, Nasonex, Rhinocort, Rhinocort AQUA
NSAIDs /
COX II Inhibitors		 diclofenac, diclofenac XR*, difunisal, etodolac, etodolac SR*, enoprofen, flurbiprofen, ibuprofen, indomethacin, ketoprofen, ketoprofen SR*, ketorolac, meclofenamate, nabumetone*, naproxen, oxaprozin*, piroxicam, salsalate, sulindac, tolmetin*

*Not covered by Aetna		 Vioxx (PR, ST, QL) Celebrex (ST) Celebrex, Vioxx Celebrex, Vioxx GENERICS ONLY
Proton Pump
Inhibitors		 omeprazole Aciphex, Prevacid Protonix Nexium, Prilosec Prilosec, Protonix Nexium, Prilosec
© 2003 Central Ohio Formulary Medical Directors. All rights reserved.