State & FederalHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingSeptember 28, 2018

Updated Formulary: Asthma controller medication

Effective August 1, 2018, Anthem updated the formulary for asthma controller medications. The table below provides details regarding the new requirements for members:

 

Inhaled corticosteroid (ICS) products

 

 

May prescribe without Prior Authorization

Medication

Formulary status

Under

age 12

Age 12

and older

Arnuity® Ellipta®

Preferred

 

X

Budesonide Respules

Preferred

X

(age 0-5)

 
Alvesco® Nonpreferred    
Asmanex HFA Nonpreferred    
Asmanex Twisthaler® Nonpreferred

X

(age 0-5)

 
Flovent® Diskus® Preferred X X
Flovent® HFA Preferred X X
Pulmicort Flexhaler® Nonpreferred    
Pulmicort Respules® Nonpreferred    
Qvar Redihaler Nonpreferred    
Qvar HFA Preferred only under age 12

X

(age 0-11)

 

 

ICS/long-acting beta agonists products

 

 

May prescribe without Prior Authorization

Medication

Formulary status

Under

age 12

Age 12

and older

Breo® Ellipta®

Preferred

 

X

fluticasone-salmeterol

(generic for AirDuo RespiClick®)

Preferred

 

X

Advair Diskus®

Nonpreferred

X

(age 4-11)

 

Advair® HFA

Nonpreferred

 

 

Dulera®

Nonpreferred

 

 

Symbicort®

Nonpreferred

 

 

 

Preferred spacers for inhalers

 

New name

Type

Status

Available mask

Antistatic

Latex free

Breatherite™

VHC

Preferred

Yes

Yes

Yes

LiteAire®

Spacer

Preferred

N/A

 

 

Microspacer/Chamber

Spacer

Preferred

N/A

 

 

OptiChamber

VHC

Preferred

Yes

Yes

Yes

Pocket Spacer

Spacer

Preferred

N/A

 

 

Vortex®

VHC

Preferred

Yes

Yes

 


Prescribing preferred products helps prevent the need for PA as well as eliminates the inconvenience of denied medications for your patients.

 

If you determine preferred products are not clinically appropriate for a specific patient, you can do one of the following to obtain PA:
  • Call our Pharmacy department and follow the voice prompts for pharmacy PA at:
    • 1-866-408-6132 for Hoosier Healthwise
    • 1‑844‑533‑1995 for Healthy Indiana Plan
    • 1-844-284-1798 for Hoosier Care Connect
  • Fax the Pharmacy PA Form (www.anthem.com/inmedicaiddoc / Provider Support / Forms / Pharmacy) and all required information to 1-844-864-7860
  • Submit a request using the electronic PA process at https://covermymeds.com