Since 1908

Updated 10/8/08

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Selected Drug Tables

MPS has created a set of drug tables in order to analyze coverage of selected drugs by the stand-alone Prescription Drug Plans (PDPs) participating in the Medicare Part D benefit in Michigan.  Psychotropic drugs were chosen on the basis of frequent use in the Medicaid population or for unique clinical characteristics.

The information was obtained from the CMS web tool, the Formulary Finder Tool at www.medicare.gov Information for one plan, Priority MedicareRX, also includes equivalent tier information, as the plan has a unique tier structure.

Selecting any linked drug below will open a table showing the coverage for that drug among PDPs in Michigan. This coverage may be changed by a plan or by CMS, and in fact, the coverage changed numerous times over the last few weeks of 2005. Since the January 1st implementation, further formulary changes are subject to CMS approval and affected beneficiaries must be notified. There may be errors or omissions in these tables and this should not be construed as a recommendation for any plan.

Drug class

Brand name and dose
(single source drugs bolded)

Generic name
(dose included for generic tables)

Notes

Antipsychotics

Abilify (30 mg)

aripiprazole

 

Clozaril (100 mg)

clozapine (100 mg)

comparison table

Geodon (80 mg)

ziprasidone

 

Haldol decanoate

haloperidol decanoate (40 mg)

injectable

Prolixin

fluphenazine decanoate ( 25 mg)

injectable

Risperdal (4 mg)

risperidone

 

Risperdal Consta (50 mg)

risperidone (inj)

injectable

Seroquel (300 mg)

quetiapine

 

Zyprexa (20 mg)

olanzapine

 

Zyprexa Zydis (20 mg)

olanzapine

 

 

 

 

 

Antidepressants

Celexa

citalopram (40 mg)

 

Cymbalta (60 mg)

duloxetine hcl

 

Desyrel

trazodone hcl (300 mg)

 

Effexor XR (150 mg)

venlafaxine hcl

 

Elavil

amitriptyline (150 mg)

 

Lexapro (20 mg)

escitalopram

 

Luvox

fluvoxamine mal (100 mg)

 

Paxil

paroxetine hcl (40 mg)

 

Paxil CR (37.5 mg)

paroxetine hcl E-R

 

Prozac

fluoxetine hcl (40 mg)

 

Remeron

mirtazapine (45 mg)

 

Wellbutrin XL (300 mg)

bupropion hcl E-R

 

Zoloft (100 mg)

sertraline

 

 

 

 

 

Anticonvulsants

Depakote (500 mg)

divalproex sodium

 

Equetro

carbamazepine XR

Drug not listed at CMS

Lamictal (200 mg)

lamotrigine

 

Neurontin

gabapentin (400 mg)

 

Trileptal (600 mg)

oxcarbazepine

 

 

 

 

 

Anxiolytics

Buspar

buspirone (30 mg)

 

Klonopin

clonazepam (2 mg)

CMS excluded class

 

 

 

 

Bipolar Agents

Symbyax (12–50 mg)

olanzapine/fluoxetine

 

 

 

 

 

ADD treatment

Strattera (60 mg)

atomoxetine

 

 

 

 

 

Stimulants

Adderall

amphet./dextroamphetamine (30 mg)

 

Adderall XR (30 mg)

amphet./dextroamphetamine E-R

 

Concerta (54 mg)

methylphenidate E-R

 

Cylert

pemoline (75 mg)

 

Dexedrine

dextroamphetamine sulfate (10 mg)

 

Provigil (200 mg)

modafinil

 

Ritalin

methylphenidate (10 mg)

 

 

 

 

 

Sedative/hypnotics

Ambien (10 mg)

zoldipem

 

Lunesta (3 mg)

eszpoiclone

 

Rozerem

ramelteon

Drug not listed at CMS

Sonata (10 mg)

zaleplon

 

chloral hydrate syrup

chloral hydrate syrup (500 mg / 5 ml)

 

 

 

 

 

Anti-dementia

Aricept (10 mg)

donepezil

 

Cognex (40 mg)

tacrine

 

Exelon (6 mg)

rivastigmine

 

Reminyl

galantamine

Drug not listed at CMS

Namenda (10 mg)

memantine hydrochloride

 

 

 

 

 

Antiparkinson

Cogentin tab

benztropine mesylate (2 mg)

 

 

 

 

 

Substance Abuse

Antabuse (500 mg)

disulfiram

 

Campral

acamprosate

Drug not listed at CMS

Revia

naltrexone hcl (50 mg)

 

Suboxone (8 mg)

buprenorphine