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APIPA Personal Care Plus (HMO)
STEP THERAPY ALGORITHMS – Formulary 4
Treatment Group
Description
Step 1: Metformin
Step 2: Actoplus Met
Step 1: Metformin
Step 2: Actos
Step 1: One of the following: Inhaled corticosteroid or long-acting beta agonist or
anticholinergic agent.
Step 2: Advair Diskus or Advair HFA
Step 1: lactulose or polyethylene glycol.
Step 2: Amitiza
Step 1: tier 1 ACE inhibitor.
Step 2: Diovan or Diovan HCT or Benicar or Benicar HCT or Cozaar or Hyzaar
The federal government has approved APIPA Personal Care Plus (HMO) as a Special Needs Plan for people with Medicare (Parts A and B) and Medicaid. APIPA Personal Care Plus (HMO)
Treatment Group
Description
Step 1: At least 2 of the following: fluoxetine, citalopram, sertraline, paroxetine, or
Step 2: Cymbalta or Effexor XR or Lexapro or Emsam or Pristiq
Step 1: Metformin.
Step 2: Avandamet
Step 1: Metformin
Step 2: Avandaryl
Step 1: Metformin
Step 2: Avandia
Step 1: alendronate.
Step 2: Boniva tablets
Step 1: (2) tier 1 NSAIDs.
Step 2: Celebrex
Dipeptidyl Peptidase-4 Inhibitor Therapy Step 1: metformin
Step 2: Januvia
Dipeptidyl Peptidase-4 Inhibitor/Metformin Step 1: metformin.

Step 2: Janumet
APIPA Personal Care Plus (HMO) is offered by UnitedHealthcare Insurance Company and its affiliated companies, Medicare Advantage organizations with a Medicare contract. APIPA Personal Care Plus (HMO)
Treatment Group
Description
Step 1: metformin.
Step 2: Duetact
Step 1: Prednisone.
Step 2: Entocort EC
Step 1: Permethrin 5% cream.
Step 2: Eurax cream or lotion
Step 1: risperidone and One of the following: Seroquel, Abilify, Geodon, or Zyprexa.
Step 2: Invega
Step 1: Inhaled corticosteroid.
Step 2: Singluair or Accolate or Zyflo CR
Step 1: ropinirole.
Step 2: Mirapex
Step 1: Fluticasone and Flunisolide.
Step 2: Nasonex
Step 1: Morphine sulfate ER and Fentanyl Transdermal.
Step 2: Opana ER
APIPA Personal Care Plus (HMO) is offered by UnitedHealthcare Insurance Company and its affiliated companies, Medicare Advantage organizations with a Medicare contract. APIPA Personal Care Plus (HMO)
Treatment Group
Description
Step 1: rifampin and isoniazid.
Step 2: Paser
Step 1: Astelin.
Step 2: Patanase
Step 1: Zaditor OTC.
Step 2: Patanol
Step 1: omeprazole.
Step 2: Protonix
Step 1: Long-acting nitrate, Beta-blocker, or Calcium-channel blocker.
Step 2: Ranexa
Step 1: Inhaled corticosteroid or Long-acting beta agonist or anticholinergic agent.
Step 2: Symbicort
Step 1: tier 1 ACE inhibitor.

Step 2: Tekturna or Tekturna HCT
Step 1: Topical Corticosteroid.
Step 2: Elidel
APIPA Personal Care Plus (HMO) is offered by UnitedHealthcare Insurance Company and its affiliated companies, Medicare Advantage organizations with a Medicare contract. APIPA Personal Care Plus (HMO)
Treatment Group
Description
Step 1: rifampin and isoniazid.
Step 2: Trecator
Step 1: Sumatriptan.

Step 2: Maxalt or Maxalt MLT
Step 1: Baraclude or Hepsera.
Step 2: Tyzeka
Step 1: Allopurinol.
Step 2: Uloric
Step 1: Lumigan or Travatan.
Step 2: Xalatan
Step 1: Albuterol (Nebulizer).
Step 2: Xopenex Nebulizer
Step 1: Zolpidem.
Step 2: Zaleplon

*Step therapy applies to new starts only
APIPA Personal Care Plus (HMO) is offered by UnitedHealthcare Insurance Company and its affiliated companies, Medicare Advantage organizations with a Medicare contract.

Source: http://uhccponline.org/edocs/en/members/general/uhcaz_medicare_step_therapy_2010.pdf

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