Headers - Salmon

Drug Formulary

If you have medications that are not currently on the Samish Approved Drug List, and would like them to be considered for addition, you may submit your request for consideration by the Pharmacy and Therapeutics Workgroup. You must use the Samish Formulary Request Form, which is located on the MEMBERS ONLY page of the website, or Purchased & Referred Care can send you a copy of the form. The Workgroup will meet as needed to review the requests.

Samish PRC is pleased to announce the following additions to the Samish Approved Drug List.

New additions for Samish Drug Formulary effective 06/01/2022

  • Cimetidine 400 mg tablets
  • Methotrexate Injectable 25 ml vials only
  • Semaglutide Injectable

Additions and changes to the Samish Drug Formulary effective 08/01/2021

Added:
  • Rybelsus (semaglutide)
  • Dexilant (dexlansoprazole)
  • 5% Lidocaine patch
Updated:
  • NovoLog (insulin aspart) Make Novolog the preferred fast-acting insulin, unless physician confirms no substitute allowed
Declined due to high cost:
  • Humira (adalumimab)

New additions for formulary effective 02/15/2020

  • Added--Ciclesonide (Alvesco)
  • Revised--Freestyle Libre 14-day Continuous Glucose Monitoring System will now be available to Type 2 Diabetics with preapproval from the Diabetes Program Manager

For questions about the PRC eligibility, pre-authorizations, program limitations, or general health coverage issues, please call our Contract Health Program at (877) 470-8737

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