Connecticut Medicaid P&T Meeting Minutes March 4, 2010

Transcription

1 The meeting started at 6:30 pm Attendance Connecticut Medicaid P&T Meeting Minutes March 4, 2010 Present Members: Carl Sherter, MD Eric Einstein, MD Charles Thompson, MD Richard T. Carbray, Jr., RPh Lawrence Sobel, RPh Emmett Sullivan, RPh Tsampika Apostolidis Elizabeth Rodriguez, RN Stella Cretella Absent Members: Manage Nissanka, MD Hilda Slivka, MD Peggy Manning Memoli, Pharm D DSS: Evelyn Dudley Mark Schaefer, PhD Robert Zavoski, MD, MPH Jason Gott, RPh Jim Zakszewski, RPh HP/Provider Synergies Chris Andrews, Pharm D Ellen Arce, RPh Joy DeNardo, RPh Opening remarks: Dr. Sherter made the following announcements: Dr. Lester Silberman has resigned from the P & T Committee. Evelyn Dudley made the following announcements: Mental health medications will be added to the PDL as outlined in Public Act 09-5, House Bill Prior authorization is not required for any mental-health-related drug that has been filled or refilled, in any dosage, at least one time in the one-year period prior to the date the individual presents a prescription for the drug at the pharmacy. A fourteen-day supply of medication is allowed for the initial fill of any non-preferred medication to allow time for the physician to either request a PA or change the medication to a preferred product. Mark Schaefer is the director of Medicaid. Mark Schaefer spoke to the Committee about future plans to add two pediatric psychiatrists to the P & T Committee. Approval of minutes: Committee members approved the meeting minutes from the December 3, 2009 meeting. Public Presentations: Alicia Woodsby, MSW of the National Alliance on Mental Illness (NAMI) addressed the committee regarding the importance of open access to mental health medications. Robert Davidson, PhD of the Eastern Regional Mental Health Board (ERMHB) addressed the committee regarding the diversity of treatment with mental health medications. Paul Desan, MD, PhD of the Connecticut Psychiatric Society (CPS) addressed the committee regarding the challenges of subjecting psychotropic medications to a PDL. Dr. Joan Narad and Dr. Jacqueline Harris of the Connecticut Department of Children and Families (DCF) addressed the committee to explain the monitoring and guidelines established by DCF to promote the safe and effective use of mental health medications. Sheldon Toubman of New Haven Legal Assistance, Inc. addressed the committee regarding the obstacles that prior authorization presents. Dr. Sherter recommended reviewing the mental health classes at this time. The outcomes of the committee s reviews are listed under the therapeutic class reviews.

2 New Generics: Chris Andrews informed the committee members regarding the following new generic products: The generics for Loprox shampoo (ciclopirox shampoo), Spectracef (cefditoren), and Valtrex (valacyclovir) were recommended to be non-preferred products for the Medicaid PDL and the ConnPACE/SAGA PDL. The Beta Blocker class has been expanded to include beta blocker/diuretic combinations. The generic for Inderide (propranolol/hctz) was recommended to be preferred on the Medicaid PDL. The Committee motioned to approve and accept Provider Synergies recommendations. The motion was passed unanimously. Therapeutic Class Reviews: Chris Andrews, from Provider Synergies, presented clinical data and financial analysis, as well as answered questions from committee members on the following seventeen therapeutic classes. The recommendations for each PDL will be listed with the class review and the PDL status will be distinguished by program name, with the products that differ between the two PDLs italicized. Outcomes and votes are recorded below by class: Acne Agents, Topical Chris Andrews presented the evaluation and recommendation for this class. He noted that the 2009 update to the consensus guidelines from the Global Alliance to Improve Outcomes in Acne states that topical retinoids are the foundation in the treatment of acne and the combination of retinoids and antibiotics is the preferred treatment initially for a limited duration with the combination of retinoids and benzoyl peroxide recommended for maintenance therapy once inflammation has resolved. Dr. Thompson noted that Dr. Slivka requested that the Committee include Differin as a preferred treatment option for the Medicaid population. The recommended changes to this class for the Medicaid PDL are the addition of Benzaclin and Nuox and the removal of Duac. Dr. Thompson motioned to approve and accept Provider Synergies recommendations with the addition of Differin as preferred with Dr. Einstein seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that Azelex, benzoyl peroxide, Clinac BPO, clindamycin phosphate, erythromycin, Nuox, Retin-A Micro, sulfacetamide, sulfacetamide/sulfur, and tretinoin are preferred and Acanya, Aczone, Akne-Mycin, Atralin, Avar/Avar-E, Benzaclin, Benzamycin, Benzefoam, Benziq, benzoyl peroxide/sulfur, Brevoxyl, Clarifoam, Cleanse and Treat, Clindagel, clindamycin/benzoyl peroxide, Clindareach, Differin, Duac, Epiduo, erythromycin-benzoyl peroxide, Evoclin, Inova, Klaron, Lavoclen, Neobenz Micro, Ovace, Pacnex, Panoxyl, Plexion, Prascion, Rosac, Rosaderm, Rosanil, Rosula, sulfacetamide/sulfur/meratan, Sulfatol, Suphera, Tazorac, Topisulf, Triaz, Zacare, Zaclir, Zetacet, Ziana, and Zoderm are non-preferred. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented for the ConnPACE/SAGA PDL with Dr. Thompson seconding. The motion was passed unanimously. Azelex, Benzaclin, benzoyl peroxide, Clinac BPO, clindamycin phosphate, Differin, erythromycin, Nuox, Retin-A Micro, sulfacetamide, sulfacetamide/sulfur, tretinoin OFF Medicaid PDL: Acanya, Aczone, Akne-Mycin, Atralin, Avar/Avar-E, Benzamycin, Benzefoam, Benziq, benzoyl peroxide/sulfur, Brevoxyl, Clarifoam, Cleanse and Treat, Clindagel, clindamycin/benzoyl peroxide, Clindareach, Duac, Epiduo, erythromycin-benzoyl peroxide, Evoclin, Inova, Klaron, Lavoclen, Neobenz Micro, Ovace, Pacnex, Panoxyl, Plexion, Prascion, Rosac, Rosaderm, Rosanil, Rosula, sulfacetamide/sulfur/meratan, Sulfatol, Suphera, Tazorac, Topisulf, Triaz, Zacare, Zaclir, Zetacet, Ziana, Zoderm ON ConnPACE/SAGA PDL: Azelex, benzoyl peroxide, Clinac BPO, clindamycin phosphate, erythromycin, Nuox, Retin-A Micro, sulfacetamide, sulfacetamide/sulfur, tretinoin OFF ConnPACE/SAGA PDL: Acanya, Aczone, Akne-Mycin, Atralin, Avar/Avar-E, Benzaclin, Benzamycin, Benzefoam, Benziq, benzoyl peroxide/sulfur, Brevoxyl, Clarifoam, Cleanse and Treat, Clindagel, clindamycin/benzoyl peroxide, Clindareach, Differin, Duac, Epiduo, erythromycin-benzoyl peroxide, Evoclin, Inova, Klaron, Lavoclen, Neobenz Micro, Ovace, Pacnex, Panoxyl, Plexion, Prascion, Rosac, Rosaderm, Rosanil, Rosula, sulfacetamide/sulfur/meratan, Sulfatol, Suphera, Tazorac, Topisulf, Triaz, Zacare, Zaclir, Zetacet, Ziana, Zoderm

3 Antidepressants, Other Chris Andrews presented the evaluation and recommendation for this class. He noted that this is a new class being added to both PDLs. He also noted that Aplenzin is an extended-release bupropion hydrobromide tablet that is alcohol-resistant and indicated for the treatment of major depressive disorder. Dr. Thompson questioned why bupropion XL was not recommended as preferred. Chris Andrews explained that the brand name product, Wellbutrin XL, was recommended as preferred. Stella Cretella suggested adding Pristiq to the PDLs. Richard Carbray, Jr. noted that the other products in this class were sufficient treatment options and pointed out the low utilization for Pristiq. The recommendations for the Medicaid PDL are that bupropion, bupropion SR, Effexor XR, Marplan, mirtazapine, Nardil, Parnate, trazodone, venlafaxine, venlafaxine ER, and Wellbutrin XL are preferred and Aplenzin, bupropion XL, Desyrel, Effexor, Emsam, nefazodone, Pristiq, Remeron, tranylcypromine sulfate, Wellbutrin, and Wellbutrin SR are non-preferred. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL with Emmett Sullivan seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that bupropion, bupropion SR, Marplan, mirtazapine, Nardil, Parnate, trazodone, venlafaxine, venlafaxine ER, and Wellbutrin XL are preferred and Aplenzin, bupropion XL, Desyrel, Effexor, Effexor XR, Emsam, nefazodone, Pristiq, Remeron, tranylcypromine sulfate, Wellbutrin, and Wellbutrin SR are non-preferred. Larry Sobel motioned to approve and accept Provider Synergies recommendations with the addition of Effexor XR as preferred for the ConnPACE/SAGA PDL with Dr. Thompson seconding. The motion was passed with Richard Carbray, Jr. and Emmett Sullivan voting against. bupropion, bupropion SR, Effexor XR, Marplan, mirtazapine, Nardil, Parnate, trazodone, venlafaxine, venlafaxine ER, Wellbutrin XL OFF Medicaid PDL: Aplenzin, bupropion XL, Desyrel, Effexor, Emsam, nefazodone, Pristiq, Remeron, tranylcypromine sulfate, Wellbutrin, Wellbutrin SR ON ConnPACE/SAGA PDL: bupropion, bupropion SR, Effexor XR, Marplan, mirtazapine, Nardil, Parnate, trazodone, venlafaxine, venlafaxine ER, Wellbutrin XL OFF ConnPACE/SAGA PDL: Aplenzin, bupropion XL, Desyrel, Effexor, Emsam, nefazodone, Pristiq, Remeron, tranylcypromine sulfate, Wellbutrin, Wellbutrin SR Antidepressants, SSRI Chris Andrews presented the evaluation and recommendation for this class. He noted that this is a new class being added to both PDLs. He also noted that Lexapro is indicated for major depressive disorder for adolescents ages The recommendations for the Medicaid PDL are that citalopram, fluoxetine, fluvoxamine, paroxetine IR, and sertraline are preferred and Celexa, Lexapro, Luvox CR, paroxetine CR, Paxil, Paxil CR, Pexeva, Prozac, Prozac weekly, Sarafem, Selfemra, and Zoloft are non-preferred. Dr. Thompson motioned to approve and accept Provider Synergies recommendations with the addition of Lexapro as preferred for the Medicaid PDL with Larry Sobel seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that citalopram, fluoxetine, fluvoxamine, paroxetine IR, and sertraline are preferred and Celexa, Lexapro, Luvox CR, paroxetine CR, Paxil, Paxil CR, Pexeva, Prozac, Prozac weekly, Sarafem, Selfemra, and Zoloft are non-preferred. Dr. Einstein motioned to approve and accept Provider Synergies recommendations with the addition of Lexapro as preferred for the ConnPACE/SAGA PDL with Tsampika Apostolidis seconding. The motion was passed unanimously. citalopram, fluoxetine, fluvoxamine, Lexapro, paroxetine IR, sertraline OFF Medicaid PDL: Celexa, Luvox CR, paroxetine CR, Paxil, Paxil CR, Pexeva, Prozac, Prozac weekly, Sarafem, Selfemra, Zoloft ON ConnPACE/SAGA PDL: citalopram, fluoxetine, fluvoxamine, Lexapro, paroxetine IR, sertraline OFF ConnPACE/SAGA PDL: Celexa, Luvox CR, paroxetine CR, Paxil, Paxil CR, Pexeva, Prozac, Prozac weekly, Sarafem, Selfemra, Zoloft

4 Antihistamines, Minimally Sedating Chris Andrews presented the evaluation and recommendation for this class. He noted that Xyzal is now indicated for use in patients six months and older for chronic idiopathic urticaria or perennial allergic rhinitis and patients two years and older for seasonal allergic rhinitis. There were no recommended changes to this class for the Medicaid PDL. Richard Carbray, Jr. motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL with Emmett Sullivan seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that loratadine/loratadine-d and loratadine syrup are preferred and Allegra/Allegra-D, Allegra ODT, Allegra syrup, cetirizine/cetirizine-d, cetirizine syrup, cetirizine syrup Rx, Clarinex/Clarinex-D, Clarinex syrup, Claritin/Claritin-D OTC, Claritin syrup OTC, fexofenadine, fexofenadine-d, Semprex-D, Xyzal, Xyzal syrup, Zyrtec/Zyrtec-D, and Zyrtec syrup are non-preferred. Larry Sobel motioned to approve and accept Provider Synergies recommendations as presented for the ConnPACE/SAGA PDL with Richard Carbray, Jr. seconding. The motion was passed unanimously. loratadine/loratadine-d, loratadine syrup OFF Medicaid PDL: Allegra/Allegra-D, Allegra ODT, Allegra syrup, cetirizine/cetirizine-d, cetirizine syrup, cetirizine syrup Rx, Clarinex/Clarinex-D, Clarinex syrup, Claritin/Claritin-D OTC, Claritin syrup OTC, fexofenadine, fexofenadine-d, Semprex-D, Xyzal, Xyzal syrup, Zyrtec/Zyrtec- D, Zyrtec syrup ON ConnPACE/SAGA PDL: loratadine/loratadine-d, loratadine syrup OFF ConnPACE/SAGA PDL: Allegra/Allegra-D, Allegra ODT, Allegra syrup, cetirizine/cetirizine-d, cetirizine syrup, cetirizine syrup Rx, Clarinex/Clarinex-D, Clarinex syrup, Claritin/Claritin-D OTC, Claritin syrup OTC, fexofenadine, fexofenadine-d, Semprex-D, Xyzal, Xyzal syrup, Zyrtec/Zyrtec-D, Zyrtec syrup Antipsychotics Chris Andrews presented the evaluation and recommendation for this class. He noted that this is a new class being added to both PDLs. He also noted that Abilify is indicated for the treatment of irritability associated with autistic disorder for children ages Zyprexa s indications for the treatment of schizophrenia and acute manic episodes and mixed episodes of bipolar disorder have been expanded to patients ages Invega Sustenna is indicated for the acute and maintenance treatment of schizophrenia in adults. Seroquel s indication for the treatment of schizophrenia has been expanded to patients ages and the indication for the treatment of manic episodes of bipolar disorder has been expanded to patients ages Seroquel XR is indicated for adjunctive treatment of depression in adults. Fanapt is indicated for the acute treatment of schizophrenia in adults. Saphris is indicated for acute treatment of schizophrenia and acute treatment of manic or mixed episodes associated with bipolar I disorder in adults. Elizabeth Rodriguez suggested adding Risperdal Consta to the PDLs. Emmett Sullivan noted that this product is administered by medical personnel so it is mostly billed as a medical/professional claim. The recommendations for the Medicaid PDL are that Abilify, amitriptyline/perphenazine, chlorpromazine, clozapine, Fanapt, fluphenazine, fluphenazine decanoate, Geodon, Geodon IM, haloperidol, haloperidol decanoate, Invega Sustenna, Moban, Orap, perphenazine, risperidone, Saphris, Seroquel, Seroquel XR, thioridazine, thiothixene, and trifluoperazine are preferred and Clozaril, Fazaclo, Haldol Decanoate, Invega ER, Navane, Risperdal, Risperdal Consta, Symbyax, Zyprexa tablets, Zyprexa IM, and Zyprexa Relprevv are non-preferred. Emmett Sullivan motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL with Richard Carbray, Jr. seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that Abilify, amitriptyline/perphenazine, chlorpromazine, clozapine, Fanapt, fluphenazine, fluphenazine decanoate, Geodon, Geodon IM, haloperidol, haloperidol decanoate, Moban, Orap, perphenazine, risperidone, Seroquel IR, thioridazine, thiothixene, and trifluoperazine are preferred and Clozaril, Fazaclo, Haldol Decanoate, Invega ER, Invega Sustenna, Navane, Risperdal, Risperdal Consta, Saphris, Seroquel XR, Symbyax, Zyprexa tablets, Zyprexa IM, Zyprexa Relprevv are non-preferred. Richard Carbray, Jr. motioned to approve and accept Provider Synergies recommendations as presented for the ConnPACE/SAGA PDL with Larry Sobel seconding.

5 The motion was passed unanimously. This class was reopened for review by Dr. Sherter. The committee discussed the addition of Zyprexa tablets to the Medicaid PDL. Chris Andrews discussed the declining utilization, mostly attributed to the metabolic side effects. Drs Narad and Harris noted that they have been utilizing Zyprexa less frequently. Dr. Desan noted that although the utilization is decreasing, Zyprexa should be available to the Medicaid population. Elizabeth Rodriguez motioned to approve and accept Provider Synergies recommendations with the addition of Zyprexa tablets as preferred for the Medicaid PDL with Larry Sobel seconding. The motion was passed with Richard Carbray, Jr. and Emmett Sullivan voting against. Abilify, amitriptyline/perphenazine, chlorpromazine, clozapine, Fanapt, fluphenazine, fluphenazine decanoate, Geodon, Geodon IM, haloperidol, haloperidol decanoate, Invega Sustenna, Moban, Orap, perphenazine, risperidone, Saphris, Seroquel, Seroquel XR, thioridazine, thiothixene, trifluoperazine, Zyprexa tablets OFF Medicaid PDL: Clozaril, Fazaclo, Haldol Decanoate, Invega ER, Navane, Risperdal, Risperdal Consta, Symbyax, Zyprexa IM, Zyprexa Relprevv ON ConnPACE/SAGA PDL: Abilify, amitriptyline/perphenazine, chlorpromazine, clozapine, Fanapt, fluphenazine, fluphenazine decanoate, Geodon, Geodon IM, haloperidol, haloperidol decanoate, Moban, Orap, perphenazine, risperidone, Seroquel IR, thioridazine, thiothixene, trifluoperazine OFF ConnPACE/SAGA PDL: Clozaril, Fazaclo, Haldol Decanoate, Invega ER, Invega Sustenna, Navane, Risperdal, Risperdal Consta, Saphris, Seroquel XR, Symbyax, Zyprexa tablets, Zyprexa IM, Zyprexa Relprevv Bone Resorption Inhibitors Chris Andrews presented the evaluation and recommendation for this class. He noted that Forteo is indicated for the treatment of osteoporosis associated with sustained systemic glucocorticoid therapy in men and women at high risk for fracture. The recommended changes to this class are the addition of Fortical and the removal of Miacalcin. Dr. Einstein motioned to approve and accept Provider Synergies recommendations as presented with Larry Sobel seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that alendronate and calcitonin salmon are preferred and Actonel, Actonel with Calcium, Boniva, Didronel, etidronate disodium, Evista, Forteo, Fortical, Fosamax, Fosamax plus D, Fosamax solution, and Miacalcin are non-preferred. Larry Sobel motioned to approve and accept Provider Synergies recommendations as presented for the ConnPACE/SAGA PDL with Richard Carbray, Jr. seconding. The motion was passed unanimously. Actonel, alendronate, Fortical OFF Medicaid PDL: Actonel with Calcium, Boniva, calcitonin salmon, Didronel, etidronate disodium, Evista, Forteo, Fosamax, Fosamax plus D, Fosamax solution, Miacalcin ON ConnPACE/SAGA PDL: alendronate, calcitonin salmon OFF ConnPACE/SAGA PDL: Actonel, Actonel with Calcium, Boniva, Didronel, etidronate disodium, Evista, Forteo, Fortical, Fosamax, Fosamax plus D, Fosamax solution, Miacalcin

6 Calcium Channel Blockers Chris Andrews presented the evaluation and recommendation for this class. He noted that there has been no significant new information since the last review of this class. There were no recommended changes to this class for the Medicaid PDL. Richard Carbray, Jr. motioned to approve and accept Provider Synergies recommendations as presented with Larry Sobel seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that amlodipine, diltiazem IR/ER/SA, Dynacirc CR, felodipine ER, isradipine, nicardipine, nifedipine IR/ER, verapamil IR/ER, and verapamil PM ER are preferred and Adalat CC, Calan/Calan SR, Cardene SR, Cardizem/Cardizem CD, Cardizem LA, Covera-HS, Isoptin SR, nimodipine, Nimotop, nisoldipine, Norvasc, Procardia/Procardia XL, Sular, Tiazac, and Verelan/Verelan PM are non-preferred. Larry Sobel motioned to approve and accept Provider Synergies recommendations as presented for the ConnPACE/SAGA PDL with Stella Cretella seconding. The motion was passed unanimously. amlodipine, diltiazem IR/ER/SA, Dynacirc CR, felodipine ER, isradipine, nicardipine, nifedipine IR/ER, verapamil IR/ER, verapamil PM ER OFF Medicaid PDL: Adalat CC, Calan/Calan SR, Cardene SR, Cardizem/Cardizem CD, Cardizem LA, Covera-HS, Isoptin SR, nimodipine, Nimotop, nisoldipine, Norvasc, Procardia/Procardia XL, Sular, Tiazac, Verelan/Verelan PM ON ConnPACE/SAGA PDL: amlodipine, diltiazem IR/ER/SA, Dynacirc CR, felodipine ER, isradipine, nicardipine, nifedipine IR/ER, verapamil IR/ER, verapamil PM ER OFF ConnPACE/SAGA PDL: Adalat CC, Calan/Calan SR, Cardene SR, Cardizem/Cardizem CD, Cardizem LA, Covera-HS, Isoptin SR, nimodipine, Nimotop, nisoldipine, Norvasc, Procardia/Procardia XL, Sular, Tiazac, Verelan/Verelan PM Erythropoiesis Stimulating Proteins Chris Andrews presented the evaluation and recommendation for this class. He noted that the FDA is requiring that all drugs in this class be prescribed and used under a risk management program to ensure the safe use of these drugs. There were no recommended changes to this class for the Medicaid PDL. Larry Sobel motioned to approve and accept Provider Synergies recommendations for the Medicaid PDL as presented with Emmett Sullivan seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that Epogen and Procrit are preferred and Aranesp is non-preferred. Dr. Einstein motioned to approve and accept Provider Synergies recommendations as presented for the ConnPACE/SAGA PDL with Richard Carbray, Jr. seconding. The motion was passed unanimously. Aranesp, Procrit OFF Medicaid PDL: Epogen ON ConnPACE/SAGA PDL: Epogen, Procrit OFF ConnPACE/SAGA PDL: Aranesp Growth Hormones Chris Andrews presented the evaluation and recommendation for this class. He noted that there has been no new significant information for this class. There are no recommended changes to this class for the Medicaid PDL. Richard Carbray, Jr. motioned to approve and accept Provider Synergies recommendations for the Medicaid PDL as presented with Dr. Thompson seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that Omnitrope and Serostim are preferred and Genotropin, Norditropin, Nutropin, Nutropin AQ, Saizen, Tev-Tropin and Zorbtive are non-preferred. Emmett Sullivan motioned to approve and accept Provider Synergies recommendations as presented for the ConnPACE/SAGA PDL with Larry Sobel seconding. The motion was passed unanimously.

7 Genotropin, Norditropin, Nutropin, Nutropin AQ OFF Medicaid PDL: Humatrope, Omnitrope, Saizen, Serostim, Tev-Tropin, Zorbtive ON ConnPACE/SAGA PDL: Omnitrope, Serostim OFF ConnPACE/SAGA PDL: Genotropin, Norditropin, Nutropin, Nutropin AQ, Humatrope, Saizen, Tev- Tropin, Zorbtive Intranasal Rhinitis Agents Chris Andrews presented the evaluation and recommendation for this class. He noted that Astepro is indicated for the treatment of perennial allergic rhinitis in adults and children 12 years and older and that Patanase is approved for use in patients 6 years and older. The recommended changes to this class are the addition of Astelin, Astepro, and Veramyst and the removal of Flonase. Dr. Einstein motioned to approve and accept Provider Synergies recommendations as presented with Richard Carbray, Jr. seconding. The motion was passed unanimously with Dr. Einstein abstaining. The recommendations for the ConnPACE/SAGA PDL are that Astelin, Beconase AQ, and Nasonex are preferred and Astepro, Atrovent, Flonase, flunisolide, fluticasone, ipratropium, Nasacort AQ, Omnaris, Patanase, Rhinocort Aqua, and Veramyst are non-preferred. Larry Sobel motioned to approve and accept Provider Synergies recommendations as presented for the ConnPACE/SAGA PDL with Richard Carbray, Jr. seconding. The motion was passed unanimously. Astelin, Astepro, ipratropium, Nasacort AQ, Nasonex, Patanase, Veramyst OFF Medicaid PDL: Atrovent, Beconase AQ, Flonase, flunisolide, fluticasone, Omnaris, Rhinocort Aqua ON ConnPACE/SAGA PDL: Astelin, Beconase AQ, Nasonex OFF ConnPACE/SAGA PDL: Astepro, Atrovent, Flonase, flunisolide, fluticasone, ipratropium, Nasacort AQ, Omnaris, Patanase, Rhinocort Aqua, Veramyst Non-Steroidal Anti-Inflammatory Drugs (NSAIDS) Chris Andrews presented the evaluation and recommendation for this class. He noted that Zipsor is indicated for the treatment of mild to moderate acute pain. There are no recommended changes to this class for the Medicaid PDL. Emmett Sullivan motioned to approve and accept Provider Synergies recommendations as presented with Larry Sobel seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that diclofenac, flurbiprofen, ibuprofen Rx, indomethacin, ketorolac, meloxicam, naproxen Rx, oxaprozin, piroxicam, and sulindac are preferred and Anaprox/Anaprox DS, Ansaid, Arthrotec, Celebrex, Clinoril, Daypro, etodolac, Feldene, fenoprofen, Indocin, ketoprofen, meclofenamate, mefenamic acid, Mobic, Motrin, nabumetone, Nalfon, Naprelan, Naprosyn, Ponstel, tolmetin, Voltaren, and Zipsor are nonpreferred. Richard Carbray, Jr. motioned to approve and accept Provider Synergies recommendations as presented for the ConnPACE/SAGA PDL with Larry Sobel seconding. The motion was passed unanimously. Celebrex, flurbiprofen, ibuprofen Rx, indomethacin, ketorolac, meloxicam, naproxen Rx, piroxicam, sulindac OFF Medicaid PDL: Anaprox/Anaprox DS, Ansaid, Arthrotec, Clinoril, Daypro, diclofenac, etodolac, Feldene, fenoprofen, Indocin, ketoprofen, meclofenamate, mefenamic acid, Mobic, Motrin, nabumetone, Nalfon, Naprelan, Naprosyn, oxaprozin, Ponstel, tolmetin, Voltaren, Zipsor ON ConnPACE/SAGA PDL: diclofenac, flurbiprofen, ibuprofen Rx, indomethacin, ketorolac, meloxicam, naproxen Rx, oxaprozin, piroxicam, sulindac

8 OFF ConnPACE/SAGA PDL: Anaprox/Anaprox DS, Ansaid, Arthrotec, Celebrex, Clinoril, Daypro, etodolac, Feldene, fenoprofen, Indocin, ketoprofen, meclofenamate, mefenamic acid, Mobic, Motrin, nabumetone, Nalfon, Naprelan, Naprosyn, Ponstel, tolmetin, Voltaren, Zipsor Opiate Dependence Treatments Chris Andrews presented the evaluation and recommendation for this class. He noted that this was a new class being added to the PDL. The recommendations for the Medicaid PDL are that Suboxone is preferred and buprenorphine/naloxone is non-preferred. Larry Sobel motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL with Tsampika Apostolidis seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that Suboxone is preferred and buprenorphine/naloxone is non-preferred. Emmett Sullivan motioned to approve and accept Provider Synergies recommendations as presented for the ConnPACE/SAGA PDL with Dr. Thompson seconding. The motion was passed unanimously. Suboxone OFF Medicaid PDL: buprenorphine/naloxone ON ConnPACE/SAGA PDL: Suboxone OFF ConnPACE/SAGA PDL: buprenorphine/naloxone Otic Antibiotics Chris Andrews presented the evaluation and recommendation for this class. He noted that the name for this class is being changed to include more than only fluoroquinolone antibiotics. The recommended changes to this class for the Medicaid PDL are the addition of Coly-Mycin S, Cortisporin-TC, neomycin/polymyxin/hydrocortisone, and ofloxacin and the removal of Floxin. Dr. Thompson motioned to approve and accept Provider Synergies recommendations as presented with Richard Carbray, Jr. seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that Cipro HC, Coly-Mycin S, Cortisporin-TC, neomycin/polymyxin/hydrocortisone, and ofloxacin are preferred and Cetraxal, Ciprodex, and Cortisporin are non-preferred. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented for the ConnPACE/SAGA PDL with Larry Sobel seconding. The motion was passed unanimously. Ciprodex, Coly-Mycin S, Cortisporin-TC, neomycin/polymyxin/hydrocortisone, ofloxacin OFF Medicaid PDL: Cetraxal, Cipro HC, Cortisporin ON ConnPACE/SAGA PDL: Cipro HC, Coly-Mycin S, Cortisporin-TC, neomycin/polymyxin/hydrocortisone, ofloxacin OFF ConnPACE/SAGA PDL: Cetraxal, Ciprodex, Cortisporin

9 Proton Pump Inhibitors Chris Andrews presented the evaluation and recommendation for this class. He noted that Kapidex will be renamed Dexilant in the near future to avoid confusion with another product with a similar sounding name. He also noted that several studies have reported an increased risk of cardiovascular events, including myocardial infarction and death, associated with concurrent use of Plavix and PPIs. The recommended changes to this class for the Medicaid PDL are the addition of Kapidex (or Dexilant) and the removal of Prevacid capsules and Prevacid Solutab. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented with Richard Carbray, Jr. seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that Aciphex, omeprazole OTC, Prevacid capsules, Prevacid OTC, Prilosec OTC, and Protonix suspension are preferred and Kapidex (or Dexilant), lansoprazole, Nexium capsules, Nexium suspension, omeprazole Rx, pantoprazole, Prevacid Solutab, Prilosec Rx, Prilosec suspension, and Protonix tablets are non-preferred. Richard Carbray, Jr. motioned to approve and accept Provider Synergies recommendations as presented for the ConnPACE/SAGA PDL with Larry Sobel seconding. The motion was passed unanimously. Kapidex (or Dexilant), Nexium capsules OFF Medicaid PDL: Aciphex, lansoprazole, Nexium suspension, omeprazole Rx, omeprazole OTC, pantoprazole, Prevacid capsules, Prevacid OTC, Prevacid Solutab, Prilosec OTC, Prilosec Rx, Prilosec suspension, Protonix tablets, Protonix suspension ON ConnPACE/SAGA PDL: Aciphex, omeprazole OTC, Prevacid capsules, Prevacid OTC, Prilosec OTC, Protonix suspension OFF ConnPACE/SAGA PDL: Kapidex (or Dexilant), lansoprazole, Nexium capsules, Nexium suspension, omeprazole Rx, pantoprazole, Prevacid Solutab, Prilosec Rx, Prilosec suspension, Protonix tablets Skeletal Muscle Relaxants Chris Andrews presented the evaluation and recommendation for this class. He noted that Amrix is now owned by Innoviant. There are no recommended changes to this class for the Medicaid PDL. Emmett Sullivan motioned to approve and accept Provider Synergies recommendations with Stella Cretella seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that baclofen, carisoprodol, carisoprodol compound, chlorzoxazone, cyclobenzaprine, and methocarbamol are preferred and Amrix, Dantrium, dantrolene, Fexmid, Flexeril, orphenadrine/orphenadrine compound, Parafon Forte, Robaxin, Skelaxin, Soma/Soma 250 mg, tizanidine, and Zanaflex/Zanaflex capsules are non-preferred. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented for the ConnPACE/SAGA PDL with Richard Carbray, Jr. seconding. The motion was passed unanimously. baclofen, carisoprodol, carisoprodol compound, chlorzoxazone, cyclobenzaprine, methocarbamol OFF Medicaid PDL: Amrix, Dantrium, dantrolene, Fexmid, Flexeril, orphenadrine/orphenadrine compound, Parafon Forte, Robaxin, Skelaxin, Soma/Soma 250 mg, tizanidine, Zanaflex/Zanaflex capsules ON ConnPACE/SAGA PDL: baclofen, carisoprodol, carisoprodol compound, chlorzoxazone, cyclobenzaprine, methocarbamol OFF ConnPACE/SAGA PDL: Amrix, Dantrium, dantrolene, Fexmid, Flexeril, orphenadrine/orphenadrine compound, Parafon Forte, Robaxin, Skelaxin, Soma/Soma 250 mg, tizanidine, Zanaflex/Zanaflex capsules

10 Stimulants and Related Agents Chris Andrews presented the evaluation and recommendation for this class. He noted that this is a new class being added to both PDLs. He also noted that Intuniv is indicated for the treatment of attention-deficit hyperactivity disorder (ADHD) in children ages Nuvigil is indicated to improve wakefulness in adult patients with excessive sleepiness associated with obstructive sleep apnea/hypopnea syndrome, narcolepsy, and shift work sleep disorder. Dr. Thompson reminded committee members about the recommendations for the treatment of ADHD provided by Dr. Daniel Connor and Dr. Sarah Schlegel and suggested adding Methylin chewable tablets and solution, Procentra, and Strattera. The recommendations for the Medicaid PDL are that amphetamine salts combination, amphetamine salts combination ER, Concerta, Daytrana, Desoxyn, dexmethylphenidate, dextroamphetamine, Focalin, Focalin XR, Intuniv, Metadate CD, methylphenidate, methylphenidate ER, Ritalin LA, and Vyvanse are preferred and Adderall, Adderall XR, Dexedrine, Methylin chewable tablets and solution, Nuvigil, Procentra, Provigil, Ritalin, Ritalin SR, and Strattera are non-preferred. Dr. Thompson motioned to approve and accept Provider Synergies recommendations with the addition of Methylin chewable tablets and solution, Procentra, and Strattera as preferred for the Medicaid PDL with Elizabeth Rodriguez seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that amphetamine salts combination, amphetamine salts combination ER, Desoxyn, dexmethylphenidate, dextroamphetamine, Focalin, Focalin XR, Metadate CD, methylphenidate, and methylphenidate ER are preferred and Adderall, Adderall XR, Concerta, Daytrana, Dexedrine, Intuniv, Methylin chewable tablets and solution, Nuvigil, Procentra, Provigil, Ritalin, Ritalin LA, Ritalin SR, Strattera, and Vyvanse are non-preferred. Dr. Einstein motioned to approve and accept Provider Synergies recommendations as presented for the ConnPACE/SAGA PDL with Richard Carbray, Jr. seconding. The motion was passed unanimously. amphetamine salts combination, amphetamine salts combination ER, Concerta, Daytrana, Desoxyn, dexmethylphenidate, dextroamphetamine, Focalin, Focalin XR, Intuniv, Metadate CD, Methylin chewable tablets and solution, methylphenidate, methylphenidate ER, Procentra, Ritalin LA, Strattera, Vyvanse OFF Medicaid PDL: Adderall, Adderall XR, Dexedrine, Nuvigil, Provigil, Ritalin, Ritalin SR ON ConnPACE/SAGA PDL: amphetamine salts combination, amphetamine salts combination ER, Desoxyn, dexmethylphenidate, dextroamphetamine, Focalin, Focalin XR, Metadate CD, methylphenidate, methylphenidate ER OFF ConnPACE/SAGA PDL: Adderall, Adderall XR, Concerta, Daytrana, Dexedrine, Intuniv, Methylin chewable tablets and solution, Nuvigil, Procentra, Provigil, Ritalin, Ritalin LA, Ritalin SR, Strattera, Vyvanse Ulcerative Colitis Agents Chris Andrews presented the evaluation and recommendation for this class. He noted that Dipentum is now owned by Alaven. The recommended changes to this class for the Medicaid PDL are the addition of Apriso and sfrowasa. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented with Larry Sobel seconding. The motion was passed unanimously. The recommendations for the ConnPACE/SAGA PDL are that Asacol, mesalamine enema, Pentasa, and sulfasalazine are preferred and Apriso, Azulfidine, balsalazide, Canasa, Colazal, Dipentum, Lialda, Rowasa, and sfrowasa are non-preferred. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented for the ConnPACE/SAGA PDL with Emmett Sullivan seconding. The motion was passed unanimously. Apriso, Asacol, Canasa, Lialda, mesalamine enema, Pentasa, sfrowasa, sulfasalazine OFF Medicaid PDL: Azulfidine, balsalazide, Colazal, Dipentum, Rowasa ON ConnPACE/SAGA PDL: Asacol, mesalamine enema, Pentasa, sulfasalazine OFF ConnPACE/SAGA PDL: Apriso, Azulfidine, balsalazide, Canasa, Colazal, Dipentum, Lialda, Rowasa, sfrowasa

11 Recommendations for next class reviews: Provider Synergies recommended the following classes be reviewed at the next P&T meeting: Alzheimer s Agents Analgesics, Narcotic Long Acting Analgesics, Narcotic Short Acting Angiotensin Modulators Anticoagulants, Injectable Anticonvulsants Antiparasitics, Topical Antiparkinson s Agents Atopic Dermatitis Beta Blockers Cytokine & CAM Antagonists Fibromyalgia Agents Hypoglycemics, Incretin Mimetics/Enhancers Hypoglycemics, TZDs Impetigo Agents, Topical Lipotropics, Other Lipotropics, Statins Multiple Sclerosis Agents Schedule next meeting: Committee members agreed on Thursday, June 3, 2010 for the next P & T meeting Meeting adjourned at 8:45pm