Beneficiary Advisory Panel Handout Uniform Formulary Decisions 25 March 2010
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1 Beneficiary Advisory Panel Handout Uniform Formulary Decisions 25 March 2010 PURPOSE: The purpose of this handout is to provide BAP Committee members with a reference document for the relative clinical effectiveness presentations for each Uniform Formulary () Class review 25 Mar 2010 Beneficiary Advisory Panel Meeting Page 1 of 13
2 Table 1: Uniform Formulary Recommendations from the Feb 2010 DoD P&T Committee meeting Basal Insulins Status / Implementation Period Brand Name (Generic) Basal Insulins Insulin glargine vials (Lantus) Formulary Insulin glargine pens (Lantus SoloStar) Insulin detemir vials (Levemir) Non-Formulary Insulin detemir pens (Levemir FlexPen) recommended for NF February 2010 implementation period 60 days Figure 1: Basal Insulins 25 Mar 2010 Beneficiary Advisory Panel Meeting Page 2 of 13
3 Table 2: Uniform Formulary Recommendations from the Feb 2010 DoD P&T Committee meeting Antihemophilic Factors Factor VIII and Factor IX concentrates Status / Implementation Period Factor type and Brand Name NF implementation period Factor VIII Koate DVI Kogenate FS Refacto Xyntha Factor IX Alphanine SD Benefix Factor VIII Monoclate P Hemofil M Recombinate Helixate FS Advate Factor IX Mononine 180 days Table 3: Recommendations from the Feb 2010 DoD P&T Committee meeting Antihemophilic Factors Factor VIII/vonWillebrand factor complexes, human Prothrombin Concentrate Complexes and Inhibitor Bypassing Products Status / Implementation Period Factor type and Brand Name Factor VIII/vonWillebrand Factor Complexes NF implementation period Alphanate Human Prothrombin Concentrate Complexes Profilnine SD Inhibitor Bypassing Products Novoseven RT Factor VIIII/vonWillebrand Factor Complexes Humate-P Human Prothrombin Concentrate Complexes Bebulin VH Inhibitor Bypassing Products Feiba VH 180 days 25 Mar 2010 Beneficiary Advisory Panel Meeting Page 3 of 13
4 Table 4: Utilization of Antihemophilic Factors in MHS (Unique Utilizers) Factor Unique Utilizers Factor Unique Utilizers Human factor VIII Human Factor IX Hemofil 1 Alphanine 0 Koate 2 Mononine 2 Monoclate 0 Recombinate IX Recombinate VIII Benefix 22 Advate 142 Factor VIII/vWF Helixate 7 Humate 0 Kogenate 30 Alphanate 1 Refacto 3 Human PCCs Recombinate 44 Bebulin 3 Xyntha 6 Profilnine 0 Inhibitor Bypassing Agents Novoseven 21 Feiba 6 25 Mar 2010 Beneficiary Advisory Panel Meeting Page 4 of 13
5 Table 5: Morphine ER/Naltrexone (Embeda): Uniform Formulary Recommendations from Feb 2010 for the Narcotic Analgesics Narcotic Analgesics Uniform Formulary High-potency single analgesic agents Long-acting agents (> 12 hour duration) Fentanyl transdermal system (Duragesic) patch Morphine sulfate ER 24 hr (Kadian, Avinza) cap No Morphine sulfate ER 12 hr (MS Contin, Oramorph) tab, soln, supp, inj Morphine sulfate ER/Naltrexone (Embeda) for Feb 2010 caps No Oxycodone ER (Oxycontin) tabs No Oxymorphone (Opana ER) tabs No Short acting agents (<12 hour duration) Codeine tabs, soln, inj Fentanyl citrate buccal (Fentora) tabs No Fentanyl citrate transmucosal (Actiq) lozenges Hydromorphone (Dilaudid) tab, inj, liquid, except for 1 mg tab Levorphanol (Levo-Dromoran) tab, inj Meperidine (Demerol) tab, soln, inj Meperidine / promethazine (Mepergan Fortis) caps Methadone (Dolophine) tab, oral conc, soln, inj Morphine sulfate IR tabs Opium tincture Opium / belladonna alkaloids supp Oxycodone IR caps, oral conc, soln Oxymorphone IR (Opana) tabs No High-potency combination agents Oxycodone /APAP (e.g., Percocet, Tylox, others) tab, cap, soln Oxycodone / ASA (Percodan) tabs Low potency single analgesic agents Buprenorphine (Buprenex) inj (excludes SL tabs) Butorphanol (Stadol) nasal spray, inj Pentazocine / naloxone (Talwin NX) tabs Propoxyphene (Darvon) caps, tabs Nalbuphine (Nubain ) not a controlled substance) Inj Tramadol IR(Ultram) not a controlled substance tab 25 Mar 2010 Beneficiary Advisory Panel Meeting Page 5 of 13
6 Table 5: Morphine ER/Naltrexone (Embeda): Uniform Formulary Recommendations from Feb 2010 for the Narcotic Analgesics (continued) Uniform Formulary Non-Formulary Low potency combination agents Codeine / APAP (Tylenol with codeine) tabs, elixir, oral susp Codeine / ASA tabs Codeine / ASA / carisoprodol (Soma) tabs Codeine / caffeine / butalbital / APAP (Fioricet with codeine) caps Codeine / caffeine / butalbital / ASA (Fiorinal with caffeine) caps, tabs Dihydrocodeine / caffeine / APAP e.g., Panlor DC, Panlor SS) caps, tabs Dihydrocodeine / caffeine / ASA (Synalgos-DC) caps Hydrocodone / APAP (e.g., Lortab, Lorcet, Vicodin, others) caps Pentazocine / APAP (Talacen) tabs Propoxyphene / APAP (Darvocet) tabs Propoxyphene / ASA / caffeine (Darvon Compound 65) caps Tramadol/APAP (Ultracet) not a controlled substance tab Low potency single analgesic agents Tramadol extended release (Ultram ER) tab No Tramadol extended release (Ryzolt) tab No High potentcy single analgesic agents; short-acting agents (<12 hours duration) Tapentadol (Nucynta) tab No Implementation Period Not Applicable for Embeda Figure 2: Narcotic Analgesics - Embeda 25 Mar 2010 Beneficiary Advisory Panel Meeting Page 6 of 13
7 Table 6: Guanfacine ER (Intuniv): Uniform Formulary Recommendations from Feb 2010 for the ADHD/Narcolepsy agents Attention Deficit Hyperactivity (ADHD) and Narcolepsy Agents Uniform Formulary Non-Formulary implementation period Narcolepsy Agents Modafinil (Provigil) Armodafinil (Nuvigil) Sodium Oxybate (Xyrem) ADHD Agents Non-Stimulants Atomoxetine (Strattera) Guanfacine ER (Intuniv) for Feb 2010 Stimulants Once daily use products Methylphenidate IR (Ritalin, Methylin, generics) Methylphenidate ER tablets (Concerta) Mixed amphetamine salts, ER (Adderall XR) Methylphenidate OROS (Concerta) Methylphenidate 30% IR/70% ER (Metadate CD) Methylphenidate SODAS (Ritalin LA) Mixed amphetamine salts ER (Adderall XR) Multiple daily use products Methylphenidate SR (Ritalin SR) Methylphenidate IR (Ritalin, generics) Mixed Amphetamine salts (Adderall, generics) Dexamphetamine IR (Dexedrine, Dextrostat, generics) Methamphetamine IR (Desoxyn, generics) Methylphenidate transdermal system (Daytrana) Dexmethylphenidate IR (Focalin) Dexmethylphenidate SODAS (Focalin XR) Lisdexamfetamine (Vyvanse) (November 2007) Not applicable for Intuniv 25 Mar 2010 Beneficiary Advisory Panel Meeting Page 7 of 13
8 Figures 3: ADHD Stimulant and Non-stimulant utilization Figures 4: ADHD Non-stimulant utilization - Intuniv 25 Mar 2010 Beneficiary Advisory Panel Meeting Page 8 of 13
9 Table 7: Aliskiren/Valsartan (Valturna) and Telmisartan/Amlodipine (Twynsta): Uniform Formulary Recommendations from Feb 2010 for the Renin Angiotensin Antihypertensives (RAAs) Renin Angiotensin Antihypertensives (RAAs) ARB /CCB / Diuretic Combinations Valsartan /amlodipine / hydrochlorothiazide (Exforge HCT) ARB /CCB Combinations Direct Renin Inhibitors & Combinations ARBs ACE Inhibitors ACE/CCB Combinations implementation period Non-Formulary Non-formulary Non-formulary NF Non-formulary Olmesartan / amlodipine (Azor) Valsartan / amlodipine (Exforge) Telmisartan/Amlodipine (Twynsta) for NF Feb 2010 Aliskiren hydrochlorothiazide (Tekturna HCT) Aliskiren (Tekturna) Aliskiren/Valturna (Valturna) for NF Feb 2010 Candesartan (Atacand) Candesartan /HCTZ (Atacand HCT) Losartan (Cozaar) Losartan/HCTZ (Hyzaar) Telmisartan (Micardis) Telmisartan/HCTZ (Micardis HCT) Candesartan (Atacand) Eprosartan (Teveten) Eprosartan/HCTZ (Teveten HCT) Irbesartan (Avapro) Irbesartan/HCTZ (Avalide) Olmesartan (Benicar) Olmesartan/HCTZ (Benicar HCT) Valsartan (Diovan) Valsartan/HCTZ (Diovan) Benazepril and combo with HCTZ (Lotensin, Lotensin HCT; generics) Captopril and combo with HCTZ (Capoten, Capozide; generics) Enalapril and combo with HCTZ (Vasotec, Vaseretic; generics) Fosinopril and combo with HCTZ (Monopril, Monopril HCT; generics) Lisinopril and combo with HCTZ (Prinivil, Zestril, Prinzide, Zestoretic; generics) Trandolapril (Mavik) Quinapril (Accupril) and combo with HCTZ (generics) Ramipril (Altace; generics)) Moexipril (Univasc) and combo with HCTZ (generics) Perindopril (Aceon) Quinapril (Accupril) and combo with HCTZ (generics) Ramipril (Altace; generics)) Amlodipine / benazepril (Lotrel; generics) Felodipine / enalapril (Lexxel) removed from market Verapamil sustained release / trandolapril (Tarka) 60 days for Twynsta and Valturna ACE: Angiotensin Converting Enzyme Inhibitor; ARB: Angiotensin Receptor Blocker; CCB: Calcium Channel Blocker; HCTZ: hydrochlorothiazide 25 Mar 2010 Beneficiary Advisory Panel Meeting Page 9 of 13
10 Figures 5: Renin Angiotensin Antihypertensives (RAAs) ARB/CCB Combos - Twynsta Figures 6: Renin Angiotensin Antihypertensives (RAAs) Direct Renin Inhibitors and combos - Valturna 25 Mar 2010 Beneficiary Advisory Panel Meeting Page 10 of 13
11 Table 8: Sublingual zolpidem (Edluar): Uniform Formulary Recommendations from Feb 2010 for the Newer sedative-hypnotic agents Newer Sedative-Hypnotic Agents Zolpidem Immediate Release (Ambien) Uniform Formulary Eszoplicone (Lunesta) Ramelteon (Rozerem) Zaleplon (Sonata) Non-Formulary Zolpidem ER (Ambien CR) Zolpidem sublingual (Edluar) for NF Feb days for Edluar implementation period Figure 7: Newer Sedative-Hypnotic agents- Edluar 25 Mar 2010 Beneficiary Advisory Panel Meeting Page 11 of 13
12 Table 9: Formulary Implementation Plan Summary February 2010 Meeting Drug Class Non-Formulary Medications Total Beneficiaries Affected (# of patients affected) Beneficiaries Affected by POS MTF Retail Mail Order Implementation Plan First Wednesday X days after the decision date Step Therapy Feb 10 Basal Insulins Insulin detemir pens (Levemir FlexPen) 11,782 3,510 6,226 2, days No Feb 10 Antihemophilic Factors Factor VIII: Advate, Helixate, Hemofil M, Monoclate, Recombinate Factor IX: Mononine; Factor VIII/vWF: Humate-P Human PCC: Bebulin VH Inhibitor bypassing product: Feiba VH days No Feb 10 Narcotic Analgesics Not applicable (Note: Embeda remains Uniform Formulary) N/A No Feb 10 ADHD drugs Not applicable (Note: Intuniv remains Uniform Formulary) N/A No Feb 10 RAAs Telmisartan/amlodipine (Twynsta) days No Feb 10 RAAs Aliskiren/valsartan (Valturna) days No Feb 10 Newer Sedative Hypnotics Zolpidem sublingual tablets (Edluar) days ; zolpidem IR tablets (Ambien generic) in front of step 25 Mar 2010 Beneficiary Advisory Panel Meeting Page 12 of 13
13 25 Mar 2010 Beneficiary Advisory Panel Meeting Page 13 of 13
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