Summary of all approved changes are posted under Materials section at

Transcription

1 Meeting called by: Pharmacy Services San Francisc Health Plan Pharmacy & Therapeutics Cmmittee Wednesday, Octber 18, :30AM 9:30AM 50 Beale St., 13 th Flr, San Francisc, CA James Glauber, MD Meeting Objective: Vte n prpsed frmulary and prir authrizatin(pa) criteria changes Type f meeting: Quarterly Minutes: Sheila Zen, CPhT (SFHP Pharmacy Analyst) Back-up: Andrew Cstinian, CPhT (SFHP Pharmacy Specialist) Attendees: Members Absent: Vting Members: James Glauber, MD (SFHP Chief Medical Officer) Rnald Ruggier, Pharm. D Shawn Hughtaling, Pharm. D Steven Wzniak, MD Jamie Ruiz, MD Linda Trung, Pharm. D Rbert (Brad) Williams, MD Ted Li, MD Maria Lpez, Pharm. D Jseph Pace, MD Lisa Ghtbi, Pharm. D (SFHP Directr f Pharmacy) Nichlas Jew, MD Others in Attendance:, Pharm. D (SFHP Pharmacist) Ralph Crwder, R.Ph (SFHP Pharmacist) Jessica Shst, Pharm. D (SFHP Pharmacist) Ken Trung, Pharm. D (SFHP Resident Pharmacist), Pharm. D (PerfrmRx Pharmacist) Patrick DeHratius, Pharm. D (PerfrmRx Pharmacist) Stephanie Rman, Pharm. D (Missin Wellness Resident) Yuna Sng (SFHP APPE- UCSF Student) Guests: Alan Kaska, MBA (Abbtt) Meeting Materials: Summary f all apprved changes are psted under Materials sectin at SFHP frmulary is lcated at SFHP prir authrizatin criteria are lcated at 1. Call t Order James Glauber The meeting was called t rder at 7:31 am. Cnflict f interest check Agenda verview 2. Infrmatinal Updates James Glauber Tpics: Health Hmes Health Care Services- Aggregated Quality scres Lcal Specialty pharmacy cntract wrapping up (Missin Wellness Pharmacy) Cnflict f Interest checked and instructins given. Intrductin agenda tpics dne.

2 3. Review and Apprval f July 18, 2018 P&T minutes (pp.5-15 f Octber 2018 P&T James Glauber The cmmittee apprved the minutes as presented. Review and Apprval f July 18, 2018 P&T Minutes 4. Discussin and Recmmendatin fr Change t SFHP Frmulary and Prir Authrizatin Criteria fr Select Drug Classes. Frmulary Maintenance Items: White Bld Cell Stimulant (pp f Octber 2018 P&T 5. Frmulary Maintenance Items: (NSAIDS) Nn-Steridal Anti- Inflammatry Drugs (pp f Octber 2018 P&T ****Adjurn t Clsed Sessin**** Clsed Sessin pursuant t Welfare and Institutins Cde Sectin (w) The fllwing drug classes were reviewed fr pertinent literature (including meta-analyses and pivtal clinical trials), guideline updates, and drug additins t r remvals frm market since last class review. Majr recmmendatins included the fllwing: (Medi-Cal, Healthy Kids HMO, Healthy Wrkers HMO) N Frmulary changes made Prir Authrizatin (PA) Criteria Recmmendatins: Updated White Bld Cell Stimulatrs criteria t include Nivestym and Fulphila as nn-frmulary Drug Utilizatin Review (DUR) Recmmendatins: (Medi-Cal, Healthy Kids HMO, Healthy Wrkers HMO & Healthy San Francisc) Added diclfenac ptassium t frmulary tier 1 and ketrlac t frmulary tier 1 with quantity limit t ensure apprpriate use Added age limit t naprxen suspensin t ensure apprpriate use in pediatrics Remved the fllwing tier 3 medicatins frm frmulary due t n utilizatin and lack f drug specific prir authrizatin criteria: melxicam ral suspensin ketprfen IR and ER capsules meclfenamate capsule mefenamic acid capsule tlmetin capsule and tablet fenprfen capsule Updated Tpical NSAIDs criteria t reflect current diclfenac 1% gel quantity limit The cmmittee asked that indmethacin ER capsule be 2 nd : Rnald Ruggier, Pharm. D Frmulary Maintenance Items: AWhite Bld Cell Stimulant Class Review 2 nd : Shawn Hughtaling, Pharm. D. Frmulary Maintenance Items: Apprved recmmendatins as presented with the additin f adding indmethacin ER capsule t frmulary. (NSAIDS) Nn-Steridal Anti-Inflammatry Drugs 2 nd : Shawn Hughtaling, Pharm. D.

3 6. Frmulary Maintenance Items: Infectius Disease: Anti-parisitics (pp f Octber 2018 P&T 7. Infectius Disease Systemic and Tpical Antibitics Class Review (pp f Octber 2018 P&T added t the frmulary after a brief discussin and added indmethacin ER capsule t frmulary due t sme use and prir authrizatin apprval rate. (Medi-Cal, Healthy Kids HMO, Healthy Wrkers HMO & Healthy San Francisc) Extended quantity limit f Albenza t reflect typical dsing fr intestinal rundwrms Added quantity limit t praziquantel tablet t reflect typical dsing fr tapewrms Remved Pin-X chewable tablet frm frmulary due t lack f utilizatin (bslete) and available alternatives Remved Pentam 300 IV slutin frm frmulary as it is a medical benefit drug The plan presented class reviews and recmmendatins fr Infectius Disease medicatins. Majr recmmendatins included the fllwing: (Medi-Cal, Healthy Kids HMO, Healthy Wrkers HMO & Healthy San Francisc) Remve prir authrizatin frm cefadrxil 500 mg capsule and maintain n frmulary tier 1 due t cst effectiveness Remve step therapy requirement frm vancmycin capsules and Firvanq suspensin and maintain n frmulary tier 1 with quantity limits t align with guideline recmmendatins Remve days supply limits frm amxicillinclavulanate due t lack f cncern fr veruse Add age limit, maximum f 12 years t the fllwing slutins, suspensins, and chewable tablets t align with ther liquid and chewable frmulatins n frmulary: amxicillin 125 mg/5 ml, 200 mg/ 5mL, 250 mg/5 ml, 400 mg/5 ml suspensin recnstituted amxicillin/clavulanate mg/5 ml ral suspensin penicillin V ptassium 125 mg/5 ml, 250 mg/5 ml suspensin amxicillin 125, 250 mg chewable tablet Frmulary Maintenance Items: Infectius Disease 2 nd : Shawn Hughtaling, Pharm. D. Infectius Disease Systemic and Tpical Antibitics Mtin: Shawn Hughtaling, Pharm. D. 2 nd : Rbert (Brad) Williams, MD

4 8. Infectius Disease Oral and Tpical Antifungals Class Review (pp f Octber 2018 P&T amxicillin/clavulanate , mg chewable tablet azithrmycin 100mg/5mL, 200mg/5mL suspensin recnstituted sulfamethxazle/trimethprim mg/5mL ral suspensin cephalexin 125mg/5mL, 250mg/5mL ral suspensin nitrfurantin 25mg/5mL ral suspensin Remve the fllwing medicatins frm frmulary and remve prir authrizatin due t lack f utilizatin and n prir authrizatin criteria: cefadrxil 250mg/5mL, 500mg/5mL suspensin recnstituted cefadrxil 1g tablet cefditren 200, 400mg tablet Remve Primsl (trimethprim) 50mg/5mL ral slutin frm tier 5, and maintain as nn-frmulary as it is n lnger listed n the Fee- Fr-Service Cntract Drug List Update criteria fr clstridium difficile infectins t reflect the frmulary changes fr vancmycin and Firvanq (Medi-Cal, Healthy Kids HMO, Healthy Wrkers HMO & Healthy San Francisc Remve ketcnazle 2% fam and Xlgel 2% gel frm frmulary and remve prir authrizatin due t lack f utilizatin and cst-effective alternatives available Infectius Disease Oral and Tpical Antifungals Class Review Mtin: Rnald Ruggier, Pharm. D 2 nd : Shawn Hughtaling, Pharm. D.

5 9. Infectius Disease Antiviral Class Review (pp f Octber 2018 P&T 10. Infectius Disease Immunizatins Abbreviated Review (pp f Octber 2018 P&T (Medi-Cal, Healthy Kids HMO, Healthy Wrkers HMO & Infectius Disease Healthy San Francisc) Add valganciclvir tablet t frmulary and require prir authrizatin t align with prir authrizatin criteria Systemic and Tpical Antibitics Remve age limit frm seltamivir 30mg capsule t Mtin: Shawn Hughtaling, Pharm. D. allw fr apprpriate renal dsing in adults 2 nd : Rbert (Brad) Williams, MD Add fill limit t seltamivir ral slutin t align with ther dsage frms, and apply max days supply limit per fill t ensure apprpriate use Add age limit t acyclvir suspensin t ensure apprpriate pediatric use Add quantity limits t famciclvir tablets t ensure apprpriate use: Kent Trung 125 mg: #2 tablets/day (max 1 tablet BID fr episdic/recurrent herpes in immuncmpetent patients) 250 mg: #3 tablets/day (max 1 tablet TID fr initial herpes episde) 500 mg: #4 tablets/day (max 2 tablets BID fr episdic/recurrent herpes) Remve rimantadine frm frmulary due t remval f (ACIP)Advisry Cmmittee n Immunizatin Practices recmmendatins and lack f ther indicatins Update valganciclvir criteria t include ral slutin (Medi-Cal): ; n active criteria Infectius Disease Immunizatins Abbreviated Review N changes therefre n vte 11. Hematlgy Erythrpietin Stimulating Agents Class Review (pp f Octber 2018 P&T The plan presented class reviews and recmmendatins fr Hematlgy medicatins. Majr recmmendatins included the fllwing: (Medi-Cal, Healthy Kids HMO and Healthy Wrkers HMO): Add Retacrit t frmulary tier 3 and require prir authrizatin t ensure apprpriate diagnsis Hematlgy Apprve recmmendatins as presented. Tpical Crticsterids Abbreviated Review Mtin: Jseph Pace, MD 2nd: Shawn Hughtaling, Pharm. D.

6 Update criteria t prefer bisimilar Retacrit ver alternatives 12. Hematlgy Thrmbcytpenia Class Review (pp f Octber 2018 P&T 13. Neurlgy Anticnvulsants Class Review (pp f Octber 2018 P&T (Medi-Cal, Healthy Kids HMO and Healthy Wrkers HMO): Update Thrmbpietin Receptr Agnists criteria: Prefer Prmacta based n range f indicatins and cmparative csteffectiveness Include Tavalisse as secnd-line after TPA Include Dptelet and Mulpleta listed as nn-frmulary, preferring Mulpleta ver Dptelet fr thrmbcytpenia assciated with chrnic liver disease in patients requiring elective prcedures The plan presented a class review and recmmendatins fr Neurlgy medicatins. Majr recmmendatins included the fllwing: (Medi-Cal, Healthy Kids HMO, Healthy Wrkers HMO and Healthy San Francisc): Remve quantity limits frm Dilantin 30 mg ER capsule and divalprex 125 mg DR sprinkles t align with ther anticnvulsants due t lack f safety cncerns and t allw titratin Add age restrictin, limiting t members 12 years f age r yunger t the fllwing medicatins, t align with ther nn-slid dsage frmulatins n frmulary: ethsuximide 250 mg/5 ml slutin phenytin 50 mg chewable tablet carbamazepine 100 mg chewable tablet phenbarbital 25 mg/5 ml elixir Remve the fllwing medicatins frm frmulary due t lack f utilizatin and/r requests: Peganne 250 mg tablet Lamtrigine IR dse packs Celntin 300 mg capsule Phenytin 50 mg/5 ml vial (medical benefit) Hematlgy Apprve recmmendatins as presented. Thrmbcytpenia Class Review Mtin: Rnald Ruggier, Pharm. D 2nd: Jseph Pace, MD Neurlgy Apprve recmmendatins as presented with the additin f increasing the age restrictin t 16 years f age r yunger. Anticnvulsants Class Review Mtin: Rbert (Brad) Williams, MD 2nd: Maria Lpez, Pharm. D.

7 14. Pain Nn-Opiid Pain Management Class Review (pp f Octber 2018 P&T 15. Rheumatlgy Olumiant (baricitinib) Mngraph (pp f Octber 2018 P&T Banzel 40 mg/ml ral suspensin ; n active criteria The cmmittee has determined t increase the recmmended age restrictin fr nn-slid frmulatins f anticnvulsants t 16 years frm 12 years t accunt fr develpmental delay in members with epilepsy. Kent Trung The plan presented a class review and recmmendatins fr a Pain medicatin. Majr recmmendatins are listed belw. (Medi-Cal, Healthy Kids HMO, Healthy Wrkers HMO): Add the fllwing t frmulary tier 1 due t sme utilizatin and cst-effectiveness: pramxine 1% ltin lidcaine 4% cream, with quantity limit f #60/30 days t align with ther frmulary ptins Add age limit, maximum age f 12 years, t gabapentin 250 mg/5 ml slutin t align with ther liquid frmulatins and allw apprpriate pediatric use Remve gabapentin 250 mg/5 ml unit dse slutin frm frmulary due t lack f utilizatin Update Lyrica criteria t include extended release frmulatin quantity limit After discussin the cmmittee determined t add OTC lidcaine 4% patch t the frmulary and change frm prir authrizatin needed t step therapy fr Lyrica (requiring gabapentin). The plan presented a mngraph with recmmendatins fr Rheumatlgy medicatins. Majr recmmendatins are listed belw. (Medi-Cal, Healthy San Francisc and Medicare/Medi-Cal) Maintain Olumiant as nn-frmulary Update Disease Mdifying Bilgics criteria t include Olumiant as nn-frmulary Pain Apprve recmmendatins as presented with the additin t add OTC Lidcaine patch t the frmulary and change frm prir authrizatin t step therapy fr Lyrica. Nn-Opiid Pain Management Class Review Mtin: Linda Trung, Pharm. D 2 nd : Rnald Ruggier, Pharm. D Rheumatlgy Olumiant (baricitinib) Mngraph Apprve recmmendatins as presented. 2 nd : Shawn Hughtaling, Pharm. D.

8 16. Tpical Antiseptics Abbreviated Review (pp f Octber 2018 P&T 17. Fllw-up Item Prbitics Review (pp f Octber 2018 P&T 18. Fllw-up Item Drug Utilizatin Review (DUR) (Presenter prvider a handut t cmmittee) Jessica Shst The plan presented an abbreviated class review with recmmendatins fr Tpical medicatins. Majr recmmendatins are listed belw. (Medi-Cal, Healthy San Francisc and Medicare/Medi-Cal) The plan presented a class review with recmmendatins fr Prbitics medicatins. Majr recmmendatins are listed belw. (Medi-Cal and Healthy San Francisc) Cnsider adding the fllwing prbitic prducts t frmulary based n utilizatin, lw cst, and available literature: saccharmyces bulardii (Flrastr )(tier 1) Culturelle (lactbacillus rhamnsus GG[LGG]) (tier 2) Cnsider adding VSL#3 t frmulary tier 3 based n guideline recmmendatins and utilizatin, with prir authrizatin t ensure apprpriate diagnsis (Medi- Cal nly) Update Acidphilus criteria t address all prbitic requests The cmmittee discussed and agreed t add pediatric frmulatin Culturelle Kids as well as adult dsing. DUR Prgram Updates SFHP DUR Fllw-up Impact Analysis n the 7-day Limit n Initial Opiid prescriptins 5/17/18-8/17/2018 Tpical Antiseptics Abbreviated Review N changes therefre n vte Fllw-up Item Apprve recmmendatins as presented. Prbitics Review Mtin: Rnald Ruggier, Pharm. D 2 nd : Maria Lpez, Pharm. D. Nn-vting item ****RECONVENE IN OPEN SESSION**** 19. Summary f Clsed Sessin James Glauber Recnvened Open sessin arund 9:05 am Nn-vting item 20. Annual Pharmacy Plicies and Prcedures (P&Ps) Review (pp Octber 2018 P&T Ralph Crwder The plan presented changes t the Pharmacy Plicy and Prcedures (P&P) fr P&T cmmittee annual review and apprval: Annual Pharmacy Plicy and Prcedure Review Apprve recmmendatins as presented.

9 21. Review and Apprval f Prir Authrizatin Criteria Interim Changes (pp Octber 2018 P&T Pharm-03: Oversight f Delegated Pharmacy Prvider Credentialing Prcess Credentialing Dcument Changes: Nne 2 nd : Jseph Pace, MD Pharm-09: Drug Recalls and Safety Withdrawals - Pharmaceutical Patient Safety Updates: the plicy statement t specify cmpliance with regulatry and quality standards and timely ntificatin and tracking and the prcedure regarding respnsibility PBM, SFHP (Pharmacy, Marketing, Prvider Relatins and Custmer Service) departments in identifying recalls and actins, ntificatin f pssibly affected members, prviders and pharmacies as well as addressing calls SFHP may receive regarding ntificatin. Added HMO t Healthy Kids & Wrkers lines f business (LOBs) fr rebranding, affected parties within SFHP (Marketing, Prvider Relatins and Custmer Service) and related quality standard f frm NCQA. Rewrding the mnitring prcess and the definitin f Market Withdrawal. Pharm-10: PGY1 Managed Care Pharmacy Residency Prgram Dcument Changes: Nne Pharm-11: Member Reimbursements fr Pharmacy Services Added HMO t Healthy Kids & Wrkers lines f business (LOBs) fr rebranding. Update prcedures fr the Claim Submissin Prcess nting that the member reimbursement is dcumented thrugh the PBM case review system and that all requests will be reviewed if dcumentatin is less than 1 year ld and thse greater will be cnsidered based n circumstances. Fr the Payment Determinatin Prcess nting that apprvals are placed in the PBM case management system and checks are requested by the PBM frm the claims prcessr which the detail is dcumented in the check stub. Decisins may take up t 30 days f the request submissin. The plan presented Prir Authrizatin interim changes f (New Criteria, Revised Existing Criteria & a table f criteria that were evaluated per the Annual review prcess where n clinical changes were mad) fr review and apprval that will be implemented n 8/20/2018: Review and Apprval f Prir Authrizatin Criteria Interim Changes Apprve recmmendatins as presented. 2 nd : Jseph Pace, MD

10 The plan presented interim frmulary changes and frmulary status fr new drugs t market. 22. Review and Apprval f Interim Frmulary Changes and Frmulary Placement fr New Drugs t Market (pp f Octber 2018 P&T 23. Infrmatinal Update n New Develpments in the Pharmacy Market (pp f Octber 2018 P&T The plan prvided infrmatin n new develpments in the pharmacy market. (Fr detail f changes, please see pages f P&T packet.) 24. Adjurnment James Glauber The meeting adjurned at 9:25 am P&T Cmmittee Meeting dates are: Wednesday, January 16, 2019 Wednesday, April 17, 2019 Wednesday, July 17, 2019 Wednesday, Octber 16, 2019 Respectfully submitted by: Review and Apprval f Interim Frmulary Changes and Frmulary Placement fr New Drugs t Market Apprve recmmendatins as presented. Mtin: Jseph Pace, MD 2 nd : Rbert (Brad) Williams, MD Nn-vting item Nvember 6, James Glauber, MD, MPH Chief Medical Officer Date