Covered California Formulary Analysis of Top 100 Drugs and Select Classes Prepared for the California HealthCare Foundation Avalere.
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1 Covered California Formulary Analysis of Top 100 Drugs and Select Classes Prepared for the California HealthCare Foundation 2015 Avalere.com
2 About the Researchers ABOUT THE CALIFORNIA HEALTHCARE FOUNDATION The California HealthCare Foundation (CHCF) works as a catalyst to fulfill the promise of better health care for all Californians. CHCF supports ideas and innovations that improve quality, increase efficiency, and lower the costs of care. ABOUT AVALERE HEALTH Avalere is a strategic advisory firm dedicated to solving the challenges of the healthcare system. It delivers a comprehensive perspective, compelling substance, and creative solutions to stakeholders from across the full healthcare spectrum to help improve care delivery through better data, insights, and strategies. 2
3 Table of Contents Overview and Methodology Commonly Used Drugs (Top 100) Analysis Class-Level Analysis o Findings Across Classes o Findings By Therapeutic Area HIV/AIDS Mental Health Diabetes Immunology Asthma/ COPD Appendix and Glossary 3
4 Study Overview Objective The study analyzed formulary inclusion for 100 commonly utilized brand name and generic drugs and 11 drug classes representing certain medical conditions in unique qualified health plans offered in the 2014 Covered California market compared to select employer plans. Formulary features examined included listing, tier placement, and utilization management. Two Analyses of Focus Top 100 Drug Analysis: The analysis focused on 100 commonly utilized drugs by a commercial population, as compiled by Symphony Health based on 2014 data (through early May). 1 Drug Class List Analysis: For products within the 11 selected classes, Avalere collected data on all drug names available in the US market at the time of the study, including brands and generics, immediate release and extended release, and combination products. 1. Symphony Health collects data from commercially insured consumers to drive analytics of physician prescribing and pharmacy fulfillment 4
5 Methodology Methodology 1 Each single-source brand drug, including multiple formulations, is counted as a single distinct chemical entity. Where multiple versions of the same drug exist i.e., legally substitutable, generics and the corresponding brand data are reported only for the drug that is placed on the lower tier. The study compared 2014 Covered California formularies to the group formularies from the top four fully-insured carriers in California, plus the CALPERS preferred drug list that covers state employees. Limitations The findings of this study rely on publicly available formulary documents as of May 2014, which vary in format, comprehensiveness, and accuracy across carriers. Due to the ever evolving nature of coverage policies and the lag time in updating public documents, the formularies reviewed in this study may not reflect the most up-to-date prescription drug benefits for the plans analyzed. The analysis focused on pharmacy benefit drugs and excluded over-the-counter medications and medical benefit drugs. 1. A more detailed methodology description is available in the full report entitled Disease Matters: Comparing Prescription Drug Benefits in Covered California Plans available at 5
6 Top 100 Drug Analysis, income level/subsidy eligibility, and plan selection. Importantly, most consumers are eligible for advance payment tax credits or cost sharing reductions that provide substantial premium support Younger and and healthier reduce consumers, healthcare as well as those costs with for relatively this limited population. drug needs, often select health coverage based on premium price and access to other health services. However, their ability to obtain affordable commonly used medications when needed is vital to maintaining good health. Ninety of the top 100 most commonly prescribed drugs, such as those used to treat high blood pressure, high cholesterol, and acid reflux, are generics and they are widely included on Covered California formularies with low cost sharing.
7 Exchange Formulary Breadth for Commonly Used Generics Is Similar to Select Employer Plans, Slightly Less Generous for Brands PERCENTAGE OF BRANDS LISTED, % 12% 82% 88% TOP 100 DRUGS GENERICS VS. BRAND CA Exchange Plans CA Employer Plans Brand Not Listed PERCENTAGE OF GENERICS LISTED, % 6% % 94% 9 CA Exchange Plans CA Employer Plans Generic Not Listed Generics Brands 7
8 Most Commonly Used Drugs Are Placed on the Generic Tier, Which Is Not Surprising Given the Drug List Composition DISTRIBUTION OF TIER PLACEMENT FOR TOP 100 DRUGS, AMONG LISTED DRUGS, 2014 Exchange Plans 1% 2% 4% 5% Employer Plans 6% 0.4% 3% 1% 88% 89% $0 Tier Generic Preferred Brand Non-preferred Brand Specialty 8
9 Exchange Plans Place Commonly Used Brand Therapies on Higher Tiers than Employer Plans DISTRIBUTION OF TIER PLACEMENT FOR TOP 100 DRUGS, AMONG LISTED BRAND DRUGS, 2014 Exchange Plans Employer Plans 6% 8% 5% 23% 11% 26% 49% 61% $0 Tier Generic Preferred Brand Non-preferred Brand Specialty 9
10 Employer and Exchange Plans Use Similar Rates of UM for Commonly Used Generics; PA Required More Often for Brands DISTRIBUTION OF UM TOP 100 DRUGS, AMONG LISTED DRUGS, 2014 Employer (All Drugs) 96% 4% Exchange (All Drugs) 94% 6% Employer (Brands Only) 8 Exchange (Brands Only) 72% 28% No PA/ST PA/ST PA Prior Authorization ST Step Therapy UM Utilization Management 10
11 Formulary Analysis by Therapeutic Area: Cross-Class Summary, income level/subsidy eligibility, and plan selection. Importantly, most consumers are eligible for advance payment tax credits or cost sharing reductions that provide substantial premium support While commonly and used reduce drugs healthcare are broadly included costs on plan for formularies this population. with low cost sharing, some patients with chronic diseases or those who rely on specialty drugs may face more access and affordability challenges. For some medications, specialty tiers and tight utilization management can lead to higher out-of-pocket costs or barriers to obtaining necessary drugs in a timely manner. The following section summarizes drug coverage in 2014 Covered California plans for products used to treat medicationdependent chronic conditions.
12 Categories and Classes of Analyzed Drugs, 2014 DISEASE STATE USP CATEGORY USP CLASS ABBREVIATION HIV/AIDS Antivirals Anti-HIV agents, non-nucleoside reverse NNRTIs transcriptase inhibitors Anti-HIV agents, nucleoside and nucleotide reverse transcriptase inhibitors Anti-HIV agents, protease inhibitors Anti-HIV agents, other NRTIs PIs HIV-Other Mental Health Antidepressants Serotonin/ Norepinephrine reuptake SNRIs inhibitors Antipsychotics 2 nd generation/ atypical Atypicals Diabetes Blood Glucose Regulators Antidiabetic agents Insulins Antidiabetics Insulins Immunology Immunological Agents Immune suppressants Immunosup COPD/Asthma Respiratory Tract Agents Bronchodilators, Sympathomimetic Anti-inflammatories, Inhaled Corticosteroids B 2 agonists ICS 12
13 On Average, Across the Classes, 8 of Drugs Are Listed on Exchange Plan Formularies 2014 EXCHANGE PLAN FORMULARIES NUMBER OF CHEMICAL ENTITIES LISTED, BY CLASS Antidiabetics Insulins HIV/AIDS Mental Health Immunology Asthma/COPD Maximum Listed Minimum Listed Average Listed Employer Average Antidiabetics - Antidiabetic agents; Atypicals - 2nd generation/ atypical; B2 agonists -Bronchodilators, Sympathomimetic; ICS -Antiinflammatories, Inhaled Corticosteroids; NNRTIs - Anti-HIV agents, non-nucleoside reverse transcriptase inhibitors ; NRTIs - Anti-HIV agents, nucleoside and nucleotide reverse transcriptase inhibitors; PIs - Anti-HIV agents, protease inhibitors; SNRIs - Serotonin/ Norepinephrine reuptake inhibitors Diabetes 13
14 PERCENTAGE OF CHEMICAL ENTITIES, BY CLASS HIV Drugs and Immunology Medicines Are Placed on Higher Tiers in Exchange Plans than in Employer Plans AVERAGE PERCENTAGE OF CHEMICAL ENTITIES LISTED ON NON-PREFERRED BRAND OR SPECIALTY TIER, BY CLASS, 2014 HIV/AIDS Mental Health Diabetes Immunology Asthma/COPD Exchange Average Employer Average Antidiabetics - Antidiabetic agents; Atypicals - 2nd generation/ atypical; B2 agonists -Bronchodilators, Sympathomimetic; ICS -Antiinflammatories, Inhaled Corticosteroids; NNRTIs - Anti-HIV agents, non-nucleoside reverse transcriptase inhibitors ; NRTIs - Anti-HIV agents, nucleoside and nucleotide reverse transcriptase inhibitors; PIs - Anti-HIV agents, protease inhibitors; SNRIs - Serotonin/ Norepinephrine reuptake inhibitors 14
15 PERCENTAGE OF CHEMICAL ENTITIES, BY CLASS Mental Health, Immunology, and HIV Drugs Face Greater UM in Exchange Plans Compared to Employer Plans 5 45% 4 35% 3 25% 15% 5% AVERAGE PERCENTAGE OF LISTED CHEMICAL ENTITIES SUBJECT TO UM IN EXCHANGE AND EMPLOYER PLANS, BY CLASS, 2014 HIV/AIDS Mental Health Diabetes Immunology Asthma/COPD Exchange Average Employer Average Antidiabetics - Antidiabetic agents; Atypicals - 2nd generation/ atypical; B2 agonists -Bronchodilators, Sympathomimetic; ICS -Antiinflammatories, Inhaled Corticosteroids; NNRTIs - Anti-HIV agents, non-nucleoside reverse transcriptase inhibitors ; NRTIs - Anti-HIV agents, nucleoside and nucleotide reverse transcriptase inhibitors; PIs - Anti-HIV agents, protease inhibitors; SNRIs - Serotonin/ Norepinephrine reuptake inhibitors UM Utilization Management 15
16 Formulary Analysis by Therapeutic Area: HIV/AIDS Summary, income level/subsidy eligibility, and plan selection. Importantly, most consumers are eligible for advance payment tax credits or cost sharing reductions that provide substantial premium support Most individuals and with reduce HIV/AIDS healthcare rely on a combination costs of for several this antiretroviral population. medications to reduce their viral load, limit symptoms, and improve immune system function. A singletablet regimen (STR) contains several different drugs in one tablet and can reduce pill burden for patients. If HIV/AIDS patients have difficulty accessing their prescribed therapies, they may interrupt their treatment, which could lead to drug resistance and increased risk of spreading the disease.
17 HIV/AIDS Medications Appear on Specialty Tier More Often in Exchange Plans than in Employer Plans DISTRIBUTION OF TIER PLACEMENT IN EXCHANGE AND EMPLOYER PLANS, LISTED HIV/AIDS 1 CHEMICAL ENTITIES, 2014 DISTRIBUTION OF TIER PLACEMENT Exchange 14% 53% 7% 27% Employer 17% 69% 13% 1% Generic Preferred Brand Non-preferred Brand Specialty 1. Includes Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), Nuceloside and Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Protease Inhibitors (PIs), and HIV-Other (Enfuvirtide, Maraviroc, and Raltegravir) 17
18 Exchange Plans Employ UM Three Times More Often than Employer Plans for HIV/AIDS Medications DISTRIBUTION OF UM IN EXCHANGE AND EMPLOYER PLANS, LISTED HIV/AIDS 1 CHEMICAL ENTITIES, % 4% DISTRIBUTION OF UM % 96% Exchange Employer No PA/ST PA/ST 1. Includes Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), Nuceloside and Nucleotide Reverse Transcriptase Inhibitors (NRTIs), Protease Inhibitors (PIs), and HIV-Other (Enfuvirtide, Maraviroc, and Raltegravir) PA Prior Authorization ST Step Therapy UM Utilization Management 18
19 Fewer STRs Are Listed in Exchange Formularies Compared to Other NNTRIs and Placed on Higher Tiers than in Employer Plans EXCHANGE PLANS, 2014 EMPLOYER PLANS, 2014 DISTRIBUTION OF TIER PLACEMENT, LISTED NNRTIs % 24% 4% 35% 2% 25% 9% 64% Single-Tablet Regimens All Other Single Source NRTIs % 13% 8 5% 95% Single-Tablet Regimens All Other Single Source NRTIs Generic Preferred Brand Non-preferred Brand Specialty Not Listed analyzing exchange plan features. Additionally, Avalere analyzed select employer plan formularies NRTI = Nucleoside and Nucleotide Reverse Transcriptase Inhibitors STR = Single Tablet Regimen 19
20 Similarly, STRs Face Stricter UM in Exchange Plans Compared to Employer Plans Where UM is Rare EXCHANGE PLANS, 2014 EMPLOYER PLANS, % 17% % DISTRIBUTION OF UM, LISTED NNRTIs % 52% 82% % 10 Single-Tablet Regimens All Other Single Source NNRTIs Single-Tablet Regimens All Other Single Source NNRTIs No PA/ST PA & ST Not Listed NRTI = Nucleoside and Nucleotide Reverse Transcriptase Inhibitors STR = Single Tablet Regimen PA Prior Authorization ST Step Therapy UM Utilization Management 20
21 Formulary Analysis by Therapeutic Area: Mental Health Summary, income level/subsidy eligibility, and plan selection. Importantly, most consumers are eligible for advance payment tax credits or cost sharing reductions that provide substantial premium support Consumers and with mental reduce health healthcare diagnoses like costs depression, for anxiety, this population. or schizophrenia often rely on medications to manage their condition. Some patients may respond to one drug better than another, and understanding their prescription drug access is very important to ensure medication adherence.
22 Majority of Mental Health Medicines Appear on Generic Tiers in Both Exchange and Employer Plans DISTRIBUTION OF TIER PLACEMENT IN EXCHANGE AND EMPLOYER PLANS, MENTAL HEALTH 1 LISTED CHEMICAL ENTITIES, 2014 DISTRIBUTION OF TIER PLACEMENT Exchange 63% 28% Employer 6 14% 26% Generic Preferred Brand Non-preferred Brand Specialty 1. Includes 2nd Generation/Atypical and SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors) 22
23 Mental Health Drugs Require Prior Authorization Twice as Often in Exchange Compared to Employer Plans DISTRIBUTION OF UM DISTRIBUTION OF UM IN EXCHANGE AND EMPLOYER PLANS, LISTED MENTAL HEALTH 1 MEDICINES, % 78% 9% 91% Exchange Employer No PA/ST PA/ST 1. Includes 2nd Generation/Atypical and SSRIs/SNRIs (Selective Serotonin Reuptake Inhibitors/Serotonin and Norepinephrine Reuptake Inhibitors) PA Prior Authorization ST Step Therapy UM Utilization Management 23
24 Formulary Analysis by Therapeutic Area: Diabetes Summary, income level/subsidy eligibility, and plan selection. Importantly, most consumers are eligible for advance payment tax credits or cost sharing reductions that provide substantial premium support Diabetes is and a chronic reduce and often healthcare progressive disease costs that for is primarily this population. self-managed. Adequate and affordable access to antidiabetic therapies is important in order to prevent or delay the onset of complications.
25 Diabetes Medicines Tend to Be Placed on Generic or Brand Tiers in Both Exchange and Employer Plans DISTRIBUTION OF TIER PLACEMENT IN EXCHANGE AND EMPLOYER PLANS, LISTED DIABETES 1 CHEMICAL ENTITIES, 2014 DISTRIBUTION OF TIER PLACEMENT Exchange 27% 53% Employer 22% 5 28% Generic Preferred Brand Non-preferred Brand Specialty 1. Includes Antidiabetics and Insulins 25
26 Most Plans Grant Fairly Open Access for Most Diabetic Medicines; UM Slightly More Common in Exchange Plans DISTRIBUTION OF UM IN EXCHANGE AND EMPLOYER PLANS, LISTED DIABETES 1 CHEMICAL ENTITIES, % 12% DISTRIBUTION OF UM % 88% Exchange Employer No PA/ST PA/ST 1. Includes Antidiabetics and Insulins PA Prior Authorization ST Step Therapy UM Utilization Management 26
27 Newer Antidiabetic Therapies Are Included on Formularies Less Frequently in the Exchanges than in Employer Plans EXCHANGE PLANS, 2014 EMPLOYER PLANS, 2014 DISTRIBUTION OF TIER PLACEMENT % 2% 19% New Generation Antidiabetics 32% 11% 5% 51% Older Antidiabetics % 36% 33% New Generation Antidiabetics 22% 15% 9% 54% Older Antidiabetics Generic Preferred Brand Non-preferred Brand Specialty Not Listed 27
28 Newer Antidiabetic Drugs Require Prior Authorization More Often Compared to Other Drugs in the Class in Both Markets EXCHANGE PLANS, 2014 EMPLOYER PLANS, DISTRIBUTION OF UM % 23% 32% 58% % 33% 22% 5% 73% 36% 18% New Generation Antidiabetics Older Antidiabetics New Generation Antidiabetics Older Antidiabetics No PA/ST PA & ST Not Listed PA Prior Authorization ST Step Therapy UM Utilization Management 28
29 Formulary Analysis by Therapeutic Area: Immunology Summary, income level/subsidy eligibility, and plan selection. Importantly, most consumers are eligible for advance payment tax credits or cost sharing reductions that provide substantial premium support Immunological and drugs reduce work by healthcare suppressing the costs immune for system this in order population. to treat autoimmune conditions like rheumatoid arthritis (RA), Crohn s disease, and psoriasis, as well as to prevent organ rejection after transplants. Many immunosuppressants are biologic drugs genetically engineered in a living system, like plant or animal cells, which means their production process is more complex and expensive. Due to their high cost, drugs in the immunology class are often tightly managed by health plans.
30 Immune Suppressants, When Listed, Most Commonly Appear on Specialty Tier Among Exchange Plans DISTRIBUTION OF TIER PLACEMENT IN EXCHANGE AND EMPLOYER PLANS, LISTED IMMUNE SUPPRESSANTS, 2014 DISTRIBUTION OF TIER PLACEMENT Exchange 28% 15% 16% 42% Employer 38% 25% 22% 15% Generic Preferred Brand Non-preferred Brand Specialty 30
31 Almost Half of Immune Suppressants Are Subject to Prior Authorization in the Exchange Plans 10 DISTRIBUTION OF UM IN EXCHANGE AND EMPLOYER PLANS, LISTED IMMUNE SUPPRESSANTS, 2014 DISTRIBUTION OF UM % 55% 29% 71% Exchange Employer No PA/ST PA/ST PA Prior Authorization ST Step Therapy UM Utilization Management 31
32 Biologic Immune Suppressants Are More Frequently Placed on Specialty Tiers in Exchange Plans than Employer Plans EXCHANGE PLANS, 2014 EMPLOYER PLANS, 2014 DISTRIBUTION OF TIER PLACEMENT % 6% 13% 48% Non-Biologics 5% 78% 12% 5% Biologics % 7% 17% 63% Non-Biologics 37% 33% Biologics Generic Preferred Brand Non-preferred Brand Specialty Not Listed 32
33 Biologic Immune Suppressants More Frequently Subject to PA in Exchange Plans Compared to Employer Plans EXCHANGE PLANS, 2014 EMPLOYER PLANS, % % DISTRIBUTION OF UM % % 57% 33% Non-Biologics 6% Biologics Non-Biologics Biologics No PA/ST PA & ST Not Listed PA Prior Authorization ST Step Therapy UM Utilization Management 33
34 Formulary Analysis by Therapeutic Area: Asthma/COPD Summary, income level/subsidy eligibility, and plan selection. Importantly, most consumers are eligible for advance payment tax credits or cost sharing reductions that provide substantial premium support Chronic obstructive and reduce pulmonary healthcare disease (COPD) costs and asthma for this are chronic population. respiratory conditions. Reliable and affordable access to medications is particularly important for consumers who need to control and prevent exacerbations that can be life-threatening.
35 Majority of Asthma/COPD Medicines Appear on Preferred Brand Tier in Both Exchange and Employer Formularies DISTRIBUTION OF TIER PLACEMENT Exchange Employer DISTRIBUTION OF TIER PLACEMENT IN EXCHANGE AND EMPLOYER PLANS, LISTED ASTHMA/COPD 1 CHEMICAL ENTITIES, % 37% % 48% 16% 19% Generic Preferred Brand Non-preferred Brand Specialty 1. B2 Agonists = Bronchodilators, Sympathomimetic; ICS = Anti-inflammatories, Inhaled Corticosteroids COPD = Chronic Obstructive Pulmonary Disease 35
36 Access to Asthma/COPD Medicines Largely Unrestricted, UM Is More Common in Exchange Plans DISTRIBUTION OF UM IN EXCHANGE AND EMPLOYER PLANS, LISTED ASTHMA/COPD 1 CHEMICAL ENTITIES, % DISTRIBUTION OF UM % 99% Exchange Employer No PA/ST PA/ST 1. B2 Agonists = Bronchodilators, Sympathomimetic; ICS = Anti-inflammatories, Inhaled Corticosteroids COPD = Chronic Obstructive Pulmonary Disease PA Prior Authorization ST Step Therapy UM Utilization Management 36
37 Appendix and Glossary, income level/subsidy eligibility, and plan selection. Importantly, most consumers are eligible for advance payment tax credits or cost sharing reductions that provide substantial premium support and reduce healthcare costs for this population.
38 Glossary Formulary Tiers: Health plans array drugs on tiers that link to consumer cost sharing, providing financial incentives for consumers to select lower-cost drugs. o Tier $0: Formulary tier for drugs (typically generics) covered with no cost-sharing. 1 o Generic Tier: Lowest formulary tier (Tier 1), usually with lowest cost-sharing and fewest limits on access. o Preferred Brand Tier: Tier 2, usually with higher cost-sharing and more UM than Tier 1. o Non-Preferred Brand Tier: Tier 3, usually with higher cost-sharing and more UM than Tier 2. o Specialty Tier: Highest formulary tier (4 or higher), often subject to high cost-sharing and UM. Utilization Management (UM): Procedures required by health plans or pharmacy benefit managers that govern consumer access to drugs. o Prior Authorization (PA): Requirement that a health plan or pharmacy benefit manager reviews requests for certain medicines, on an individual patient basis, before granting coverage. o Step Therapy (ST): Requirement that, before accessing a prescribed drug, patients try and fail on at least one alternative drug. o Other UM: Requirements such as restrictions on coverage due to patient age, limits on quantity dispensed, and dose optimization. Biologic drugs: Biologics are very large, complex molecules or mixtures of molecules manufactured in or extracted from biological sources, unlike traditional prescription pills that are synthesized from chemicals. Single Tablet Regimens (STRs) for HIV/AIDS: A combination of oral antiretroviral therapies from at least two different classes to keep the HIV virus from developing resistance. 1. ACA requires coverage of U.S. Preventive Services Task Force A & B Recommendation medications and FDA-approved prescription and over-the-counter (OTC) contraceptive methods for women at 10, without charging a copayment, co-insurance or deductible, when prescribed by a healthcare professional and filled at a network pharmacy 38
39 U.S. Pharmacopeial Convention (USP) Drug Class Definitions HIV/AIDS Non-nucleoside Reverse Transcriptase Inhibitors: NNRTIs are non-nucleoside analogues that inhibit reverse transcriptase, an enzyme that controls the replication of the genetic material of HIV. Nucleoside and Nucleotide Reverse Transcriptase Inhibitors: NRTIs are nucleoside analogues that inhibit the reverse transcriptase, an enzyme that controls the replication of the genetic material of HIV. Protease Inhibitors: PIs prevent viral replication by selectively binding to viral proteases (e.g., HIV-1 protease) and blocking proteolytic cleavage of protein precursors that are necessary for the production of infectious viral particles. Anti-HIV Agents, Other: A drug class that consists of antiretrovirals with different mechanism of action (e.g, fusion inhibitors, integrase inhibitors and CCR5 receptor antagonist), but based on USP classification they do not map to any of the predefined classes with the USP Model Guidelines V5 for Anti-HIV agents. MENTAL HEALTH Serotonin/Norepinephrine Reuptake Inhibitors: Selective serotonin reuptake inhibitors (SSRIs) are a class of compounds typically used in the treatment of depression; they act as antidepressants by potentiating the serotonergic activity in the central nervous system. Serotonin norepinephrine reuptake inhibitors (SNRIs) are an antidepressant class that potentiates the neurotransmitter activity in the central nervous system and also inhibits neuronal serotonin and norepinephrine reuptake. 2 nd Generation/Atypical: Atypical antipsychotics (also known as second generation antipsychotics) are a group of antipsychotic drugs that act on many receptor types including dopamine and serotonin, but they are more selective for dopamine receptors. They cause less extrapyramidal side effects compared to the older (first generation) typical antipsychotic drugs. 39
40 USP Drug Class Definitions DIABETES Antidiabetic Agents: Oral and injectable drugs used to treat diabetes mellitus by lowering glucose levels in the blood. Insulins: Injectable treatment of diabetes by administration of exogenous insulin. These include shortacting, intermediate, and long-acting insulins. IMMUNOLOGY Immune Suppressants: Immunosuppressive agents or antirejection medications are drugs that inhibit or prevent activity of the immune system. They are used in immunosuppressive therapy for transplant rejection, autoimmune diseases or diseases that are most likely of autoimmune origin (e.g., rheumatoid arthritis, multiple sclerosis, myasthenia gravis, systemic lupus erythematosus, sarcoidosis, focal segmental glomerulosclerosis, Crohn's disease, Behcet's disease, pemphigus, and ulcerative colitis), and other non-autoimmune inflammatory diseases (e.g., long term allergic asthma control). ASTHMA/COPD Bronchodilators, Sympathomimetic: A beta-2 receptor agonist that reduces bronchial muscle spasm through action that mimics the sympathetic nervous system in producing smooth muscle relaxation. Anti-inflammatories, Inhaled Corticosteroids: Inhaled corticosteroids are potent anti-inflammatory agents that act locally in the lungs to inhibit the inflammatory process, which causes asthma. 40
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