WellINFORMED. From the PRESIDENT S DESK. Every Little Thing Brings BIG OUTCOMES.

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1 WellINFORMED From the PRESIDENT S DESK At WellDyneRx, we believe that every little thing brings big outcomes. We re committed to optimizing and enhancing every health plan, every prescription fill, and every interaction we have no matter how small. That commitment shows in our 2017 Drug Trend Report. The numbers included within it underscore our goal to drive improved patient outcomes and lower costs. I hope you were able to join our live 'May 24th' 2017 Drug Trend Report webinar and see first-hand how we're helping our clients solve key problems. The proof is in the impressive outcomes we shared during this event. In this edition of Well Informed, you ll learn more about our 2017 Drug Trend Report as well as our response to a recent 60 Minutes story about PBM concerns and high drug prices. We ll also highlight some July 1st formulary changes, client FAQs, current HIV treatments, and our new WellManaged - Respiratory program. Additionally, we ve included information about industry events we will attend as well as new FDA-approved drugs. We appreciate your business and hope you find this information interesting and beneficial. As always, your feedback is important to us, please let us know if you have any questions or comments. Sincerely, Zach Johnson Every Little Thing Brings BIG OUTCOMES. May 2018

2 2017 Drug Trend Report Webinar REPORTS In 2017, with the help of our WellManaged clinical programs and strategic formulary designs, WellDyneRx helped clients maintain a low 1.2% rate of growth in per-person prescription drug spend. We were able to contain costs for our clients despite significant increases in utilization of specialty medications and double digit price inflation in many drug categories. These achievements and more are covered in detail in our new 2017 Drug Trend Report. Total drug trend is made up of the utilization and unit cost of drugs, and can be further subdivided into traditional and specialty drug categories, as well as the top therapeutic drug classes for each. The top overall category for increases in spend was the specialty drug category of Inflammatory Conditions, which includes disease states such as rheumatoid arthritis, psoriasis, Crohn s disease, and ulcerative colitis. The most commonly used drugs within this category are Humira and Enbrel, and they account for almost 50% of the utilization. The top traditional drug category, and the second top category overall, was diabetes. Diabetes accounted for almost 12% of total spend, and the increases in trend were driven largely by unit cost increases in insulin. To actively manage traditional drug spend, clients can implement our WellManaged-Formulary programs, such as WellManaged-Generics, WellManaged-Preferred Brands, and WellManaged- Hyperinflationary Drugs. Also, while WellManaged- Diabetes and WellManaged-Opioids are focused primarily on clinical outcomes, our 2017 Drug Trend Report demonstrates that they also deliver financial benefits. In 2017, WellManaged-Diabetes helped clients achieve a negative unit cost trend while increasing medication adherence and reducing hemoglobin A1c, the primary health outcome related to the management of diabetes. In the same year, WellManaged-Opioids helped clients achieve a 36% lower average cost per 30-day supply of opioid medication. To learn more about the WellDyneRx 2017 Drug Trend Report and the efficacy of our clinical programs and utilization management strategies, listen to a recording of our recent webinar. Click Here to Listen Drug Trend Report Webinar During the webinar, WellDyneRx s clinical leaders discussed data trends, presented significant findings and analyzed the highlights of the 2017 Drug Trend Report. 2

3 WellDyneRx Response to Recent PBM News Coverage On a recent episode of 60 Minutes, Lesley Stahl did a segment called The Rockford File where she investigated a pending class-action lawsuit brought by the city of Rockford, Illinois against pharmaceutical manufacturer Mallinckrodt and their pharmacy benefit manager (PBM). The case involves a drug called HP Acthar that originally sold for $40 a vial in 2001, but today is sold for more than $40,000. Knowing about this and other similar medications that have experienced significant price hikes in recent years, WellDyneRx launched the WellManaged Hyperinflationary Drugs program. This program monitors the pricing and clinical relevance of new and existing medications. Drugs are added to an exclusion list if they are significantly more costly than medications offering similar clinical outcomes. To date, WellDyneRx has identified 243 medications which are part of the Hyperinflationary Drugs program. Unfortunately, many of our clients have not implemented this program and are at risk of paying too much for medications that WellDyneRx deems wasteful because there are less expensive, clinicallyequivalent options available. FOR MORE INFORMATION please visit WellDyneRx.com or call Every Little Thing Brings BIG OUTCOMES Quality Care Is Our Prescription You may have seen a piece by Lesley Stahl that ran on CBS 60 Minutes recently entitled The Rockford File. In it, she discusses a pending class-action lawsuit brought by the city of Rockford, Illinois against pharmaceutical manufacturer Mallinckrodt and their Pharmacy Benefits Manager (PBM). The reason? One drug in particular: HP Acthar. In 2001, Acthar sold for about $40 a vial. Today, it costs more than $40,000 an increase of 100,000 percent. These soaring costs have forced the city of Rockford to forego vital city improvements in staffing for police and firefighters, effectively pushing the city s finances to the brink. As a PBM, WellDyneRx would like to take this opportunity to highlight our approach and the different outcomes we ve generated when it comes to HP Acthar. Knowing about this and other similar medications that have had high price increases, WellDyneRx decided to proactively combat this problem by creating the WellManaged Hyperinflationary Drugs program. The WellManaged Hyperinflationary Drugs program monitors the pricing and clinical relevance of new and existing medications. Drugs are added to an exclusion list if they are significantly more costly than medications offering similar clinical outcomes. To date, WellDyneRx has identified 243 medications which are part of the Hyperinflationary Drugs program. Unfortunately, many of our clients have not implemented this program and are at risk of paying too much for medications that WellDyneRx deems wasteful because there are less expensive, clinically-equivalent options available WellDyneRx Read WellDyneRx s full response to the 60 Minutes episode here. 3 *60 Minutes image, property of CBS News, not WellDyneRx..

4 We re Listening! Client FAQs As one of the nation s premier PBMs, WellDyneRx is extremely fortunate to have built such a robust array of unique clinical and cost containment programs as seen in our WellManaged programs. As a whole, they allow us to do two things: one, provide outstanding service to both clients and members. And two, they boost our ability to be flexible so we can give our clients the strategic business advantages they need to be successful. All of this is important to note because we frequently get asked the same questions by our clients, often around issues addressed by our umbrella of WellManaged programs. So, for the purpose of this article, we thought it would be helpful to highlight a few of those questions and show how our WellManaged Clinical and WellManaged Formulary Programs help to answer them. Question: How do you manage your plan spend and address the growing cost of specialty medications? Answer: WellDyneRx s patented Intercept Shared Savings Program helps clients control specialty spend by shifting drug costs to other payment avenues. Clients achieve a net effective AWP discount of 30% Clients realize a $512 lower cost per specialty drug Clients realized savings of $45.05 PMPY Saved clients over $15 million in 2017 (continued on next page) 4

5 We re Listening! Client FAQs Question: (continued) What is the potential savings for the plan/member and the potential disruption to the member? Answer: Our WellManaged Formulary Program brings the most balanced benefit design to the market, with formulary choice as its foundation. WellManaged programs help to positively influence total healthcare costs by managing unit cost of prescriptions with Prior Authorizations (PAs), Quantity Limits (QLs), and step edits. Member engagement to promote quality of care through our full suite of programs Diabetes Respiratory Opioids Hepatitis C As far as disruption to our members, we point to this fact: US Specialty Care has been recognized as the specialty pharmacy with the highest patient satisfaction ratings across the United States for two years in a row. Question: What are you doing in regard to the opioid epidemic? Answer: Our WellManaged Opiods Program takes a comprehensive approach to addressing this growing problem. Maintaining access to opioid medications while prioritizing patient safety and controlling costs. Real time point of service (POS) cumulative morphine equivalent dose (MED) edits Prior Authorization for targeted high-risk medications Proprietary risk stratification evaluation Physician communication on at-risk members Cancer, end-of life care, or hospice patients are excluded Do you have more questions? Let us know! 5

6 Effective July 1, 2018: Formulary Changes On July 1, 2018, the formulary status of the following medications will change. WellDyneRx is committed to offering our clients and plan participants the best prescription benefit options at the lowest cost. To accomplish this, the clinical team at WellDyneRx partners with a Pharmacy and Therapeutics (P&T) committee to evaluate the efficacy and safety of new drug approvals and to review clinical components of existing medications. These drugs were evaluated during the March 2018 P&T Committee meeting and final determinations were based upon multiple factors, including safety profile, therapeutic impact, medical necessity, and cost-effectiveness. Formularies play a critical role in prescription drug benefits as they guide medication therapy choices. The table below outlines the changes to the WellDyneRx Clinical Focus formulary. Clinical Focus Formulary Brand Name Generic Name Typical Use 2018 Tier Change Preferred Alternatives Dexilant dexlansoprazole Acid Reflux Preferred N/A Cialis tadalafil Erectile Dysfunction Preferred N/A Lo Loestrin Fe norethinedrone acetate; ethinyl estradiol; ferrous fumarate Contraception Preferred N/A Steglatro ertugliflozin Type 2 Diabetes Mellitus Preferred N/A Segluromet ertugliflozin; metformin Type 2 Diabetes Mellitus Preferred N/A Jardiance empagliflozin Type 2 Diabetes Mellitus Non-preferred Farxiga, Steglatro Synjardy Synjardy XR empagliflozin; metformin Type 2 Diabetes Mellitus Non-preferred Xigduo, Segluromet Ibrance palbociclib Cancer Non-preferred Kisqali Gleevec imatinib Cancer Non-preferred imatinib Copaxone glatiramer Multiple Sclerosis Non-preferred glatiramer Omnitrope somatropin Growth Hormone Excluded Norditropin, Genotropin This list is not comprehensive and does not contain every possible formulary alternative. Formulary items are subject to change. 6

7 Effective July 1, 2018: Formulary Changes The table below outlines the changes to the WellDyneRx Clinical Outcomes formulary. Clinical Outcomes Formulary Brand Name Generic Name Typical Use 2018 Tier Change Preferred Alternatives Steglatro ertugliflozin Type 2 Diabetes Mellitus Preferred N/A Segluromet ertugliflozin; metformin Type 2 Diabetes Mellitus Preferred N/A Jardiance empagliflozin Type 2 Diabetes Mellitus Non-preferred Farxiga, Steglatro Synjardy Synjardy XR empagliflozin; metformin Type 2 Diabetes Mellitus Non-preferred Xigduo, Segluromet Ibrance palbociclib Cancer Non-preferred Kisqali Gleevec imatinib Cancer Excluded imatinib Copaxone glatiramer Multiple Sclerosis Excluded glatiramer This list is not comprehensive and does not contain every possible formulary alternative. Formulary items are subject to change. We constantly evaluate our formulary to match patients with the most effective treatments. If there s a better or more practical prescription option for our clients and members, we tell them. With that transparency comes trust. That s the WellDyneRx approach. 7

8 May is Hepatitis Awareness Month The month of May is designated as Hepatitis Awareness Month in the United States, and May 19th was Hepatitis Testing Day. During May, the Centers for Disease Control and Prevention (CDC) and its public health partners work to shed light on this hidden epidemic by raising awareness of viral hepatitis and encouraging priority populations to get tested. The hepatitis C virus (HCV) is among the most common bloodborne viral infections in the United States. Approximately 2.7 to 3.9 million Americans are currently living with a chronic form of this infection. The risk of infection with HCV is increased if a person: Shared needles to inject drugs or straws to inhale them Obtained tattoos or body piercings in an unclean environment using unsterile equipment Worked in a place where they came in contact with infected blood or needles, for example, healthcare workers Received a blood transfusion or organ transplant before July 1992 Received a blood product for clotting problems made before 1987 Needed to have blood filtered by a machine (hemodialysis) for a long period of time because their kidneys weren t working Were born to a mother with HCV Encourage your plan members to get tested if they are part of this priority population. To learn more about how WellDyneRx helps our clients manage the costs associated with HCV treatments, read our case study. 8

9 Current Management of Human Immunodeficiency Virus (HIV) According to the Centers for Disease Control and Prevention (CDC), more than 1.1 million Americans are infected with the human immunodeficiency (HIV) virus and roughly 14% of them are unaware of their infection. Since the start of the epidemic, there have been more than 700,000 deaths in the United States due to the progression of HIV to acquired immunodeficiency syndrome (AIDS). Currently, there are two types of the HIV virus worldwide, with HIV-1 being the most prevalent. Management of HIV is intricate and requires rapid initiation of antiretroviral therapy (ART) at the time of diagnosis. Due to the nature of the virus mutating quickly, complex multi-drug regimens are required for effective viral suppression. The primary goals of treatment include controlling viral replication, preventing resistance, decreasing medication side effects and pill burden, minimizing long-term co-morbidities and preventing new infections. In order to achieve these goals, adherence must be at least 95% to the patients prescribed ART. Early treatment must involve patient engagement to reveal any barriers influencing the patient s ability to adhere to the ART and approaches should be tailored to an individual s needs. Current Therapies for HIV and Looking Ahead HIV medications are grouped into seven drug classes according to their mechanism of action. These drug classes include non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), protease inhibitors (PIs), fusion inhibitors, CCR5 antagonists, integrase strand transfer inhibitors (INSTIs), and post-attachment inhibitors. An individual s first HIV regimen usually includes a 3-drug regimen consisting of two NRTI s plus an INSTI or an NNRTI or a PI boosted with cobicistat. It is very common for patients to switch from one regimen (or combination of drugs) to another due to intolerance or development of resistance. Therefore, patient education and coordinated multidisciplinary care are paramount to successful and effective ART therapy. The ART pipeline remains robust with the development of new co-formulations to address issues with adherence and side effects along with biologics to treat specific populations with multidrug resistant HIV. Since the fourth quarter of 2017, several new drugs received FDA-approval to target safety and efficacy along with validating two-drug regimens as a durable maintenance treatment. (continued on next page) 9

10 Current Management of Human Immunodeficiency Virus (HIV) (continued) The table below illustrates the most recent FDA drug approvals and provides a preview of agents currently under investigation in the pipeline. Additionally, HIV vaccines and passive immunity models are currently under investigation with a goal of curing HIV. To date, there is no vaccination proven to be fully effective against preventing the spread of HIV. In 2009, a landmark trial known as RV144 in Thailand provided the first signal of HIV vaccine efficacy. Several current phase II clinical trials used findings from this study to supplement research. More recently, passive immunization models involving injections or IV infusions with broad neutralizing antibodies (bnabs) appear promising. While developing an HIV vaccination is challenging due to characteristic rapid mutations, significant progress is underway. Drug Manufacturer Mechanism Route Approval Juluca (dolutegravir and rilpivirine) Symfi Lo (efavirenz/ lamivudine/tdf) ViiV Healthcare INSTI/NNRTI Oral 11/21/2017 Mylan NNRTI/NRTI/NRTI Oral 2/5/2018 Biktarvy (BIC/FTC/TAF) Gilead INSTI/NRTI/NRTI Oral 2/7/2018 Cimduo (lamivudine/tdf) Mylan NRTI/NRTI Oral 2/28/2018 Trogarzo (ibalizumab uiyk) Theratechnologies/TaiMed Post-Attachment Inhibitor IV 3/6/2018 Symfi (efavirenz/ lamivudine/tdf) Mylan NNRTI/NRTI/NRTI Oral 3/6/2018 TBD (COBI/DRV/FTC/TAC) Janssen Booster/PI/NRTI/NRTI Oral 7/25/2018 TBD (doravirine/ lamivudine/tdf) TBD (cabotegravir/ rilpivirine) Merck NNRTI/NRTI/NRTI Oral 2018 ViiV Healthcare INSTI/NNRTI IM 2019 TBD (PRO-140) CytoDyne Viral Entry Inhibitor SC 2019 (TBD To Be Determined) 10

11 WellManaged - Respiratory Program The WellManaged Respiratory program helps clients control costs, ensure appropriate utilization, and improve the overall quality of care for asthma and chronic obstructive pulmonary disease (COPD) patients. While uncontrolled asthma can lead to increased emergency room visits, hospitalizations and fatalities, COPD is the third leading cause of death in the United States. Due to the prevalence of these diseases in our society and their associated treatment costs, asthma and COPD medications are typically included in the top five cost drivers for our clients. Therefore, the newly launched WellManaged Respiratory program includes an aggressively-managed formulary, adherence interventions, and patient education to ensure optimal clinical outcomes while containing costs. Asthma is a respiratory condition marked by spasms in the bronchi of the lungs, causing difficulty in breathing. It is an inflammatory disease that may be linked to allergens or genetic components. Long-term goals for the management of asthma are symptom control and risk reduction. Every patient should have a reliever medication (short-acting beta agonist for fast relief of symptoms), and most adults and adolescents should have a controller medication to maintain symptom control and reduce the need for reliever medications. In addition to medications, asthma treatment involves identifying and treating modifiable risk factors that can exacerbate or worsen symptoms, like smoking, allergens, etc. COPD is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. It is caused by longterm exposure to irritants or particulate matter. Traditionally, it has been associated with cigarette smoking, but other environmental irritants are associated with COPD as well. The goals for effective COPD management include preventing disease progression, relieving symptoms, improving exercise tolerance and health status, preventing and treating complications and exacerbations, and reducing overall patient mortality. Almost all patients with COPD should be prescribed long-acting bronchodilator therapy and patients with persistent symptoms should receive combination therapy. In addition to medications, COPD treatment involves identifying and treating modifiable risk factors that can exacerbate or worsen symptoms, like smoking and other environmental irritants. 11

12 Upcoming CONFERENCES & TRADESHOWS Representatives from WellDyneRx will be attending the following industry events in the near future. To schedule an onsite meeting, please contact us. CSAHU Annual Symposium June 5, 2018 Parker, CO IFEBP Trustees and Administrators Institutes June 24 27, 2018 Las Vegas, NV UFCW Local 1996 Leadership Conference June 11 13, 2018 Myrtle Beach, SC HCAA TPA Summit July 16-18, 2018 Minneapolis, MN SHRM Annual Conference & Exposition June 17-20, 2018 Chicago, IL 12

13 FDA Approval LIST Formulary management is one way to bring down drug costs, and deciding which medications to include on a formulary is part of this process. New drug releases are generally associated with higher costs, and being aware of new medications coming to market assists with cost containment. Market impact (adoption and use of a new medication) can cause drug costs to increase, but WellDyneRx helps you take proactive measures to manage your plan s drug spend. The Q FDA Approval list is shown below. Brand Name (manufacturer) Generic Name(s) Therapeutic Use Brief Description Potential Impact Rhopressa (Aerie Pharms) netarsudil ophthalmic solution 0.02% Glaucoma/Ocular Hypertension Rhopressa is indicated for the reduction of elevated intraocular pressure in patients with open-angle glaucoma or ocular hypertension. This is the first in the class of rho kinase inhibitors believed to reduce intraocular pressure (IOP) by increasing the outflow of aqueous humor (fluid inside the eye) through the trabecular meshwork, the main fluid drain of the eye. The recommended dosage is one drop into the affected eye(s) once daily in the evening. Low Steglujan (Merck Sharp Dohme) ertugliflozinsitagliptin Type 2 Diabetes Steglujan is used in combination with diet and exercise to improve glycemic control in adults with type 2 diabetes, when treatment with both ertugliflozin and sitagliptin is appropriate. The recommended starting dose is 5mg ertugliflozin- 100mg sitagliptin once daily up to a maximum dose of 15 mg- 100mg daily. Moderate Segluromet (Merck Sharp Dohme) ertugliflozinmetformin Type 2 Diabetes Segluromet is indicated as adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus who are inadequately controlled on a regimen containing ertugliflozin or metformin, or in patients who are already treated with both ertugliflozin and metformin. Starting dose is individualized based on patient s current regimen with a maximum recommended dose of 7.5 mg ertugliflozin/1,000 mg metformin twice daily. Moderate Macrilen (Strongbridge Ireland) macimorelin Growth Hormone Macrilen is a ghrelin agonist indicated for the diagnosis of adult growth hormone deficiency (AGHD). The recommended dosage is a single oral dose of 0.5 mg/kg. Prior to Macrilen s approval, the historical gold standard for evaluation of AGHD was the insulin tolerance test (ITT). High 13

14 Brand Name (manufacturer) Generic Name(s) Therapeutic Use Brief Description Potential Impact Giapreza (La Jolla Pharm) angiotensin II Low-blood Pressure Giapreza is an IV infusion vasoconstrictor indicated to increase dangerously low blood pressure in adults with septic or other distributive shock. It is dosed by weight and adjusted every five minutes according to blood pressure readings. Moderate Lutathera (Advanced Accelerator Applications) lutetium Lu-177 dotatate Gastro-enteropancreatic neuroendocrine tumors Lutathera is an orphan drug and first radiopharmaceutical indicated for the treatment of adults who have gastroenteropancreatic neuroendocrine tumors (GEP-NETs). It contains a peptide that targets cancer cells and a radioactive element that destroys them. The peptide part of Lutathera sticks to somatostatin receptors on tumor cells and then invades the cells where the radiation damages the cancer s DNA beyond repair. High Biktarvy (Gilead Sciences) bictegravir-emtricitabine-tenofovir (GEP-NETs) Biktarvy is three-drug combination indicated as a complete regimen for the treatment of HIV-1 infection in adults who have no antiretroviral treatment history or to replace the current antiretroviral regimen in those who are virologically suppressed on a stable antiretroviral regimen for at least 3 months with no history of treatment failure and no known substitutions associated with resistance to the individual components. The recommended dosage is one tablet once daily with or without food. Moderate Symdeko (Vertex) ivacaftortezacaftor HIV-1 Symdeko is a combination of tezacaftor and ivacaftor, indicated for the treatment of patients with cystic fibrosis (CF) aged 12 years and older who are homozygous for the F508del mutation or who have at least one mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene that is responsive to tezacaftor/ ivacaftor based on in vitro data and/or clinical evidence. Dose for adults and pediatric patients is one tablet in the morning and one tablet in the evening about 12 hours apart. High 14

15 Brand Name (manufacturer) Generic Name(s) Therapeutic Use Brief Description Potential Impact Erleada (Janssen Biotech) apalutamide Prostate Cancer Erleada is an androgen receptor inhibitor indicated for the treatment of patients with nonmetastatic castration-resistant prostate cancer (NM-CRPC). This is first FDA-approved treatment for NM-CRPC; phase III clinical trial data showing a decreased risk of distant metastasis or death by 72 percent and improved metastasis-free survival by more than 2 years. The recommended dosage is 240 mg (four 60 mg tablets) once daily. High Symfi (Matrix) efavirenz-lamivudine-tenofovir disoproxil fumarate HIV-1 Symfi is a three-drug combination (a nonnucleoside reverse transcriptase inhibitor [efavirenz] and two nucleoside reverse transcriptase inhibitors), indicated as a complete regimen for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults and pediatric patients weighing at least 40 kg. The recommended dosage is one tablet daily on an empty stomach, preferably at bedtime. Moderate Symfi Lo (Mylan) efavirenz-lamivudine-tenofovir disoproxil fumarate HIV-1 Symfi Lo is a once-daily single-tablet regimen (STR) indicated as a complete regimen for the treatment of human immunodeficiency virus type 1 (HIV-1) in adult and pediatric patients weighing at least 35 kg. Moderate Cimduo TM (Mylan) lamivudine-tenofovir disoproxil fumarate HIV-1 Cimduo TM is a combination of two nucleoside reverse transcriptase inhibitors indicated in combination with other retroviral agents for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in adults and pediatric patients weighing at least 35 kg. The recommended daily dose is one tablet daily. Moderate 15

16 Brand Name (manufacturer) Generic Name(s) Therapeutic Use Brief Description Potential Impact Trogarzo (TaiMed Biologics) ibalizumab-uiyk HIV-1 Trogarzo is a CD4-directed post-attachment HIV-1 inhibitor, in combination with other antiretroviral therapies, is indicated for the treatment of human immunodeficiency virus type 1 (HIV-1) infection in heavily treatment-experienced adults with multidrug resistant HIV-1 infection failing their current antiretroviral regimen. It works by preventing HIV from infecting CD4+ immune cells to reduce the amount of HIV in the body. This medication is administered intravenously (IV) as a single loading dose of 2,000 mg followed by a maintenance dose of 800 mg every 2 weeks. High Apadaz (KemPharm) acetaminophenbenzhydrocodone hydrochloride Pain Apadaz is an immediate-release opioid/ acetaminophen combination product indicated for the short-term (no more than 14 days) treatment of acute pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate. Apadaz is chemically inactive until ingested, unlike other opioid alternatives. Treatment is initiated at 1 to 2 tablets every 4 to 6 hours as needed for pain- not to exceed 12 tablets in a 24-hour period. Low Ilumya (Merck Sharp Dohme) tildrakizumab-asmn Plaque Psoriasis Ilumya is an interleukin-23 antagonist indicated for the treatment of adults with moderate-to-severe plaque psoriasis who are candidates for systemic therapy or phototherapy. This medication should only be administered by a qualified health professional and is given as a 100 mg subcutaneous (SC) dose at weeks 0, 4, and every 12 weeks thereafter. Moderate Thank you for reading the Q Well Informed. Please contact your Account Executive if you have any questions. Are You Connected? We want you to like, follow and connect with WellDyneRx. LinkedIn Twitter Facebook By connecting with WellDyneRx, you can expect useful information, rich company content and industry facts that are beneficial to you, your partners and your members. 16