MEDICAL ASSISTANCE BULLETIN

Transcription

1 ISSUE DATE January 22, 2013 SUBJECT EFFECTIVE DATE January 15, 2013 MEDICAL ASSISTANCE BULLETIN NUMBER *See below BY Drug List (PDL) Update January 15, 2013 Pharmacy Services Vincent D. Gordon, Deputy Secretary Office of Medical Assistance Programs PURPOSE: The purpose of this bulletin is to inform providers about updates to the Drug List (PDL) effective January 15, SCOPE: This bulletin applies to all licensed pharmacies and prescribers enrolled in the Medical Assistance (MA) Program and providing services in the fee-for-service (FFS) delivery system, including pharmacy services to residents of long term care facilities. BACKGROUND: The Department of Public Welfare s (Department) Pharmacy and Therapeutics (P&T) Committee meets semi-annually to review published peer-reviewed clinical literature and make recommendations relating to new drugs in therapeutic classes already included in the PDL, changes in the status of drugs on the PDL from preferred to non-preferred and non-preferred to preferred, new quantity limits, and new classes of drugs to be added to or deleted from the PDL. The P&T Committee also recommends new guidelines or modifications to existing guidelines to evaluate requests for prior authorization of prescriptions for medical necessity. DISCUSSION: The P&T Committee made the following recommendations during the most recent semiannual meeting on November 7, 2012, which were reviewed and approved by the Department. * COMMENTS AND QUESTIONS REGARDING THIS BULLETIN SHOULD BE DIRECTED TO: The appropriate toll free number for your provider type Visit the Office of Medical Assistance Programs Web site at

2 2 1. Classes of drugs subject to the PDL with no changes: Antihypertensives, Sympatholytics Antihyperuricemics Bile Salts Botulinum Toxins Emollients Immunomodulators, Atopic Dermatitis Iron, Parenteral Otic Anti-Infectives & Anesthetics Steroids, Topical Very High Stimulants and Related Agents 2. Classes of drugs added to the PDL: Antipsoriatics, Topical Glucocorticoids, Oral Oncology Agents, Breast Cancer 3. Classes of drugs or drugs removed from the PDL None 4. PDL status of new drug classes, new drugs, drugs not previously reviewed, and drugs with a change in status Therapeutic Drug Class Brand Name Generic Name Alzheimers Agents Aricept ODT Namenda Solution Anticonvulsants Klonopin Tablet Onfi Potiga Trileptal Tablet clonazepam ODT Antidepressants, Other Effexor R mirtazapine ODT venlafaxine ER capsules Antidepressants, Paxil Suspension SSRIs citalopram solution Antihistamines, Claritin Capsule OTC Minimally Sedating levocetirizine solution Antiparkinsons Agents Neupro Antipsoriatics, Topical Dovonex Cream Taclonex Ointment

3 Therapeutic Drug Class Brand Name Generic Name Antipsoriatics, Topical (continued) Taclonex Scalp Sorilux Foam Vectical 3 calcipotriene cream calcipotriene ointment calcipotriene solution calcitrene ointment calcitriol ointment Antipsychotics Geodon Seroquel R loxapine risperidone ODT ziprasidone capsule Bronchodilators, Beta Agonists Maxair COPD Agents Combivent Respimat Cytokine and CAM Antagonists Cimzia Kit Diabetes Meters Accu-Chek Accu-Chek Aviva Plus Accu-Chek Nano Smartview Breeze 2 Contour Contour Next EZ One Touch Verio IQ Prodigy True2Go Blood Glucose System Trueresult Blood Glucose System Truetrack Smart System Diabetes Test Strips Accu-Chek Active Accu-Chek Aviva Accu-Chek Aviva Plus Accu-Chek Comfort Curve

4 Therapeutic Drug Class Brand Name Generic Name Diabetes Test Strips (continued) Accu-Chek Compact Accu-Chek Smartview Breeze 2 Contour 4 Contour Next Nova Max Test Strips Prodigy No Coding Truetest Test Strips Truetrack Test Strips Enzyme Replacement, Elelyso Gauchers Disease Zavesca Glucocorticoids, Inhaled Pulmicort Flexhaler Glucocorticoids, Oral Celestone Cortef Entocort EC Flo-Pred Medrol Tablet Orapred Orapred ODT Pediapred Rayos Tablet DR budesonide EC cortisone dexamethasone elixir dexamethasone intensol dexamethasone solution dexamethasone tablet Dexpak hydrocortisone methylprednisolone 16mg tablet methylprednisolone 32mg tablet methylprednisolone 4mg tablet methylprednisolone 8mg

5 5 Therapeutic Drug Class Brand Name Generic Name Glucocorticoids, Oral (continued) tablet methylprednisolone tab DS PK millipred DP tab DS PK millipred solution millipred tablet prednisolone sodium phosphate prednisolone solution prednisone intensol prednisone solution prednisone tab DS PK prednisone tablet veripred 20 Intranasal Rhinitis Astepro Agents Dymista Qnasl Zetonna Leukotriene Modifiers Singulair Granule Packet Neuropathic Pain (previously Horizant Myalgia/Neuropathy Agents) Neurontin Solution NSAIDs Vimovo Oncology Agents, Arimidex Breast Cancer Aromasin Fareston Femara anastrozole exemestane letrozole tamoxifen citrate Oncology Agents, Oral Erivedge Inlyta Jakafi Ophthalmic Antibiotics Ocuflox Tobrex Drops

6 Therapeutic Drug Class Brand Name Generic Name Ophthalmic Antibiotics (continued) 6 garamycin drops gentamicin ointment ilotycin sulfacetamide ointment Ophthalmic Antibiotic- Pred-G Drops Steroid Combinations Suspension Zylet Ophthalmics for Allergic Conjunctivitis Pataday Ophthalmics, Anti- Inflammatories Lotemax Ointment Ophthalmics, Cosopt PF Glaucoma Agents Iopidine Zioptan Otic Antibiotics Cipro HC Coly-Mycin S Cortisporin-TC ciprofloxacin otic solution Sedative Hypnotics Intermezzo Smoking Cessation Chantix Tablet Chantix Tab DS PK Commit Nicorette Lozenge OTC nicotine lozenge OTC Steroids, Topical High amcinonide lotion betamethasone DP ointment diflorasone diacetate ointment fluocinonide ointment Steroids, Topical Low Aqua Glycolic HC

7 7 Therapeutic Drug Class Brand Name Generic Name Steroids, Topical Medium Cloderm Dermatop Cream fluticasone propionate cream fluticasone propionate ointment hydrocortisone butyrate ointment 5. New Drugs that require clinical prior authorization: None PROCEDURE: The procedures for prescribers to request prior authorization of non-preferred drugs, preferred drugs that require prior authorization, and drugs not subject to the PDL that require prior authorization and for pharmacies to dispense an emergency supply of medication when necessary and without prior authorization are located In SECTION I of the Prior Authorization of Pharmaceutical Services Handbook. The Department will take into account the elements specified in the clinical review guidelines (which are included in the provider handbook pages in the SECTION II chapters related to specific therapeutic classes of drugs) in reviewing the prior authorization request to determine medical necessity. The requirements for prior authorization and clinical review guidelines to determine medical necessity of non-preferred and preferred drugs listed above and updated handbook chapters will be published in separate MA Bulletins. As set forth in 55 Pa. Code (a), the procedures described in the handbook pages must be followed to ensure appropriate and timely processing of prior authorization requests for drugs that require prior authorization. ATTACHMENTS: Prior Authorization of Pharmaceutical Services Handbook - Updated pages SECTION I Providers can view the most recent PDL at: Providers can view the most recent Quantity Limits List at: mitslist/index.htm

8 8 NOTE: Providers may call , Option 1 to request a hard copy of the most recent PDL and Quantity Limits List SECTION II Table of Contents