Connecticut Medicaid P&T Meeting Minutes June 4, 2009

Transcription

1 Connecticut Medicaid P&T Meeting Minutes June 4, 2009 The meeting started at 6:30 pm Attendance Present Members: Carl Sherter, MD Eric Einstein, MD Lester Silberman, MD Charles Thompson, MD Peggy Manning Memoli, Pharm D Richard Carbray, Jr., RPh Emmett Sullivan, RPh Hilda Slivka, MD Tsampika (Beka) Apostolidis Stella Cretella Absent Members: Kenneth Marcus, MD Lawrence Sobel, RPh DSS: Evelyn Dudley Robert Zavoski, MD MPH Jason Gott Jim Zakszewski EDS/Provider Synergies: Chris Andrews Ellen Arce Joy DeNardo Opening remarks: Dr. Sherter made the following announcements: Emmett Sullivan is filling the vacancy for a Practicing Pharmacist. Dr. Sherter introduced him and asked him to give a brief biography. Emmett told committee members that he is a University of Connecticut graduate with a BS in Pharmacy and an MBA from Quinnipiac University. He is currently the Director of Operations at Yale-New Haven Medical Center Pharmacy. He has served as Vice President and as an Executive Committee Member for the Connecticut Pharmacist Association. Approval of minutes: Committee members approved the meeting minutes from the March 5, 2009 meeting. Public Presentation: Dr. Micha Abeles, Associate Professor of Medicine, Acting Chief Division of Rheumatic Diseases University of Connecticut addressed the committee regarding treatment with the medications in the Cytokine and CAM Antagonists class. He explained that these are not first line agents for the treatment of rheumatic diseases, ulcerative colitis, or Crohn s disease; however patients with more severe disease progression will require these medications. He expressed the need for a wide choice of medications in this class due to the complexity of treatment and further recommended that both Humira and Enbrel, although similar in treatment profiles, be preferred on the PDL. Dr. Sherter recommended reviewing the Cytokine and CAM Antagonists class at this time. The outcome of the committee s review is listed under the therapeutic class reviews.

2 New Generics: Chris Andrews informed the committee members that there were no new generics to discuss. Therapeutic Class Reviews: Chris Andrews, from Provider Synergies, presented clinical data and financial analysis, as well as answered questions from committee members on the following fourteen therapeutic classes. Outcomes and votes are recorded below by class: Analgesics, Narcotic Long-Acting that Monarch has acquired Kadian and that Avinza is now available in 45mg and 75mg capsules. The recommended changes to this class would be the addition of Avinza and the removal of fentanyl transdermal patches and Kadian. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented with Emmett Sullivan seconding. The motion was passed unanimously. Avinza, Duragesic, methadone, morphine ER fentanyl transdermal, Kadian, Opana ER, oxycodone ER, OxyContin, Ultram ER Analgesics, Narcotic Short-Acting that an FDA panel recommended that all propoxyphene-containing products be removed from the market based on their low benefit-to-risk ratio. The recommended changes to this class would be the addition of meperidine/promethazine. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented with Dr. Einstein seconding. The motion was passed unanimously. APAP/codeine, APAP/dihydrocodeine/caffeine, APAP/hydrocodone, APAP/oxycodone, APAP/pentazocine, APAP/propoxyphene, APAP/tramadol, ASA/codeine, ASA/oxycodone, butalbital compound/codeine, codeine, hydrocodone/ibuprofen, hydromorphone, meperidine, meperidine/promethazine, morphine IR, oxycodone/ibuprofen, oxycodone IR, propoxyphene, tramadol Darvon-N, Dilaudid liquid, fentanyl buccal, Fentora, levorphanol, Opana, Panlor DC, pentazocine/naloxone, Reprexain

3 Angiotensin Modulators the ONTARGET study which compared treatment with ramipril, Micardis, and a combination of ramipril and Micardis in patients with controlled hypertension with vascular disease or high-risk diabetes. The study concluded that monotherapy with either agent resulted in less adverse effects, but the combination of the two drugs was associated with more adverse events without an increase in benefit. He also noted several studies done with Tekturna that concluded that Tekturna in combination with other Angiotensin Modulators resulted in greater decreases in blood pressure. The recommended changes to this class would be the removal of Benicar and Benicar HCT. Stella Cretella motioned to approve and accept Provider Synergies recommendations with Dr. Silberman seconding. The motion was passed unanimously. Avapro/Avalide, benazepril, benazepril/hctz, captopril, captopril/hctz, Cozaar/Hyzaar, Diovan, Diovan HCT, enalapril, enalapril/hctz, fosinopril, fosinopril/hctz, lisinopril, lisinopril/hctz, Micardis, Micardis HCT, moexipril, moexipril/hctz, quinapril, quinapril/hctz, ramipril, trandolapril Aceon, Atacand/Atacand HCT, Benicar/Benicar HCT, Tekturna/Tekturna HCT, Teveten/Teveten HCT Anticoagulants, Injectable that Celgene has acquired Innohep. There were no recommended changes to this class. Dr. Silberman motioned to approve and accept Provider Synergies recommendations as presented with Stella Cretella seconding. The motion was passed unanimously. Arixtra, Fragmin, Lovenox Innohep Antiparasitics, Topical that this is a new class being added to the PDL. The only update to this class is that Ovide is available in generic. Chris also noted that this class only includes the prescription Antiparasitics. The recommendations are that Eurax, Ovide, and permethrin are preferred and lindane and malathion are non-preferred. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented with Dr. Silberman seconding. The motion was passed unanimously. Eurax, Ovide, permethrin lindane, malathion

4 Atopic Dermatitis that there has been no new clinical information since the last review of this class. There were no recommended changes to this class. Richard Carbray Jr. motioned to approve and accept Provider Synergies recommendations as presented with Dr. Thompson seconding. The motion was passed unanimously. Elidel, Protopic Beta Blockers that UCB has acquired Levatol. The recommended changes for this class would be the addition of Innopran XL and Toprol XL and the removal of Coreg CR. Dr. Einstein motioned to approve and accept Provider Synergies recommendations as presented with Beka Apostolidis seconding. The motion was passed unanimously. acebutolol, atenolol, betaxolol, bisoprolol, carvedilol, Innopran XL, labetalol, metoprolol, metoprolol XL, nadolol, pindolol, propranolol/propranolol LA, sotalol, timolol, Toprol XL Bystolic, Coreg CR, Levatol Cytokine and CAM Antagonists Chris Andrews presented the evaluation and recommendations for this class after Dr. Abeles presentation. He noted that this is a new class being added to the PDL. He noted that the 2008 American College of Rheumatology guidelines indicate that this class of medications should only be used after failure with non-biologic agents. The recommendations are that Cimzia and Humira are preferred and Amevive, Enbrel, Kineret, Orencia, Remicade are non-preferred. Dr. Silberman questioned why Humira was recommended over Enbrel and inquired if both Humira and Enbrel could be preferred. Chris Andrews noted that both products were similar, but there would be less cost savings with both products as preferred. Dr. Memoli recused herself from the voting. Dr. Silberman motioned to approve and accept Provider Synergies recommendations with the addition of Enbrel as preferred with Stella Cretella seconding. The motion was passed unanimously. Cimzia, Enbrel, Humira Amevive, Kineret, Orencia, Remicade

5 Hypoglycemics, Incretin Mimetics/Enhancers that the 2009 update to the American Diabetes Association s (ADA) Standards of Medical Care in Diabetes stated that this class of medications may be appropriate choices for glycemic control even though they were not included in the consensus statement and treatment algorithm. There were no recommended changes to this class. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented with Dr. Silberman seconding. The motion was passed unanimously. Byetta, Janumet, Januvia, Symlin Hypoglycemics, TZDs that the 2009 update to the ADA Standards of Medical Care in Diabetes stated that Actos may be used in tier two interventions, but does not recommend the use of Avandia in its treatment algorithm. The recommended change to this class would be the removal of Actoplus Met. Emmett Sullivan motioned to approve and accept Provider Synergies recommendations as presented with Richard Carbray Jr. seconding. The motion was passed unanimously. Actos, Avandamet, Avandaryl, Avandia Actoplus Met, Duetact Impetigo Agents, Topical that this is a new class being added to the PDL. He noted that there has been no new clinical information in the past year. The recommendations are that Altabax, Bactroban cream, and mupirocin ointment are preferred. Richard Carbray Jr. motioned to approve and accept Provider Synergies recommendations as presented with Dr. Thompson seconding. The motion was passed unanimously. Altabax, Bactroban cream, mupirocin ointment Lipotropics, Other that Kowa has acquired Lipofen and that Trilipix is a new product in this class. The recommended changes for this class would be the addition of Lovaza, Niacor, and Trilipix and the removal of fenofibrate, Fenoglide, Lipofen, and Triglide. Dr. Silberman motioned to approve and accept Provider Synergies recommendations as presented with Stella Cretella seconding. The motion was passed unanimously. cholestyramine, colestipol, gemfibrozil, Lovaza, Niacor, Niaspan, Tricor, Trilipix, Zetia Antara, fenofibrate, Fenoglide, Lipofen, Triglide, Welchol

6 Lipotropics, Statins the JUPITER study, which showed a decrease in cardiovascular events in patients treated with Crestor. The recommended change in this class would be the removal of Vytorin. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented with Beka Apostolidis seconding. The motion was passed unanimously. Caduet, Crestor, Lescol/Lescol XL, Lipitor, lovastatin, pravastatin, Simcor, simvastatin Advicor, Altoprev, Vytorin Multiple Sclerosis Agents Chris Andrews presented the evaluation and recommendation for this class. There were no changes recommended for this class. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented with Richard Carbray Jr. seconding. The motion was passed unanimously. Avonex, Betaseron, Copaxone, Rebif Recommendations for next class reviews: Provider Synergies recommended the following classes be reviewed at the next P&T meeting: Antifungals, Oral Antifungals, Topical Antimigraine Agents, Triptans Antivirals, Oral Bladder Relaxant Preparations BPH Agents Cephalosporins and Related Agents Fluoroquinolones, Oral Glucocorticoids, Inhaled Hepatitis C Agents Hypoglycemics, Meglitinides Macrolides/Ketolides Pulmonary Arterial Hypertension Agents, Oral Sedative Hypnotics Schedule next meeting: Committee members agreed on Thursday, September 3, 2008 for the next P & T meeting. Meeting adjourned at 7:16pm