UPMC for You Pharmacy and Therapeutics Committee Meeting April 7, 2014 meeting

Transcription

1 UPMC for You Pharmacy and Therapeutics Committee Meeting April 7, 2014 meeting 1. Call to order: The meeting was called to order at 7:05 a.m. 2. Review of the minutes: The minutes of the January meeting and March fax vote were approved by the Committee. 3. New Business: Medication Reviews Drug Class COPD Phosphate Binder Anticoagulant Narcotic Analgesic Antidiabetic Central Nervous System Androgen Antiretroviral Oral Contraceptive Anoro Ellipta (umeclidinium/vilanterol) Velphoro (sucroferric oxyhydroxide) Eliquis (apixaban) Zohydro ER (hydrocodone ER) Farxiga (dapagliflozin) Hetlioz (tasimelteon) Aveed (testosterone undecanoate) Vimizim (elosulfase alfa) Myalept (metreleptin) Isentress granules (raltegravir potassium) Lomedia 24 Fe (norethindrone acetate/ethinyl estradiol/ferrous fumarate) with quantity limit with prior authorization with quantity limit

2 Drug Class Analgesic Inhaled Steroid Multiple Sclerosis Triptan Topical antifungal NSAID Prodrin (isometheptene mucate/caffeine/acetaminophen) Aerospan (flunisolide) Copaxone 40mg (glatiramer acetate) Lupaneta Pack (leuprolide acetate/norethindrone acetate) Zomig nasal spray (zolmitriptan) Avar cleansing pads (sodium sulfacetamide 9.5%, sulfur 5%) Avar LS cleansing pads (sodium sulfacetamide 10%, sulfur 2%) Dermasorb AF Complete Kit (clioquinol and hydrocortisone cream with hydrating gel) Dermasorb HC Complete Kit (hydrocortisone lotion with shampoo and body wash) Dermasorb TA Complete Kit (triamcinolone acetonide cream with emollient cream) Dermasorb XM Complete Kit (urea cream with moisturizing cream) Ecoza topical foam (econazole nitrate) Pennsaid solution (diclofenac sodium) with quantity limit with quantity limit

3 Drug Class Retin-A Micro 0.08% gel microsphere (tretinoin) Sumadan XLT kit (sodium sulfacetamide 9% and sulfur 4.5% wash with Niseko Sunscreen SPF25) All voted in favor to approve the recommendations noted above. New policies RX.PA.224 Hydrocodone ER (Zohydro ER) RX.PA.225 Tasimelteon (Hetlioz) RX.PA.226 Elosulfase alfa (Vimizim) RX.PA.227 Metreleptin (Myalept) 4. Updates: Policy Revisions RX.PA.054 Luteinizing Hormone Releasing Hormone (LHRH) s Updated to include Lupaneta Pack which is indicated only for endometriosis. RX.PA.067 Oral and Topical Oncology s Updated to include a new FDA-approved indication for Imbruvica for Chronic Lymphocytic Leukemia in patients who have received one prior therapy. In addition, criteria for Iclusig were updated to account for revisions to the indication section of the prescribing information where there are additional uses for the first-line treatment of patients with T315I-positive Chronic Myelogenous Leukemia and Philadelphia chromosome + Acute Lymphocytic Leukemia. RX.PA. 150 Fingolimod (Gilenya) Updated to include dimethyl fumarate (Tecfidera) as a possible pre-requisite medication before approval for Gilenya is granted.

4 Psoriasis and Ankylosing Spondylitis Revisions RX.PA Etanercept (Enbrel) RX.PA Infliximab (Remicade) RX.PA Adalimumab (Humira) RX.PA Golimumab Subcutaneous (Simponi) Updated to reflect the most recent guidelines for the treatment of psoriasis and ankylosing spondyltitis. Other affected polices (such as RX.PA and RX.PA.125) have been updated already. Below are only the criteria that were changed. All voted in favor to approve the policies as presented. RX.PA.017 Celecoxib (Celebrex) Step Updated to clarify approvable diagnoses per DPW. RX.PA Teriparatide (Forteo) Updated to clarify medication trial requirements per DPW. RX.PA.080 Buprenorphine/Naloxone (Suboxone, Zubsolv) and Buprenorphine (Subutex) Updated to remove initial 1 month fill. RX.PA.142 IV Bisphosphonate Step Updated to require generic oral bisphosphonates instead of only alendronate. RX.PA.062 Interferons, Protease Inhibitors, and Polymerase Inhibitor Updated to separate each genotype by prior response to treatment, if any, to require documentation of patient assessment of compliance, and to include additional treatment regimen options based upon AASLD/IDSA guidelines for treatment of Hepatitis C. RX.PA.180 Ivacaftor (Kalydeco) Updated to include additional mutations.

5 RX.005 Quantity Limits The table below summarizes changes to the Quantity Limits policy: Drug Quantity Limit Bethkis (tobramycin) Olysio (simeprevir) Otrexup (methotrexate) Sovaldi (sofosbuvir) Noxafil (posaconazole) Imbruvica (ibrutinib) Khedezla (desvenlafaxine) Versacloz (clozapine) Aptiom (eslicarbazepine) Diclegis (doxylamine and pyridoxine) Actemra (tocilizumab) Adempas (riociguat) 56 ampules per 56 days 1 package (4 auto-injectors) per 28 days 93 tablets per 30 days 120 capsules per 30 days 540mL per 30 days 200mg, 400mg, 800mg: 600mg: 60 tablets per 30 days 120 tablets per 30 days Intravenous infusion: 800mg (40mL) per 28 days Subcutaneous injection: 4 syringes per 28 days 90 tablets per 30 days Definitions: Must add: Drug will be added to the formulary. : Drug may be added to the formulary or may be non-formulary. Other drugs already on the formulary are considered equally effective from a clinical standpoint. : Drug will be non-formulary. NOTE: All recommendations are subject to DPW approval and final decision determination by UPMC for You.