UPMC for You Pharmacy and Therapeutics Committee Meeting July 22, 2014 meeting

Transcription

1 UPMC for You Pharmacy and Therapeutics Committee Meeting July 22, 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 April meeting and the minutes of the May and June fax vote were approved by the Committee. 3. New Business: Medication Reviews Drug Class Musculoskeletal Agent Drug Name Otezla (apremilast) Oralair (Sweet Vernal, Orchard, Perennial rye, Timothy, and Kentucky Blue Grass Mixed Pollens Allergen Extract) Formulary Coverage Recommendation Respiratory Agent Androgen Androgen Platelet Inhibitor Anti-diabetic Agent Antibiotic Grastek (Timothy Grass Pollen Allergen Extract) Ragwitek (Short Ragweed Pollen Allergen Extract) Incruse Ellipta (umeclidinium) Natesto (testosterone) Vogelxo (testosterone) Zontivity (vorapaxar) Tanzeum (albiglutide) Sivextro (tedizolid) May add May add with quantity limit May add with a quantity limit

2 Drug Class Topical Antifungal Opioid Antagonist Antineoplastic Agent Gastrointestinal Agent Central Nervous System Agent NSAID Cardiovascular Agent Cardiovascular Agent Anticonvulsant Analgesic Musculoskeletal Agent Antifungal Drug Name Jublia (efinaconazole) Evzio (naloxone auto-injector) Sylvant (siltuximab) Zykadia (ceritinib) Entyvio (vedolizumab) Namenda XR (memantine hcl) Tivorbex (indomethacin) Lanoxin (digoxin) Inderal XL (propranolol) Qudexy (topiramate) Xartemis XR (oxycodone hydrochloride and acetaminophen) Monovisc (sodium hyaluronate) Noxafil (posaconazole) Bensal HP (salicylic acid) Formulary Coverage Recommendation May add with quantity limit May add with quantity limit with quantity limit with quantity limit

3 Drug Class Formulary Coverage Drug Name Recommendation Antibiotic Metronidazole 1.3% vaginal gel Stimulant Oral Agent Ophthalmic Agent Plexion % lotion (sulfacetamide sodium and sulfur) Plexion % cleansing cloths (sulfacetamide sodium and sulfur) Zenzedi (dextroamphetamine sulfate) UltraSal-ER film-forming solution (salicylic acid) TL Triseb (acifructol complex, allantoin, ascorbyl tetraisopalmitate, bisabolol, butylene glycol, butyrospermum parkii, cera alba, disodium EDTA, ethylhexyl palmitate, glycyrrhetinic acid, hydrogenated castor oil, isohexadecane, magnesium stearate, magnesium sulfate, PEG-30 dipolyhydroxystearate, pentylene glycol, piroctone olamine, polyglyceryl-6 polyricinoleate, propyl gallate, purified water, telmesteine, tocopheryl acetate, and vitis vinifera fruit extract) Orafate (sucralfate) Omidria (phenylephrine/ ketorolac) with prior authorization s All voted in favor to approve the recommendations noted above. New policies RX.PA Abatacept Subcutaneous (Orencia) RX.PA Abatacept Intravenous (Orencia)

4 RX.PA.228 Apremilast (Otezla) RX.PA.233 Vorapaxar (Zontivity) RX.PA.229 Sublingual Immunotherapy RX.PA.230 Naloxone Injection (Evzio) RX.PA.231 Siltuximab (Sylvant) RX.PA.232 Vedolizumab (Entyvio) 4. Updates: Policy Revisions RX.PA.022 Omalizumab (Xolair) Updated to include criteria for new indication of chronic idiopathic urticarial. RX.PA. 006 Growth Hormone Updated to require genetic testing for the use of growth hormone replacement therapy in patients with Short Stature due to Homeobox-containing Gene (SHOX) deficiency. RX.PA.064 Posiconazole (Noxafil) Updated to include the new FDA-approved injectable version of this medication which is indicated for the prophylaxis of Aspergillus and Candida infections. RX.PA.080 Buprenorphine/Naloxone (Suboxone, Zubsolv) & Buprenorphine (Subutex) Updated to remove the requirement for the initial authorization that members be compliant with the previous month of therapy. Updated initial authorization approval timeframe based upon whether Drug and Alcohol evaluation has occurred (approve for 6 months) or is scheduled for the future (approve for 3 months). For reauthorization, members MUST be attending counseling at the level and frequency recommended in the initial evaluation

5 RX.PA.160 Hydroxyprogesterone Caproate Injection (Makena) Updated to remove the requirement for a previous trial of the compounded formulation. RX.PA.185 Riluzole (Rilutek) Updated to revise the language in the reauthorization criteria section to state that the prescriber must submit documentation that the member still is a candidate for treatment with the medication. RX.PA.062 Interferons, Protease Inhibitors, and Polymerase Inhibitor Updated criteria to allow the new products (Sovaldi and Olysio) with or without pegylated interferon and ribavirin to only in patients with severe/advanced disease (defined as cirrhosis or fibrosis score of F3 or F4) regardless of past treatment history, genotype, or treatment regimen to be used. Additionally, revised requirement for patients with a history of substance abuse to be abstinent for the past 6 months, rather than the past 3 months, and have documentation of compliance with Drug and Alcohol treatment if in treatment. Finally, revised the criteria for genotype 3 patients, which prefers the regimen of Sovaldi/pegylatedinteferon/ribavirin for 12 weeks, rather than Sovaldi/ribavirin for 24 weeks. Updated to add decompensated cirrhosis as a contraindication to treatment (and therefore removed any decompensated cirrhosis criteria that was part of an approval path). RX.PA.213 Penicillamine (Cuprimine, Depen) Updated to include a hepatologist to the list of specialist. RX.PA.214 Trientine (Syprine) & Zinc Acetate (Galzin) Updated to include a hepatologist to the list of specialist prescribers. RX.PA.067 Oral and Topical Oncology Agents Updated to include criteria for the new agent Zykadia. RX.PA.076 Pulmonary Hypertension Agents Updated to include criteria for the new agent Orenitram.

6 RX.005 Quantity Limits The table below summarizes changes to the Quantity Limits policy: Drug Quantity Limit Farxiga (dapagliflozin) 30 tablets per 30 days Copaxone (glatiramer acetate) 40mg: 12 syringes per 30 days Myalept (metreleptin) 30 vials per 30 days Lupaneta Pack (leuprolide acetate/norethindrone acetate) One 1-month pack per 28 days One 3-month pack per 84 days Avinza (morphine sulfate ER) 30 capsules per 30 days Kadian (morphine sulfate ER) 60 capsules per 30 days Xartemis XR (oxycodone/acetaminophen) 120 tablets per 30 days Zohydro ER (hydrocodone ER) 60 capsules per 30 days Hetlioz (tasimelteon) 30 capsules per 30 days Definitions: Must add: Drug will be added to the formulary. May add: 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.