NB Drug Plans Formulary Update

Transcription

1 Bulletin # 963 December 15, 2017 NB Drug Plans Formulary Update This update to the New Brunswick Drug Plans Formulary is effective December 15, Included in this bulletin: Special Authorization Benefit Additions Changes to Existing Special Authorization Benefits Benefit Status Changes Drugs Reviewed and Not Listed If you have any questions, please contact our office at To unsubscribe from the NB Drug Plans Formulary ed announcements, please send a message to info@nbdrugsmedicamentsnb.ca. The Updates are available on the NBPDP webpage:

2 Special Authorization Benefit Additions Product Strength DIN MFR Plans Cost Base Fluoxetine (generic brands) 20mg/5mL oral solution See NB Drug Plans Formulary or List for For use in patients for whom oral capsules are not an option. Lenvatinib (Lenvima TM ) 10mg/dose compliance pack mg/dose compliance pack mg/dose compliance pack mg/dose compliance pack EIS MLP For the treatment of patients with locally recurrent or metastatic, progressive, differentiated thyroid cancer (DTC) who meet the following criteria: Pathologically confirmed papillary or follicular thyroid cancer, and Disease that is refractory or resistant to radioactive iodine therapy, and Radiological evidence of disease progression within the previous 13 months, and Previous treatment with no more than one tyrosine kinase inhibitor (TKI). Renewal Criteria: Written confirmation that the patient is responding to treatment and there is no evidence of disease progression. Clinical Notes: 1. Patients must have a good performance status. 2. Treatment should be discontinued upon disease progression or unacceptable toxicity. Claim Notes: Initial approval: 1 year Renewal approval: 1 year Changes to Existing Special Authorization Benefits Product Strength DIN MFR Plans Cost Base Axitinib (Inlyta ) 1mg tablet mg tablet PFI MLP As second line therapy for the treatment of patients with metastatic renal cell carcinoma after failure of prior therapy with either a cytokine or tyrosine kinase inhibitor. New Brunswick Drug Plans 2 December 2017

3 Renewal Criteria: Written confirmation that the patient has responded to treatment and there is no evidence of disease progression. Clinical Notes: 1. Patients must have a good performance status. 2. Treatment should be discontinued upon disease progression or unacceptable toxicity. Claim Notes: Sequential use of axitinib and everolimus will not be reimbursed. Exceptions may be considered in cases of intolerance or contraindication without disease progression. Initial approval period: 6 months. Renewal period: 1 year. Ciprofloxacin (Ciloxan ) 0.3% ophthalmic ointment NVR MLP Ciprofloxacin (Ciloxan and generic brand) 0.3% ophthalmic solution See NB Drug Plans Formulary or List for For the treatment of ophthalmic infections caused by susceptible bacteria. For the prevention of ophthalmic infections associated with non-elective eye surgery. Prescriptions written by New Brunswick ophthalmologists and prescribing optometrists do not require special authorization. Entecavir (Baraclude TM and generic brands) 0.5mg tablet See NB Drug Plans Formulary or List for For the treatment of hepatitis B. Must be prescribed by a hepatologist, gastroenterologist, infectious disease specialist or other physician with experience in the treatment of hepatitis B. New Indication and Imatinib (Gleevec and generic brands) 100mg tablet 400mg tablet See NB Drug Plans Formulary or List for Acute Lymphoblastic Leukemia Philadelphia Chromosome Positive (Ph+ ALL) For the treatment of patients with Ph+ ALL. New Brunswick Drug Plans 3 December 2017

4 Chronic Myeloid Leukemia Philadelphia Chromosome Positive (Ph+ CML) For the treatment of patients in chronic phase, blast phase or accelerated phase Ph+ CML. Gastrointestinal Stromal Tumor (GIST) 1. For the adjuvant treatment of patients who are at high risk of recurrence following complete surgical resection of c-kit positive GIST, for a period of up to 3 years. 2. For the treatment of patients with unresectable and/or metastatic c-kit positive GIST. Ofloxacin (Ocuflox and generic brand) 0.3% ophthalmic solution See NB Drug Plans Formulary or List for For the treatment of ophthalmic infections caused by susceptible bacteria. For the prevention of ophthalmic infections associated with non-elective eye surgery. Prescriptions written by New Brunswick ophthalmologists and prescribing optometrists do not require special authorization. New Strength Somatropin (Omnitrope ) 15mg/1.5mL pen cartridge SDZ MLP For the treatment of growth hormone deficiency in children under the age of 19. Claim Notes: Must be prescribed by, or in consultation with, an endocrinologist. Somatropin is a regular benefit for Plan T. Tenofovir disoproxil (Viread and generic brands) 300mg tablet See NB Drug Plans Formulary or List for For the treatment of hepatitis B. Must be prescribed by a hepatologist, gastroenterologist, infectious disease specialist or other physician with experience in the treatment of hepatitis B. New Brunswick Drug Plans 4 December 2017

5 Benefit Status Changes Product Strength DIN MFR Delisted Oxtriphylline (Choledyl Elixir ) 100mg/5mL oral solution ERF Effective December 15, 2017, oxtriphylline (Choledyl Elixir ) 100mg/5mL oral solution will be delisted as a benefit under the New Brunswick Drug Plans Formulary. Requests for special authorization will not be considered. There is no evidence for efficacy of Choledyl Elixir and there are safer and more effective agents for the treatment of asthma and/or chronic obstructive pulmonary disease. Delisted Vancomycin (Vancocin ) 250mg capsule MRS Jamp-Vancomycin 250mg capsule JPC Vancomycin Hydrochloride 250mg capsule FKB Effective December 15, 2017, vancomycin 250mg capsules will be delisted as a benefit under the NB Drug Plans Formulary. Requests for special authorization will not be considered. There is no evidence that vancomycin 250mg four times daily is more effective than 125mg four times daily in the treatment of symptomatic Clostridium Difficile infections. Drugs Reviewed and Not Listed The review of the following found that they did not offer a significant therapeutic and/or cost advantage over existing therapies. Requests for special authorization will not be considered. Product Strength DIN MFR Indication Apremilast (Otezla ) 10mg tablet mg tablet CEL Moderate-to-severe plaque psoriasis Apremilast (Otezla ) 10mg tablet mg tablet CEL Psoriatic arthritis Denosumab (Xgeva ) 120mg/1.7mL single-use vial AGA Prevention of skeletal-related events due to bone metastases from breast cancer New Brunswick Drug Plans 5 December 2017

6 Denosumab (Xgeva ) 120mg/1.7mL single-use vial AGA Prevention of skeletal-related events due to bone metastases from solid tumours Oxtriphylline and guaifenesin (Choledyl Expectorant Elixir) 100mg/50mg/5mL oral solution ERF Symptomatic relief of reversible bronchoconstriction and loosen phlegm New Brunswick Drug Plans 6 December 2017