PA Start Date Therapeutic Class P&T Review Date 7/1/13 TOP$ (Single Drug Reviews) include:
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1 Maryland Department of Health and Mental Hygiene PDL Prior Authorization Implementation Schedule PA Start Therapeutic Class P&T Review 7/1/13 5/2/13 Antidepressants, Other (ForfivoXL) COPD Agents (Tudorza Pressair) Cytokine and CAM Antagonists (Xeljanz) Neuropathic Pain (Lyrica Solution) Ophthalmics, Anti-Inflammatories (Ilevro, Lotemax Gel) Stimulants and Related Agents (Quillivant, XR, Kapvay ER Dose Pack) 1/1/13 TOP$ (New Classes) include: 11/8/12 Neuropathic Pain Analgesics, Narcotics Short Acting (Primlev, Subsys) Antiparasitics, Topical (Sklice) Erythropoiesis Stimulating Proteins (Omontys) Hypoglycemics, Incretin Mimetics/Enhancers (Janumet XR) 7/1/12 Anticonvulsants (Onfi) NSAIDs (Duexis) 5/10/12 1/1/12 TOP$ (New Classes) include: Antihypertensives, Sympatholytics Ophthalmic Antibiotic/Steroid Combinations Androgenic Agents (Axiron) Angiotensin Modulators (Edarbi) Antibiotics, GI (Dificid) Anticoagulants (Xarelto) Hepatitis C Agents (Ribapak, Incivek, Victrelis) Hypoglycemics, Incretin Mimetics/ Enhancers (Tradjenta) 7/1/11 Antidepressants, Other (Oleptro ER) Antihistamines, Minimally Sedating (Claritin Liqui-Gels) Antipsychotics (Latuda) Glucocorticoids, Inhaled (Dulera) Ophthalmics, Antibiotics (Moxeza and Zymaxid) Ophthalmics for Allergic Conjunctivitis (Lastacaft) Ophthalmics, Anti-Inflammatories (Bromday) 11/3/11 5/24/11
2 PA Start Therapeutic Class P&T Review Sedative Hypnotics (Silenor and Zolpimist) Stimulants and Related Agents (Kapvay) 10/1/10 TOP$ (New Classes) include: Antibiotics, Inhaled Bile Salts Acne Agents, Topical (SE BPO) Analgesics, Narcotics Long (Exalgo) Analgesics, Narcotics Short (Rybix ODT) Immunosuppressives, Oral (Zortress) MS Agents (Ampyra) Proton Pump Inhibitors (Zegerid OTC) 8/19/10 4/1/10 TOP$ (New Classes) include: Colony Stimulating Factors Fibromyalgia Agents Immunosuppressives, Oral Antifungals, Oral (Terbinex) Anti-Hyperuricemics (Colcrys) Antiparasitics, Topical (Ulesfia) Antipsychotics (Saphris; Invega Sustenna) Cytokine and CAM Antagonists (Simponi; Stelara) Hypoglycemics, Incretins (Onglyza) NSAIDs (Zipsor) Ophthalmics for Allergic Conjunctivitis (Bepreve) Ophthalmics, Anti-Inflammatories (Acuvail; Ozurdex) Ophthalmics, Antibiotics (Besivance) Pancreatic Enzymes (Zenpep) Platelet Aggregation Inhibitors (Effient) Stimulants and Related Agents (Intuniv; Nuvigil) 10/1/09 TOP$ (New Classes) include: Antihyperuricemics Antifungals, Topical Tetracyclines Analgesics, Short-Acting Narcotics (Dilaudid Liquid) Anticonvulsants (Banzel; Vimpat) Bladder Relaxants (Toviaz) BPH Agents (Rapaflo) Hypoglycemics, Meglitinides (Prandimet) 3/2/10 8/20/09
3 PA Start Therapeutic Class P&T Review Lipotropics, Other (Trilipix) Phosphate Binders (Eliphos) Proton Pump Inhibitors (Kapidex; Prilosec Suspension) Ulcerative Colitis Agents (Apriso;sfRowasa) 4/1/09 TOP$ (New Class) includes: PAH Agents, Oral Antidepressants, Other (Venlafaxine ER) Antiemetics (Sancuso) Antifungals, Topical (Xolegel Corepak; Xolegel Duo) Anti-Parkinson s Agents (Requip XL) Glucocorticoids, Inhaled (Alvesco) Intranasal Rhinitis Agents (Patanase) 10/1/08 TOP$ (New Classes) include: Analgesics/Anesthetics, Topical Antibiotics, Vaginal Antiparasitics, Topical Pancreatic Enzymes Acne Agents, Topical (Atralin) Antihistamines, Minimally Sedating (Allegra ODT; cetirizine; cetirizine D; cetirizine syrup) Beta Blockers (Bystolic) Lipotropics, Other (Fenoglide) Lipotropics, Statins (Simcor) Phosphate Binders (Renvela) 4/1/08 TOP$ (New Classes) include: Antibiotics, GI Impetigo Agents, Topical Skeletal Muscle Relaxants Alzheimer s Agents (Exelon Patch) Antifungals, Topical (Extina) Anti-Parkinson s Agents (Neupro Patch) Bronchodilators, Long-Acting Beta Agonists (Brovana and Perforomist) Glucocorticoids, Inhaled (Symbicort) Intranasal Rhinitis Agents (Veramyst) Leukotriene Modifiers (Zyflo CR) Ophthalmics, Fluoroquinolones and Macrolides (AzaSite) 2/5/09 8/21/08 2/14/08
4 PA Start Therapeutic Class P&T Review Stimulants and Related Agents (Vyvanse) 10/2/07 TOP$ (New Classes) include: Hepatitis B Agents Ophthalmics, NSAIDs Atypical Antipsychotics (to be implemented 1/1/08) Acne Agents, Topical (Ziana) Analgesics, Short-Acting Narcotics (Fentora) Antihistamines, Minimally Sedating (Allegra Syrup and Claritin Chewable OTC) Beta Blockers (Coreg CR) Growth Hormones (Omnitrope) Proton Pump Inhibitors (Nexium Suspension) Ulcerative Colitis Agents (Lialda) 4/3/07 Antifungals, Oral (Noxafil) Antifungals, Topical (Xolegel) Anti-Parkinson s Agents (Azilect and Zelapar) Hypoglycemics, Insulins and Related Agents (Exubera) Stimulants and Related Agents (Daytrana) 10/3/06 TOP$ (New Class) includes: Androgenic Agents Analgesic Narcotics (Ultram ER) Hypoglycemics, TZDs (Avandaryl) Proton Pump Inhibitors (Zegerid- Oral Solid Forms) 4/4/06 TOP$ (New Classes) include: Acne Agents, Topical Anticonvulsants Bone Resorption Suppressants (Actonel with Calcium; Fortical) Fluoroquinolones, Oral (Proquin XR) Glucocorticoids, Inhaled (Asmanex) 10/6/05 TOP$ (New Classes) include: Alzheimer s Agents Anti-Parkinson s Agents 8/9/07 2/8/07 8/17/06 2/9/06 8/18/05
5 PA Start Therapeutic Class P&T Review Atopic Dermatitis Hypoglycemics, Metformins Ophthalmics, Glaucoma Agents Platelet Aggregation Inhibitors Analgesics, Narcotics (Combunox) Sedative Hypnotics (Lunesta) 7/6/05 TOP$ (New Classes) include: 3/8/05 Anticoagulants, Injectable Growth Hormones (CLINICAL PA also) Sedative Hypnotics Ulcerative Colitis Agents 1/23/05 Bronchodilators, Anticholinergics 12/2/04 11/3/04 Antidepressants (SSRIs)- Symbyax ONLY 9/23/04 Antimigraine Triptans- Relpax ONLY 7/21/04 Antidepressants, SSRIs Pexeva; Antivirals 6/10/04 Valtrex; Beta Blockers Innopran XL; Disease Modifying Antirheumatic Drugs; Erectile Dysfunction Agents; Erythropoietins; Hepatitis C Agents; Multiple Sclerosis Agents; NSAIDs Prevacid Naprapac; Ophthalmics, Allergic Conjunctivitis -- Elestat 5/19/04 Antihistamines, Minimally Sedating; Phosphate 3/18/04 Binders 5/12/04 Antidepressants, Other; Beta Blockers Inderal LA 3/18/04 and Innopran XL; Bladder Relaxants; Lipotropics, Statins Crestor; Ophthalmics, Allergic Conjunctivitis; Ophthalmics, Antibiotics; Otics, Antibiotics 2/4/04 Antidepressants, SSRIs; Antiemetics; Beta-Agonist 12/11/04 Bronchodilators; Claudication Agents; Hypoglycemics, Meglitinides; Stimulants and Related Agents 1/21/04 Antifungals, Oral; Cephalosporins and Related 10/23/03 Antibiotics; Antifungals, Topical; Hypoglycemics, Insulins 1/7/04 Antimigraine Agents, Triptans; Analgesics, Narcotic; 10/23/03 Bone Resorption Suppression and Related Agents; Estrogen Agents, Combination; Estrogen Agents, Oral and Transdermal 12/17/03 Macrolides; Antivirals; Hypoglycemics, 10/23/03 Thiazolidinediones; Fluoroquinolones 12/03/03 ACE Inhibitors; Calcium Channel Blocking Agents; 9/10/03 Lipotropics, Statins 11/19/03 Angiotensin Receptor Blockers; Nasal 9/10/03 Corticosteroids; NSAIDs/COX II Inhibitors 11/05/03 ACE Inhibitor/Calcium Channel Blocker Combination; Benign Prostatic Hyperplasia; Beta Blockers; Inhaled Corticosteroids; Leukotriene Receptor Antagonists; Lipotropics, Other; Proton Pump Inhibitors 9/10/03
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