Cost Effectiveness Recommendations For Kentucky Retirement Systems MTM Plan 2011

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1 Medication Tier 2 options Tier 1 options Nexium- Tier 3 Aciphex Lansoprazole Omeprazole Pantoprazole Crestor- Tier 3 Lipitor Simvastatin Vytorin- Tier 3 Atacand- Tier 3 Avapro Benicar Cozaar Micardis Tevetan Aggrenox- Tier 3 Boniva- Tier 3 Forteo- Tier 3 with PA Celebrex- Tier 3 Diovan Effient Plavix Simvastatin Losartan Cilostazol Dipyridamole Alendronate Alendronate Diclofenac Etodolac Ibuprofen Meloxicam Nabumetone Naproxen Piroxicam Lyrica Cymbalta Amitriptyline Gabapentin Uloric- Tier 3 Colcrys Allopurinol Probenacid Lumigan- Tier 2 Travatan Z Xalatan Alvesco- Tier 3 Flonase Nasacort Omnaris Rhinocort aqua Veramyst Atrovent- Tier 3 Frova- Tier 3 Imitrex Sumavel Dosepro Zomig ZMT Asmanex Flovent Nasonex Pulmicort QVAR Spiriva Maxalt Treximet Zomig Latanoprost Flunisolide Fluticasone Sumatriptan Copayment schedules are as follows. All maintenance medications are available as 90 day supplies. 30 day supply Tier 1: $10 90 day supply Tier 1: $20 Tier 2: $30 Tier 2: $60 Tier 3: $55 Tier 3: $110

2 Suggested wording of recommendations Nexium Clinical: This is a cost effectiveness alert. Our claims records indicate that this patient is currently prescribed Nexium. To help lower patient medication co-pays you may want to consider switching to a generic alternative such as Omeprazole, Pantoprazole or Lansoprazole if clinically Patient: You are taking a medication called Nexium that has a Tier 3 co-pay. There are several other medications in the same class that are available as a generic that have a Tier 1 co-pay. Switching to a generic could save you money each month. Talk to your doctor about considering Omeprazole, Pantoprazole or Lansoprazole, if Aciphex Clinical: This is a cost effectiveness alert. Our claims records indicate that this patient is currently prescribed Aciphex. To help lower patient medication co-pays you may want to consider switching to a generic alternative such as Omeprazole, Pantoprazole or Lansoprazole if clinically Patient: You are taking a medication called Aciphex that has a Tier 3 co-pay. There are several other medications in the same class that are available as a generic that have a Tier 1 co-pay. Switching to a generic could save you money each month. Talk to your doctor about considering Omeprazole, Pantoprazole or Lansoprazole, if Crestor Clinical: This is a cost effectiveness alert. This patient is currently prescribed Crestor 5 mg. To help lower patient medication co-pays you may want to consider switching to a lower cost generic alternative such as Simvastatin 40 mg, if clinically Patient: You are taking a cholesterol medication called Crestor 5 mg which has a Tier 3 co-pay. There are other medications in this same class that are available as generics which could save you money each month. Talk to your doctor about considering Simvastatin which has a Tier 1 co-pay, if If you are switched to Simvastatin the equivalent dose is 40 mg and it is most effective when taken at bedtime. Clinical: This is a cost effectiveness alert. Our claims records indicate that this patient is currently prescribed Crestor 10 mg. To help lower patient medication co-pays you may want to consider switching to a lower cost alternative such as Lipitor 40 mg, if clinically Patient: You are taking a cholesterol medication called Crestor 10 mg which has a Tier 3 co-pay. There is another medication in this same class that has a Tier 2 co-pay which could save you money each month. Talk to your doctor about considering Lipitor, if If you are switched to Lipitor the equivalent dose is 40 mg. Vytorin Patient: Vytorin (Tier 3 copay) is a combination of two drugs: Zetia and Simvastatin. There are no other medications in the same class as Zetia (Tier 3 copay) and it is not available as a generic. Simvastatin is available by itself as a Tier 1 copay. There are two other generic medications in the same class as Simvastatin that are also Tier 1 copay: Pravastatin and Lovastatin. You are currently taking Simvastatin??mg. If you switch to Pravastatin or Lovastatin then the equivalent dose would be?? mg.

3 Dose Conversion Table for Statins: ARBs Clinical: This is a cost effectiveness alert. This patient is currently prescribed Atacand, Avapro, Benicar, Cozaar, Micardis, Tevetan. To help lower patient medication co-pays you may want to consider switching to a generic alternative such as Losartan, if clinically Patient: You are taking a medication for high blood pressure called Atacand, Avapro, Benicar, Cozaar, Micardis, Tevetan. This has a Tier 3 co-pay. There is another medication in this same class that is available as a generic called Losartan. Losartan has a Tier 1 co-pay. Switching to a generic could save you money each month. Ask your doctor about considering Losartan if Clinical: This is a cost effectiveness alert. This patient is currently prescribed Atacand, Avapro, Benicar, Cozaar, Micardis, Tevetan. To help lower patient medication co-pays you may want to consider switching to a lower cost alternative such as Diovan, if clinically Patient: You are taking a medication for high blood pressure called Atacand, Avapro, Benicar, Cozaar, Micardis, Tevetan. This has a Tier 3 co-pay. There is another medication in this same class that is a lower cost alternative called Diovan. Diovan has a Tier 2 co-pay. Switching to Diovan could save you money each month. Ask your doctor about considering Diovan if appropriate Dipyridamole Clinical: This is a cost effectiveness alert. This patient is currently prescribed Aggrenox. To help lower patient medication co-pays you may want to consider switching to a generic alternative such as Dipyridamole, if clinically

4 Patient: You are taking a medication to prevent stroke called Aggrenox. This has a Tier 3 co-pay. There is another medication in this same class that is available as a generic called Dipyridamole. Dipyridamole has a Tier 1 co-pay. Switching to a generic could save you money each month. Ask your doctor about considering Dipyridamole, if Boniva Clinical: This is a cost effectiveness alert. This patient is currently prescribed Boniva. To help lower patient medication co-pays you may want to consider switching to a generic alternative such as Alendronate, if clinically Patient: You are taking an osteoporosis medication called Boniva. This has a Tier 3 co-pay. There is another medication in this same class that is available as a generic called Alendronate. Alendronate has a Tier 1 co-pay. Switching to a generic could save you money each month. Ask your doctor about considering Alendronate, if Forteo Clinical: This is a cost effectiveness alert. This patient is currently prescribed Forteo. To help lower patient medication co-pays you may want to consider switching to a generic alternative such as Alendronate, if clinically Patient: You are taking an osteoporosis medication called Forteo. This has a Tier 3 co-pay. There is another medication in this same class that is available as a generic called Alendronate. Alendronate has a Tier 1 co-pay. Switching to a generic could save you money each month. Ask your doctor about considering Alendronate, if Celebrex Clinical: This is a cost effectiveness alert. This patient is currently prescribed Celebrex. To help lower patient medication co-pays you may want to consider switching to a generic alternative such as Diclofenac, Meloxicam, or Nabumetone, if clinically All NSAIDs should be used with caution in patients over the age of 65. Elderly patients are at greater risk of increased risk of serious gastrointestinal adverse events including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. These agents should only be prescribed for acute use in these patients. Patient: You are taking a medication for pain called Celebrex. This has a Tier 3 co-pay. There are similar medications available as generics called Diclofenac, Meloxicam, or Nabumetone. These medications have a Tier 1 co-pay. Switching to a generic could save you money each month. Ask your doctor about considering Diclofenac, Meloxicam, or Nabumetone, if Lyrica Clinical: This is a cost effectiveness alert. This patient is currently prescribed Lyrica. To help lower patient medication co-pays you may want to consider switching to a generic alternative such as Gabapentin, if clinically When switching from Lyrica to Gabapentin, Lyrica should be discontinued for 1 week prior to Gabapentin initiation. Patient: You are taking a medication for pain called Lyrica. This has a Tier 3 co-pay. There is another medication in this same class that is available as a generic called Gabapentin. Gabapentin has a Tier 1 co-pay. Switching to a generic could save you money each month. Ask your doctor about considering Gabapentin, if Uloric Clinical: This is a cost effectiveness alert. This patient is currently prescribed Uloric. To help lower patient medication co-pays you may want to consider switching to a generic alternative such as Allopurinol, if clinically

5 Patient: You are taking a medication for gout called Uloric. This has a Tier 3 co-pay. There is another medication in this same class that is available as a generic called Allopurinol. Allopurinol has a Tier 1 co-pay. Switching to a generic could save you money each month. Ask your doctor about considering Allopurinol, if Lumigan/Travatan Z Clinical: This is a cost effectiveness alert. This patient is currently prescribed Lumigan, Travatan Z, or Xalatan. To help lower patient medication co-pays you may want to consider switching to a generic alternative such as Latanoprost, if clinically Patient: You are taking a medication for glaucoma called Lumigan, Travatan Z, or Xalatan. This has a Tier 2 copay. There is another medication in this same class that is available as a generic called Latanoprost. Latanoprost has a Tier 1 co-pay. Switching to a generic could save you money each month. Ask your doctor about considering Latanoprost if Veramyst, Alvesco, Omnaris, Rhinocort aqua Clinical: This is a cost effectiveness alert. This patient is currently prescribed Veramyst, Alvesco, Omnaris, Rhinocort aqua. To help lower patient medication co-pays you may want to consider switching to a generic alternative such as Fluticasone, if clinically Patient: You are taking a medication for asthma/allergies called Veramyst, Alvesco, Omnaris, Rhinocort aqua. This has a Tier 3 co-pay. There is another medication in this same class that is available as a generic called Fluticasone. Fluticasone has a Tier 1 co-pay. Switching to a generic could save you money each month. Ask your doctor about considering Fluticasone if Atrovent Clinical: This is a cost effectiveness alert. This patient is currently prescribed Atrovent. To help lower patient medication co-pays you may want to consider switching to a lower cost alternative such as Spiriva, if clinically Patient: You are taking a medication for COPD called Atrovent. This has a Tier 3 co-pay. There is another medication in this same class that is available as a generic called Spiriva. Spiriva has a Tier 1 co-pay. Switching to a generic could save you money each month. Ask your doctor about considering Spiriva if Lunesta to zolpidem/zaleplon Clinical: This is a cost effectiveness alert. This patient is currently prescribed Lunesta. To help lower patient medication co-pays you may want to consider switching to a generic alternative such as Zolpidem, if clinically Patient: You are taking a medication for insomnia called Lunesta. This has a Tier 3 co-pay. There is another medication in this same class that is available as a generic called Zolpidem. Zolpidem has a Tier 1 co-pay. Switching to a generic could save you money each month. Ask your doctor about considering Zolpidem if Triptans Clinical: This is a cost effectiveness alert. This patient is currently prescribed Frova, Imitrex, Sumavel Dosepro, Zomig ZMT. To help lower patient medication co-pays you may want to consider switching to a generic alternative such as Sumatriptan, if clinically Patient: You are taking a medication for migraines Frova, Imitrex, Sumavel Dosepro, Zomig ZMT. This has a Tier 3 co-pay. There is another medication in this same class that is available as a generic called Sumatriptan. Sumatriptan has a Tier 1 co-pay. Switching to a generic could save you money each month. Ask your doctor about considering Sumatriptan if