Kentucky Pharmacy and Therapeutics Advisory Committee meeting minutes Triton Park Blvd., Louisville, KY April 26, p.m.-3 p.m.

Size: px
Start display at page:

Download "Kentucky Pharmacy and Therapeutics Advisory Committee meeting minutes Triton Park Blvd., Louisville, KY April 26, p.m.-3 p.m."

Transcription

1 Kentucky Pharmacy and Therapeutics Advisory Committee meeting minutes Triton Park Blvd., Louisville, KY April 26, p.m.-3 p.m. Attendees: Andrew Rudd Steven Broudy Setifah Jordan Keith Huff Dean Christy Decisions: 1. WARFARIN PRODUCTS Warfarin Products NTI Category review PRODUCTS INCLUDED IN THE REVIEW: COUMADIN TABLETS, JANTOVEN TABLETS, WARFARIN TABLETS CURRENT PREFERRED PRODUCTS: COUMADIN, JANTOVEN AND WARFARIN 2. BIPOLAR PRODUCTS Coumadin will move from Preferred to Non- Preferred (current utilizers will be grandfathered) Bipolar Disorder-NTI Category review PRODUCTS INCLUDED IN THE REVIEW: EQUETRO CAPSULE, LITHIUM CARBONATE CAP, LITHIUM CARBONATE ER TAB, LITHIUM 8 MEQ/5 ML SOLUTION, LITHOBID ER 300 MG TABLET CURRENT PREFERRED PRODUCTS: EQUETRO CAPSULE, LITHIUM CARBONATE CAP LITHIUM CARBONATE ER TAB Equetro will move from Preferred to Non-Preferred ( maintain Prior Authorization) Lithium 8 meq/5 ml will move from Non-Preferred to Preferred Anthem Blue Cross and Blue Shield Medicaid is the trade name of Anthem Kentucky Managed Care Plan, Inc., independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. WEBPAKY May 2017

2 3. THEOPHYLLINE PRODUCTS Anthem Blue Cross and Blue Shield Medicaid Page 2 of 14 Theophylline Products- NTI Category Review PRODUCTS INCLUDED IN THE REVIEW: ELIXOPHYLLIN 80 MG/15 ML ELIX, THEOPHYLLINE 80 MG/15 ML SOLN, THEOPHYLLINE ER 400 MG TABLET, THEOPHYLLINE ER 600 MG TABLET, THEOPHYLLINE ER 100 MG TABLET, THEOPHYLLINE ER 200 MG TABLET, THEOPHYLLINE ER 300 MG TAB, THEOPHYLLINE ER 450 MG TAB, THEO-24 ER 100 MG CAPSULE, THEO-24 ER 200 MG CAPSULE, THEO-24 ER 300 MG CAPSULE, THEO-24 ER 400 MG CAPSULE CURRENT PREFERRED PRODUCTS: ELIXOPHYLLIN 80 MG/15 ML ELIX, THEOPHYLLINE 80 MG/15 ML SOLN, THEOPHYLLINE ER 100 MG TABLET, THEOPHYLLINE ER 200 MG TABLET, THEOPHYLLINE ER 300 MG TAB, THEOPHYLLINE ER 450 MG TAB, THEO-24 ER 100 MG CAPSULE, THEO-24 ER 200 MG CAPSULE, THEO-24 ER 300 MG CAPSULE, THEO-24 ER 400 MG CAPSULE Elixophyllin 80 mg/15 ml elixir (Brand) will move from Preferred to Non-Preferred (current utilizers will be grandfathered) Theophylline 400 mg ER and 600 mg ER tablet will move from Non-Preferred to Preferred Theo-24 ER capsule (Brand) will move from Preferred to Non-Preferred (current utilizers will be grandfathered) 4. LAMA AND LAMA/LABA PRODUCTS LAMA and LAMA/LABA Products Category review PRODUCTS INCLUDED IN THE REVIEW: SEEBRI NEOHALER 15.6 MCG INHALER, SPIRIVA 18 MCG CP-HANDIHALER, SPIRIVA RESPIMAT 2.5 MCG INHALER, SPIRIVA RESPIMAT 1.25 MCG INHALER, TUDORZA PRESSAIR 400 MCG INHALER, INCRUSE ELLIPTA 62.5 MCG INHALER, ANORO ELLIPTA MCG INHALER, UTIBRON NEOHALER MCG, STIOLTO RESPIMAT INHAL SPRAY, BEVESPI AEROSPHERE INHALER CURRENT PREFERRED PRODUCTS: SPIRIVA 18 MCG CP-HANDIHALER, SPIRIVA RESPIMAT 2.5 MCG INH, SPIRIVA RESPIMAT 1.25 MCG INHALER, ANORO ELLIPTA MCG INHALER Spiriva 18 mcg Handihaler will move from Preferred to Non-Preferred with Step Edit

3 5. VAGINAL ESTROGENS Anthem Blue Cross and Blue Shield Medicaid Page 3 of 14 Vaginal Estrogens Category review PRODUCTS INCLUDED IN THE REVIEW: ESTRACE 0.01% CREAM, ESTRING 2 MG VAGINAL RING, VAGIFEM 10 MCG VAGINAL TAB, YUVAFEM 10 MCG VAGINAL INSERT, PREMARIN VAGINAL CREAM, FEMRING 0.05 MG VAGINAL RING, FEMRING 0.10 MG VAGINAL RING CURRENT PREFERRED PRODUCTS: PREMARIN VAGINAL CREAM Premarin vaginal cream will move from Preferred to Non-Preferred with Step Edit Yuvafem 10mcg vaginal insert (Generic Vagifem) will move from Non-Preferred to Preferred 6. PROGESTINS Progestins (Makena) Category review PRODUCTS INCLUDED IN THE REVIEW: HYDROXYPROGESTERONE 1.25 G/5ML, MAKENA 1;250 MG/5 ML VIAL, MAKENA 250 MG/ML VIAL CURRENT PREFERRED PRODUCTS: MAKENA 1;250 MG/5 ML VIAL and MAKENA 250 MG/ML VIAL Hydroxyprogesterone 1.25 g/5 ml will move from Non-Preferred To Preferred (with Prior Authorization) 7. NALOXONE PRODUCTS Naloxone Products Category review PRODUCTS INCLUDED IN THE REVIEW: NALOXONE 0.4 MG/ML SYRINGE, NALOXONE 2 MG/2 ML SYRINGE, NALOXONE 0.4 MG/ML VIAL, NALOXONE 4 MG/10 ML VIAL, NARCAN 4 MG NASAL SPRAY, EVZIO 0.4 MG AUTO-INJECTOR, EVZIO 2 MG AUTO-INJECTOR, BD LUER-LOK SYRINGE 1ML 20GX1'' CURRENT PREFERRED PRODUCTS: NALOXONE 0.4 MG/ML SYRINGE, NALOXONE 2 MG/2 ML SYRINGE, NARCAN 4 MG NASAL SPRAY Naloxone 0.4 mg/ml vial will move from Non-Preferred to Preferred Naloxone 4 mg/10 ml vial will move from Non-Preferred to Preferred

4 Page 4 of 14 BD Luer-lok syringe 1ml 20gx1'' will move from Non-Preferred to Preferred 8. TOPICAL METRONIDAZOLE Topical Metronidazole Category Review PRODUCTS INCLUDED IN THE REVIEW: METROCREAM 0.75% CREAM, METROGEL TOPICAL 1% GEL, METROGEL TOPICAL 1% PUMP, METROLOTION TOPICAL 0.75%, METRONIDAZOLE TOPICAL 0.75% GEL, METRONIDAZOLE TOPICAL 1% GEL, METRONIDAZOLE 0.75% CREAM, METRONIDAZOLE 0.75% LOTION, METRONIDAZOLE TOP 1% GEL PUMP, NORITATE 1% CREAM, ROSADAN 0.75% GEL, ROSADAN 0.75% CREAM CURRENT PREFERRED PRODUCTS: METRONIDAZOLE TOPICAL 0.75% GL, METRONIDAZOLE 0.75% CREAM, METRONIDAZOLE 0.75% LOTION, ROSADAN 0.75% GEL, ROSADAN 0.75% CREAM Metronidazole topical 1% gel will move from Non-Preferred to Preferred Metronidazole topical 1% gel pump will move from Non-Preferred to Preferred 9. ACNE- TOPICAL RETINOIDS Acne-Topical Retinoids New Product PRODUCTS INCLUDED IN THE REVIEW: OTC DIFFERIN 0.1% GEL CURRENT PREFERRED PRODUCTS: ADAPALENE GEL,ADAPALENE CREAM,TRETINOIN GEL, TRETINOIN CREAM, TRETINOIN MICRO GEL, TRETINOIN EMOLLIENT CREAM OTC Differin 0.1% Gel will move from Non-Preferred to Preferred 10. MISCELLANEOUS UTILIZATION MANAGEMENT EDITS Anthem Blue Cross and Blue Shield Medicaid (Anthem) Medicaid UM Alignment Topical Steroids Quantity Limit Alignment Reason for Review Some need to be revised with most recent P&T limits. Revise QL with most recent P&T -approved limits.

5 Page 5 of 14 Insulin Quantity Limit Alignment Reason for Review Some need to be revised with most recent P&T limits. Add/ revise QL with most recent P&T -approved limits. Topical Lidocaine Quantity Limit Alignment Reason for Review Some need to be revised with most recent P&T limits. Add/ revise QL with most recent P&T -approved limits. Cost of Care Opportunities Class Drug Recommended Edit Targeted Immune Modulators Pulmonary Arterial Hypertension Xeljanz XR I. Maintain PA and trial of preferred products. Revatio Oral Suspension I. Add criteria to verify individual is unable to swallow tablets. Revise PA criteria documents PA for appropriate use is currently active. ss N ew UM Edits on New Drugs Class Drug Recommended Edit Atopic Dermitis Nausea and Vomitting of Pregnancy Eucrisa Bonjesta Prior Authorization I IV. Individual is 2 years of age or older; AND Has a diagnosis of mild to moderate atopic dermatitis; AND V. Had a trial of and inadequate response or intolerance to one topical corticosteroid unless use is not acceptable. QL: 100gm per 30 days. Prior Authorization I. Female, 18 years of age or older; AND I IV. Nausea and vomiting of pregnancy; AND Trial of and inadequate response to conservative management; AND Trial of immediate-release doxylamine and pyridoxine. Not be approved for: Hyperemesis gravidarum. QL: 2 tablets per day.

6 Page 6 of 14 Class Drug Recommended Edit Cancer Rubraca Prior Authorization I. Diagnosis of advanced ovarian cancer; AND I A deleterious BRCA mutation (verified by diagnostic testing); AND Trial of and insufficient response, to at least two prior chemotherapy treatments. QL 200mg: 6 tablets per day. QL 300mg: 4 tablets per day. Immune Globulin Cuvitru Prior Authorization Step I. Clinically appropriate use defined by Anthem MPTAC. I. Trial of 1 preferred product unless preferred products are not FDA approved, or medically accepted, for the prescribed indication and Cuvitru is; OR Preferred products are not acceptable due to concomitant clinical condition. Antiplatelet Yosprala Prior Authorization I. Documentation of medical necessity for Yosprala (aspirin delayed-release/omeprazole) is provided to define the inadequate response to the agents when used separately AND the medical reason the combination agent is clinically necessary. QL: 1 tablet per day. Constipation Linzess 72mcg Relistor Tablet Trulance Prior Authorization I. Individual is 18 or older (Trulance, Linzess). I QL Appropriate diagnosis based on FDA approved indications. Trial of generic Miralax. Linzess 72mcg: 1 capsule per day. Relistor 150mg: 3 tablets per day. Trulance: 1 tablet per day. Rh Immune Globulins MicRhoGam MicRhoGam RhoGam QL: 2 fills per 365 days.

7 Page 7 of 14 Class Drug Recommended Edit RhoGam Plus Pancreatic Enzyme Replacement Therapies (PERT) Pancreaze 2,600 units Pertzye 4,000 units QL: 25 capsules per day. Contraceptives Taytulla QL: 1 capsule per day. Contraceptives Xulane QL: 3 patches per 28 days. Topical Antifungals Jublia (8mL) Kerydin (10mL) QL: 1 bottle per 30 days. Dry Eye Restasis (multidose) QL: 1 bottle per 28 days Asthma ArmonAir Respiclick Step edit: Trial of 2 preferred ICS. QL: 1 inhaler (60 doses) per 30 days. Asthma AirDuo Respiclick Step: I. Individual has a diagnosis of asthma and has had a trial and inadequate response to one oral inhaled corticosteroid (ICS) agent; OR Individual has a diagnosis of (COPD). QL: 1 inhaler (60 doses) per 30 days. SGLT-2 (Diabetes) Synjardy XR Step: I. Trial and inadequate response or intolerance to metformin; OR Has a contraindication to metformin; AND QL: 2 tablets per day Duchenne Muscular Dystrophy (DMD) Emflaza Prior Authorization I. Individual is 5 years of age or older; AND I IV. Diagnosis of DMD; AND Had a 6 month trial of oral prednisone; AND Documentation has been provided for excessive weight-gain with prednisone; AND V. Weight gain is likely to be a direct result of prednisone use. Requests for continuation: I. Criteria ensures individual has returned to, and

8 Page 8 of 14 Class Drug Recommended Edit maintained, baseline status on growth chart. Approval Duration: 6 months Add Prior authorization, Step Therapy and or quantity limits to new drugs Clinical Criteria to Non-Preferred Drug Current Status Reason for Review Non-preferred with default NP criteria. Drug specific criteria is preferred for 1 or more of the following reasons: No viable preferred products to offer as alternative. P&T approved criteria limit number of preferred products to 1 rather than trial of 2 products. Drug specific criteria more clearly defines preferred products. Alignment with Anthem use of PA criteria. Class Drug Drug Specific Edit Spinal Muscular Atrophy Dry Eye Post-herpetic Neuralgia Antidepressant Immune Globulin Tuberculosis Spinraza Lacrisert Gralise EMSAM GamaSTAN S/D Cycloserine Criteria aligned with Anthem Medical policy for clinically appropriate use. Approval Duration: 6 months Individual is using to treat moderate to severe dry eye syndromes or related conditions; AND Individual has had a trial and inadequate response to one artificial tear agent. Individual is 18 years of age or older; AND Has a diagnosis of post-herpetic neuralgia; AND Had a trial of immediate release gabapentin Individual is 18 years of age or older; AND Individual has a diagnosis of major depressive disorder (MDD). Clinically appropriate indication based on FDAapproved indications, medically accepted off-label use and relevant guidelines. Individual has a diagnosis of pulmonary or extrapulmonary tuberculosis; AND The causative organisms are susceptible to cycloserine; AND Primary medications have proven inadequate; AND Use is part of multi-drug regimen; OR Individual has a diagnosis of acute urinary tract infection; AND The causative agents are susceptible to cycloserine; AND

9 Page 9 of 14 Class Drug Drug Specific Edit Conventional therapy for causative organism has failed. Not approved if contraindicated or clinically inappropriate. Tuberculosis Ophthalmic Antibiotics Sirturo Blephamide Individual is 18 years of age or older; AND Individual has a diagnosis of pulmonary multi-drug resistant tuberculosis (MDR-TB); AND Individual is unable to use an effective regimen for treatment of MDR-TB; AND Use is part of multi-drug regimen. Not approved if contraindicated or clinically inappropriate. L-Anthem to apply NP default criteria. Apply drug specific criteria to NP brands and generics.

10 Page 10 of 14 Revisions to Existing UM Edits PA Criteria Revisions Drug Edit Revision Daklinza and Sovaldi Clarify override criteria for the use in dual treatment-experienced individuals includes those with Genotype 3, without cirrhosis, and a prior trial of Sovaldi and ribavirin. Clarify criteria and approval durations for use with or without ribavirin. Update duration of treatment table based on label and AASLD/IDSA guidance. Hepatitis C Technivie and Ombitasvir + Paritaprevir + Ritonavir + Dasabuvir Agents Update to include additional agents excluded for concomitant use based on labeled drug interactions. All Add note to include a black box warning for risk of hepatitis B reactivation in HCV-HBV co-infected individuals. Wording and formatting updates to clarify protocol, rationale, and override criteria sections. Cancer Farydak Add carfilzomib as an option for combination therapy. Antifungals Noxafil Onmel Sporanox Terbinex Vfend Update prior authorization criteria based on label, relevant compendia and guidelines. Antipsychotics Invega Sustenna Clarify use as either monotherapy or adjunctive therapy. Antiplatelet Zontivity Add exclusionary criteria when contraindicated or clinically inappropriate. COPD Daliresp Update criteria based on clinical recommendations Add exclusion for use with concomitant strong cytochrome P450 inducers as recommended per label.

11 Page 11 of 14 Drug Edit Revision Gout Colcrys Mitigare Update criteria with an approval for recurrent pericarditis per off-label policy. Zurampic Add requirement for trial and inadequate response (unable to achieve target serum uric acid levels) to allopurinol. Remove exclusionary criteria that is duplicative. Add exclusionary criteria for use while contraindicated. Cancer Imbruvica Add criteria for new FDA indication for Marginal Zone Lymphoma. Transmucosal Immediate Release Fentanyl Actiq Fentora, etc Add exclusionary criteria for using for acute or postoperative pain, migraine headache pain, or noncancer related breakthrough pain. Antidepressant Cymbalta Irenka Remove benzodiazepines from edit as a potential prerequisite therapy for generalized anxiety disorder. Fibromyalgia Cymbalta Savella Revise diagnosis requirements for fibromyalgia. For fibromyalgia, update prior trial requirement from one agent to 2 agents for consistency within the class. Add remaining SSRIs as potential prerequisite therapy for fibromyalgia. Minor wording updates; updates to referenced guidelines. Fibromyalgia Lyrica Revise diagnosis requirements for fibromyalgia. Add remaining SSRIs as potential prerequisite therapy for fibromyalgia. Minor wording updates; updates to referenced guidelines. Osteoporosis Forteo Limit therapy to 24 months. Pulmonary Arterial Hypertension Tracleer Tracleer Letairis Opsumit Include exclusion for use when baseline aminotransferase levels are elevated prior to initiating therapy per labeled recommendation. Exclude combination therapy use with another endothelin receptor antagonist (ERA) agent.

12 Page 12 of 14 Drug Edit Revision Orenitram Uptravi Adempas Exclude combination therapy use with another prostacyclin analog or prostacyclin receptor agonist. Include updated label contraindication for use in Pulmonary Hypertension associated with Idiopathic Interstitial Pneumonias (PH-IIP). Update PA criteria with the above revisions Step Therapy Criteria Revisions Class Drug Recommended Edit Methotrexate Auto-injector Otrexup, Rasuvo Revise and clarify requirements for trial of generic injectable methotrexate agent. Immune Globulins Carimune, Flebogamma, Gammagard, etc Remove general approval criteria allowing a nonpreferred agent when preferred agents have contraindications to use and not associated with the non-preferred agent. Insulin Afrezza Tresiba Humalog Addition of exception criteria for pregnancy category. Novolog, etc Topical Agents for Actinic Keratosis Efudex (brand), Fluoroplex, fluorouracil 0.5% cream, Tolak Revise override language for unique labeled/ offlabel indications Clarify and revise override language for concomitant clinical situations. Oral Atypical Antipsychotic Agents Abilify, Fanapt, Vraylar, etc Added specific language allowing for continuation of a non-preferred agent if individual is currently using the non-preferred agent Update criteria for Rexulti requiring diagnosis, use of antidepressant therapy and, a trial of aripiprazole. Antidepressants Fetzima Khedezla, etc Remove override criteria based on FDA-approved indication. Antidepressants Aplenzin Forfivo Added requirement for documentation regarding need for brand agent to be consistent with similar

13 Page 13 of 14 criteria Topical Antifungal for Nails Jublia, Kerydin, Penlac, etc Add requirement for trial of 1 preferred topical antifungal for the nails. Otic Antibiotic Cetraxal, Ciprodex, Cipro HC, Otovel Include age of the individual as an additional clinical scenario for agent approval when the preferred agent(s) are not indicated in that population. Symbicort Update to include override criteria allowing approval in individual s between the ages of 6 and 12 years based on recent FDA-expanded pediatric indication. Asmtha/ COPD Advair Symbicort Update wording and formatting to maintain Asthma-specific override criteria and applicable. Advair Symbicort Flovent Pulmicort Qvar ProAir Proventil Xopenex Allow approval of a dry powder inhaler (DPI) if only metered dose inhalers (MDIs) are preferred when the individual has a weak or ineffective inspiratory effort. Allow approval of a MDI if only DPIs are preferred when the individual has a lack of handbreath coordination. Inhaled Corticosteroid (ICS) Agents Asmanex, Pulmicort, Aerospan, Alvesco, etc Include override criteria allowing approval for a designated non-preferred pressurized metered dose inhaler when individual requires utilization of an external spacer or valved-holding chamber for medication administration. Update Step Therapy Criteria with above revisions Quantity Limit Revisions Class Drug Recommended Edit Antibiotic Zyvox Add limit for 1 fill per 30 days to current QL. 600mg tablet: 28 tablets per fill; 1 fill per 30 days 100 mg/5 ml: 900 ml per fill; 1 fill per 30 days Update Quantity Limit with above revisions

14 Page 14 of 14 Medical Policy and Clinical Guidelines Policy Number Policy Name Key Revisions DRUG DRUG DRUG DRUG DRUG CG-DRUG-14 CG-DRUG-16 CG-DRUG-28 CG-DRUG-29 Tumor Necrosis Factor Antagonists Bezlotoxumab (ZINPLAVA ) Vedolizumab (Entyvio ) Botulinum Toxin Hyaluronan Injections in Joints Other Than the Knee Dihydroergotamine Mesylate (DHE) Injection for the Treatment of Migraine or Cluster Headaches in Adults White Blood Cell Growth Factors Alglucosidase alfa (Lumizyme, Myozyme ) Hyaluronan Injections in the Knee Enbrel: decreased minimum age from 18 to 4 years-old for plaque psoriasis Consultant review added definitions of severe C. difficile Consultant review - removed latent TB testing Wording revision of Clinically Equivalent Cost Effective section New Clinically Equivalent Cost Effective section Minor criteria clarification Removed biosimiliar Filgrastim-sndz (Zarxio ) New Title. Myozyme removed from U.S. market Wording revision of Clinically Equivalent Cost Effective section

Quarterly pharmacy formulary change notice

Quarterly pharmacy formulary change notice Provider Bulletin June 2017 The formulary changes listed in the table below apply to all Anthem HealthKeepers Plus patients. These changes were reviewed and approved at the first quarter Pharmacy and Therapeutics

More information

Quarterly pharmacy formulary change notice

Quarterly pharmacy formulary change notice Provider Bulletin June 24, 2016 Summary of change The Pharmacy and Therapeutics Committee reviewed and approved the formulary changes listed in the table below on March 29, 2016. What this means to you

More information

Quarterly pharmacy formulary change notice

Quarterly pharmacy formulary change notice Quarterly pharmacy formulary change notice Summary of change: The Pharmacy and Therapeutics Committee (P&T) reviewed and approved the formulary changes listed in the table below on March 29, 2016. What

More information

Quarterly pharmacy formulary change notice

Quarterly pharmacy formulary change notice MEDICAID PROVIDER BULLETIN October 2018 The formulary changes listed in the table below were reviewed and approved at the second-quarter 2018 Pharmacy and Therapeutics Committee meeting. Effective October

More information

TRELEGY ELLIPTA (fluticasone-umeclidinium-vilanterol) aerosol powder

TRELEGY ELLIPTA (fluticasone-umeclidinium-vilanterol) aerosol powder TRELEGY ELLIPTA (fluticasone-umeclidinium-vilanterol) aerosol powder Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific

More information

MDI Bonanza. Dwayne Griffin, DO

MDI Bonanza. Dwayne Griffin, DO MDI Bonanza Dwayne Griffin, DO Bonanza 3. A MDI costing $200 - $500 per month SISYPHUS MDI Griffin Mountain Evolution of Deliver Systems for COPD in the US 2003 2009 2011 2013 2004 2012 2014 Prescribing

More information

Quarterly pharmacy formulary change notice

Quarterly pharmacy formulary change notice Quarterly pharmacy formulary change notice The formulary changes listed in the table below were reviewed and approved at our second quarter 2018 Pharmacy and Therapeutics Committee meeting. Effective October

More information

Quarterly pharmacy formulary change notice

Quarterly pharmacy formulary change notice Provider Bulletin October 2018 Quarterly pharmacy formulary change notice The formulary changes listed in the table below apply to all Anthem HealthKeepers Plus patients. The changes listed in the table

More information

Quarterly pharmacy formulary change notice

Quarterly pharmacy formulary change notice Quarterly pharmacy formulary change notice Provider update Summary: Effective August 1, 2018, the preferred formulary changes detailed in the table below will apply to District of Columbia Healthy Families

More information

Quarterly pharmacy formulary change

Quarterly pharmacy formulary change Medi-Cal Managed Care L. A. Care Major Risk Medical Insurance Program Provider Bulletin The formulary changes listed in the table below were reviewed and approved at our first-quarter 2018 Pharmacy and

More information

Effective for all members on August 1, 2017

Effective for all members on August 1, 2017 August 2017 Pharmacy Formulary Change Notice BlueChoice HealthPlan Medicaid is here to help you stay on top of your health care. We want to tell you about some upcoming changes to your Preferred Drug List

More information

Quarterly pharmacy formulary change notice

Quarterly pharmacy formulary change notice Provider update Quarterly pharmacy formulary change notice Summary: The formulary changes listed in the table below were reviewed and approved at our first-quarter 2018, Pharmacy and Therapeutics Committee

More information

A Visual Approach to Simplifying Respiratory Drug Regimens

A Visual Approach to Simplifying Respiratory Drug Regimens A Visual Approach to Simplifying Respiratory Drug Regimens Stephanie Cheng, PharmD, MPH, BCGP 3 Main Categories Inhaled Respiratory Drugs Binds to beta-2 receptors Relaxation of smooth muscles in the lung

More information

Commissioner for the Department for Medicaid Services Selections for Preferred Products

Commissioner for the Department for Medicaid Services Selections for Preferred Products Commissioner for the Department for Medicaid Services Selections for Preferred Products This is a summary of the final Preferred Drug List (PDL) selections made by the Commissioner for the Department for

More information

Quarterly pharmacy formulary change notice

Quarterly pharmacy formulary change notice Provider Bulletin April 2018 This table is used by HealthKeepers, Inc. to indicate formulary changes applicable to all Anthem HealthKeepers Plus members. These changes were reviewed and approved at the

More information

March 2017 Pharmacy & Therapeutics Committee Decisions

March 2017 Pharmacy & Therapeutics Committee Decisions UCare s Pharmacy and Therapeutics Committee (P&T) is a group of physicians and pharmacists that meet throughout the year to make changes to the UCare formulary (approved drug list). These changes are reviewed

More information

Quarterly pharmacy formulary change notice

Quarterly pharmacy formulary change notice The formulary changes listed in the table below apply to all Anthem HealthKeepers Plus and Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus) members. These formulary changes,

More information

New Generics: Specialty Network: Retail Pharmacies Dispensing Specialty Products

New Generics: Specialty Network: Retail Pharmacies Dispensing Specialty Products SUPPORTING OUR PROVIDER PARTNERS THROUGH COMMUNICATION AND COLLABORATION. DATE JANUARY 2016 ISSUE 1 HELPFUL NUMBERS FOR PROVIDERS Magellan: 1-800-846-7971 Bin: 016523 Processor control: 747 HELPFUL NUMBERS

More information

Select Inhaled Respiratory Agents

Select Inhaled Respiratory Agents Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

Ferris State University College of Pharmacy MPA CE Symposium 2016 Paul Thill, PharmD, BCPS

Ferris State University College of Pharmacy MPA CE Symposium 2016 Paul Thill, PharmD, BCPS Ferris State University College of Pharmacy MPA CE Symposium 2016 Paul Thill, PharmD, BCPS Objectives Categorize the new asthma and COPD inhalers in to existing or newly created categories Discuss the

More information

Alameda Alliance for Health Pharmacy & Therapeutics (P&T) Committee Decisions

Alameda Alliance for Health Pharmacy & Therapeutics (P&T) Committee Decisions Alameda Alliance for Health FORMULARY UPDATE Effective: April 21, 2017. Drugs notated with an * have an undetermined implementation date Alameda Alliance for Health Pharmacy & Therapeutics (P&T) Committee

More information

A Visual Approach to Simplifying Respiratory Drug Regimens

A Visual Approach to Simplifying Respiratory Drug Regimens Adverse Effects of Inhaled Medications A Visual Approach to Simplifying Respiratory Drug Regimens Stephanie Cheng, PharmD, MPH, BCGP June 28, 2017 Drug Category Beta 2 agonists antagonists Adverse Effects

More information

AIRDUO RESPICLICK (fluticasone-salmeterol) aerosol DULERA (mometasone furoate and formoterol fumarate dihydrate) aerosol

AIRDUO RESPICLICK (fluticasone-salmeterol) aerosol DULERA (mometasone furoate and formoterol fumarate dihydrate) aerosol DULERA (mometasone furoate and formoterol fumarate dihydrate) aerosol Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific

More information

Aetna Better Health of Illinois Medicaid Formulary Updates

Aetna Better Health of Illinois Medicaid Formulary Updates October 2017 o DOXYLAMINE SUCCINATE 25mg-QL o DULOXETINE CAP 40MG DR-QL o GUANFACIN ER TABS (all strengths)-ql o TOBRAMYCIN NEBU SOLUTION- PA August 2017 Aetna Better Health of Illinois Medicaid 2017 Formulary

More information

A Visual Approach to Simplifying Respiratory Drug Regimens

A Visual Approach to Simplifying Respiratory Drug Regimens A Visual Approach to Simplifying Respiratory Drug Regimens Stephanie Cheng, PharmD, MPH, BCGP October 23, 2017 Learning Objectives Be able to list at least 3 major adverse effects of inhaled medications

More information

The Medical Letter. on Drugs and Therapeutics

The Medical Letter. on Drugs and Therapeutics The Medical Letter publications are protected by US and international copyright laws. Forwarding, copying or any other distribution of this material is strictly prohibited. For further information call:

More information

Inhaled Corticosteroids Drug Class Prior Authorization Protocol

Inhaled Corticosteroids Drug Class Prior Authorization Protocol Inhaled Corticosteroids Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review

More information

Updates to your prescription benefits

Updates to your prescription benefits Updates to your prescription benefits Effective Jan. 1, 2018 Update Summary Within the Prescription Drug List (PDL), medications are grouped by tier. The tier indicates the amount you pay when you fill

More information

Clinical Policy: Roflumilast (Daliresp) Reference Number: CP.PMN.46 Effective Date: Last Review Date: 08.18

Clinical Policy: Roflumilast (Daliresp) Reference Number: CP.PMN.46 Effective Date: Last Review Date: 08.18 Clinical Policy: (Daliresp) Reference Number: CP.PMN.46 Effective Date: 11.01.11 Last Review Date: 08.18 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important

More information

Quarterly pharmacy formulary change notice

Quarterly pharmacy formulary change notice MEDICAID PROVIDER BULLETIN March 2019 Quarterly pharmacy formulary change notice The formulary changes listed in the table below were reviewed and approved at the fourth quarter pharmacy and therapeutics

More information

MEDICAL ASSISTANCE BULLETIN

MEDICAL ASSISTANCE BULLETIN ISSUE DATE SUBJECT EFFECTIVE DATE January 20, 2016 MEDICAL ASSISTANCE BULLETIN NUMBER *See Below BY Drug List (PDL) Update January 20, 2016 Pharmacy Services Leesa M. Allen, Deputy Secretary Office of

More information

Your prescription benefit updates Formulary Updates - Effective January 1, 2019

Your prescription benefit updates Formulary Updates - Effective January 1, 2019 Your prescription benefit updates Formulary Updates - Effective January 1, 2019 Medications are grouped by the conditions they treat. Each medication is placed in a tier that shows the amount you will

More information

Quarterly pharmacy formulary change

Quarterly pharmacy formulary change Serving Hoosier Healthwise, Healthy Indiana Plan and Hoosier Care Connect This is an update about information in the provider manual. For access to the latest manual, go online to www.anthem.com/inmedicaiddoc.

More information

MEDICAL COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 07/05/18 SECTION: DRUGS LAST REVIEW DATE: LAST CRITERIA REVISION DATE: ARCHIVE DATE:

MEDICAL COVERAGE GUIDELINES ORIGINAL EFFECTIVE DATE: 07/05/18 SECTION: DRUGS LAST REVIEW DATE: LAST CRITERIA REVISION DATE: ARCHIVE DATE: CINQAIR (reslizumab) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs

More information

JANUVIA 50 MG TABLET BYDUREON 2 MG/0.65 ML JARDIANCE 10 MG TABLET SUBCUTANEOUS PEN INJECTOR JARDIANCE 25 MG TABLET BYDUREON BCISE 2 MG/0.

JANUVIA 50 MG TABLET BYDUREON 2 MG/0.65 ML JARDIANCE 10 MG TABLET SUBCUTANEOUS PEN INJECTOR JARDIANCE 25 MG TABLET BYDUREON BCISE 2 MG/0. ANTI DIABETICS BYDUREON 2 MG SUBCUTANEOUS JANUVIA 25 MG TABLET EXTENDED RELEASE SUSPENSION JANUVIA 50 MG TABLET BYDUREON 2 MG/0.65 ML JARDIANCE 10 MG TABLET SUBCUTANEOUS PEN INJECTOR JARDIANCE 25 MG TABLET

More information

Inhaled Corticosteroids Drug Class Prior Authorization Protocol

Inhaled Corticosteroids Drug Class Prior Authorization Protocol Inhaled Corticosteroids Drug Class Prior Authorization Protocol Line of Business: Medi-Cal P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed through review

More information

Granite Alliance Insurance Company (PDP) 2018 Step Therapy Criteria Last Updated: 10/23/18

Granite Alliance Insurance Company (PDP) 2018 Step Therapy Criteria Last Updated: 10/23/18 Granite Alliance Insurance Company (PDP) 2018 Step Therapy Criteria Last Updated: 10/23/18 Granite Alliance requires step therapy for certain drugs. This means prior to receiving a drug with a step therapy

More information

QUANTITY LIMIT CRITERIA. BROVANA (arformoterol tartrate) SEREVENT DISKUS (salmeterol) STRIVERDI RESPIMAT (olodaterol)

QUANTITY LIMIT CRITERIA. BROVANA (arformoterol tartrate) SEREVENT DISKUS (salmeterol) STRIVERDI RESPIMAT (olodaterol) Carelirst. +.V Family of health care plans DRUG CLASS COMBINATIONS QUANTITY LIMIT CRITERIA LONG ACTING BETA2-ADRENERGIC AGONIST, ORAL INHALATION BRAND NAME (generic) LONG-ACTING BETA2-ADRENERGIC AGONISTS:

More information

COPD Medicine. No one ever showed me how to use this. Wendy Happel; RRT, COPD Educator Krystal Fedoris; RRT-NPS, BA, COPD Educator

COPD Medicine. No one ever showed me how to use this. Wendy Happel; RRT, COPD Educator Krystal Fedoris; RRT-NPS, BA, COPD Educator Medicine. No one ever showed me how to use this. Wendy Happel; RRT, Educator Krystal Fedoris; RRT-NPS, BA, Educator 1 Taking prescriptions correctly Taking prescriptions can be a challenge Busy schedules

More information

ACYCLOVIR OINT (CCHP2017)

ACYCLOVIR OINT (CCHP2017) ACYCLOVIR OINT (CCHP2017) acyclovir 5 % topical ointment Step Therapy requires trial of one (1) of the following: oral generic acyclovir, oral generic famciclovir, oral generic valacyclovir. 1 ALPHAGAN

More information

The following list of recommended PDL changes were reviewed and approved by the MHS P&T Committee on December 14 th, 2016.

The following list of recommended PDL changes were reviewed and approved by the MHS P&T Committee on December 14 th, 2016. Q4 MHS PDL Changes Provider Notice The following list of recommended PDL changes were reviewed and approved by the MHS P&T Committee on December 14 th, 2016. Table 1: Summary of Medicaid PDL Additions

More information

Acyclovir Ointment. Aetna Better Health Pennsylvania. Products Affected. acyclovir ointment 5 % external Details. Criteria

Acyclovir Ointment. Aetna Better Health Pennsylvania. Products Affected. acyclovir ointment 5 % external Details. Criteria Medications that require Step Therapy (ST) require trial and failure of preferred formulary agents prior to their authorization. If the prerequisite medications have been filled within the specified time

More information

ACYCLOVIR OINT (CCHP2017)

ACYCLOVIR OINT (CCHP2017) ACYCLOVIR OINT (CCHP2017) acyclovir 5 % topical ointment Step Therapy requires trial of one (1) of the following: oral generic acyclovir, oral generic famciclovir, oral generic valacyclovir. 1 ALPHAGAN

More information

Mercy Care Plan. Acyclovir Ointment. Products Affected. acyclovir ointment 5 % external Details. Criteria. Requires use of oral Acyclovir

Mercy Care Plan. Acyclovir Ointment. Products Affected. acyclovir ointment 5 % external Details. Criteria. Requires use of oral Acyclovir Acyclovir Ointment Mercy Care Plan acyclovir ointment 5 % external Requires use of oral Acyclovir 1 Adcirca ADCIRCA TABLET 20 MG ORAL Requires use of Sildenafil 2 Albenza ALBENZA TABLET 200 MG ORAL Requires

More information

HEALTH SHARE/PROVIDENCE (OHP)

HEALTH SHARE/PROVIDENCE (OHP) HEALTH SHARE/PROVIDENCE (OHP) STEP THERAPY This is a complete list of drugs that have written coverage determination policies. Drugs on this list do not indicate that this particular drug will be covered

More information

ACYCLOVIR OINT (CCHP2017)

ACYCLOVIR OINT (CCHP2017) ACYCLOVIR OINT (CCHP2017) acyclovir 5 % topical ointment Step Therapy requires trial of one (1) of the following: oral generic acyclovir, oral generic famciclovir, oral generic valacyclovir. 1 ALPHAGAN

More information

COPD Update. Plus New and Improved Products for Inhaled Therapy. Catherine Bourg Rebitch, PharmD, BCACP Clinical Associate Professor

COPD Update. Plus New and Improved Products for Inhaled Therapy. Catherine Bourg Rebitch, PharmD, BCACP Clinical Associate Professor COPD Update Plus New and Improved Products for Inhaled Therapy Catherine Bourg Rebitch, PharmD, BCACP Clinical Associate Professor Disclosure The presenter has nothing to disclose concerning possible financial

More information

ANTIDEPRESSANTS. Details. dose pack Viibryd 10 mg tablet Viibryd 20 mg tablet Viibryd 40 mg tablet. Criteria

ANTIDEPRESSANTS. Details. dose pack Viibryd 10 mg tablet Viibryd 20 mg tablet Viibryd 40 mg tablet. Criteria ANTIDEPRESSANTS Trintellix 10 mg tablet Trintellix 20 mg tablet Trintellix 5 mg tablet Viibryd 10 mg (7)-20 mg (23) tablets in a dose pack Viibryd 10 mg tablet Viibryd 20 mg tablet Viibryd 40 mg tablet

More information

Pharmacy Medical Necessity Guidelines: Antipsychotic Medications

Pharmacy Medical Necessity Guidelines: Antipsychotic Medications Pharmacy Medical Necessity Guidelines: Antipsychotic Medications Effective: July. 1, 2016 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review Pharmacy

More information

See Important Reminder at the end of this policy for important regulatory and legal information.

See Important Reminder at the end of this policy for important regulatory and legal information. Clinical Policy: Reference Number: CP.PMN.69 Effective Date: 11/15 Last Review Date: 08/17 Line of Business: Medicaid Revision Log See Important Reminder at the end of this policy for important regulatory

More information

Quarterly Pharmacy Formulary Change Notice

Quarterly Pharmacy Formulary Change Notice MEDICAID PROVIDER BULLETIN February 26, 2015 Quarterly Pharmacy Formulary Change Notice Summary of Change: The formulary changes listed in the table below were reviewed and approved at our September 24,

More information

Step Therapy Requirements. Effective: 05/01/2018

Step Therapy Requirements. Effective: 05/01/2018 Step Therapy Requirements Effective: 05/01/2018 ANTIDEPRESSANTS TRINTELLIX 10 MG TABLET TRINTELLIX 20 MG TABLET TRINTELLIX 5 MG TABLET VIIBRYD 10 MG (7)-20 MG (23) TABLETS IN A DOSE PACK VIIBRYD 10 MG

More information

STRIVERDI RESPIMAT (olodaterol hcl) aerosol

STRIVERDI RESPIMAT (olodaterol hcl) aerosol STRIVERDI RESPIMAT (olodaterol hcl) aerosol Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy

More information

Quarterly pharmacy formulary change notice

Quarterly pharmacy formulary change notice Quarterly pharmacy formulary change notice Provider update Summary: The formulary changes listed in the table below were reviewed and approved at our second quarter 2018, Pharmacy and Therapeutics Committee

More information

CRITERIA Trial of two generic formulary products from the following: atomoxetine or ADHD stimulant medication.

CRITERIA Trial of two generic formulary products from the following: atomoxetine or ADHD stimulant medication. ADHD STIMULANTS ATOMOXETINE HCL, DEXEDRINE 10 MG TABLET, DEXEDRINE 5 MG TABLET, DEXMETHYLPHENIDATE HCL, DEXMETHYLPHENIDATE HCL ER, DEXTROAMPHETAMINE 10 MG TAB, DEXTROAMPHETAMINE 5 MG TAB, DEXTROAMPHETAMINE

More information

Step Therapy Requirements. Effective: 11/01/2018

Step Therapy Requirements. Effective: 11/01/2018 Effective: 11/01/2018 Updated 10/2018 ANTIDEPRESSANTS Sharp Health Plan (HMO) TRINTELLIX 10 MG TABLET TRINTELLIX 20 MG TABLET TRINTELLIX 5 MG TABLET VIIBRYD 10 MG (7)-20 MG (23) TABLETS IN A DOSE PACK

More information

New Product to Market: Trelegy Ellipta Magellan Health, Inc. All rights reserved.

New Product to Market: Trelegy Ellipta Magellan Health, Inc. All rights reserved. Drug Review and The following tables list the Agenda items as well as the that are scheduled to be presented and reviewed at the March 15, 2018 meeting of the Pharmacy and Therapeutics Advisory Committee.

More information

reslizumab (Cinqair )

reslizumab (Cinqair ) Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided

More information

WVCH Formulary Additions Effective 01/01/2016 Name Strength Dosage Form Route Formulary Restrictions

WVCH Formulary Additions Effective 01/01/2016 Name Strength Dosage Form Route Formulary Restrictions WVCH Formulary Additions Effective 01/01/2016 Name Strength Dosage Form Route Formulary Restrictions ANORO ELLIPTA 62.5-25MCG BLST W/DEV INHALATION ARCAPTA NEOHALER 75 MCG CAP W/DEV INHALATION CALCIPOTRIENE

More information

Antipsychotic Medications Age and Step Therapy

Antipsychotic Medications Age and Step Therapy Market DC *- Florida Healthy Kids Antipsychotic Medications Age and Step Therapy Override(s) Approval Duration Prior Authorization 1 year Quantity Limit *Virginia Medicaid See State Specific Mandates *Indiana

More information

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

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

More information

Kentucky Department for Medicaid Services Pharmacy and Therapeutics Advisory Committee Recommendations

Kentucky Department for Medicaid Services Pharmacy and Therapeutics Advisory Committee Recommendations Kentucky Department for Medicaid Services Pharmacy and March 15, 2018 The following chart provides a summary of the recommendations that were made by the Pharmacy and Therapeutics (P&T) Advisory Committee

More information

ALBUTEROL - SCORE. Products Affected. Details. Step Therapy Criteria Health Choice Generations 1 Tier Gold Effective Date: 11/01/2018.

ALBUTEROL - SCORE. Products Affected. Details. Step Therapy Criteria Health Choice Generations 1 Tier Gold Effective Date: 11/01/2018. ALBUTEROL - SCORE Ventolin Hfa Trial of ProAir Formulary ID: 18349, Ver.15 Last Updated 10/23/2018 Effective Date: 11/1/2018 1 ANTIDEPRESSANTS - SCORE Aplenzin Desvenlafaxine Er TB24 100MG, 50MG Emsam

More information

ALBUTEROL - SCORE. Products Affected. Details. Step Therapy Criteria Optima Tier Gold Formulary Date Effective: November 1, 2018.

ALBUTEROL - SCORE. Products Affected. Details. Step Therapy Criteria Optima Tier Gold Formulary Date Effective: November 1, 2018. ALBUTEROL - SCORE Ventolin Hfa Trial of ProAir Formulary ID 18354, Version 15 1 ANTIDEPRESSANTS - SCORE Aplenzin Desvenlafaxine Er TB24 100MG, 50MG Emsam Fetzima Fetzima Titration Pack Trial of two of

More information

Y0133_StepTherapyCriteria _C 10/18/18 Y0133_StepTherapyCriteria _C es 10/18/18

Y0133_StepTherapyCriteria _C 10/18/18 Y0133_StepTherapyCriteria _C es 10/18/18 Step Therapy Grid Certain cost-effective drugs must be used before other more expensive drugs are covered. For example, certain brand-name medications will only be covered if a generic alternative has

More information

2017 UnitedHealthcare Services, Inc.

2017 UnitedHealthcare Services, Inc. UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2017 P 2020-10 Program Prior Authorization/Medical Necessity PAH Agents Medication Adcirca (tadalafil), Adempas (riociguat), Letairis

More information

New Drug Update April 2016

New Drug Update April 2016 New Drug Update 2015-16 April 2016 C. Wayne Weart, Pharm D, FASHP, FAPhA, BCPS Professor of Clinical Pharmacy and Outcome Sciences South Carolina College of Pharmacy Professor of Family Medicine Medical

More information

Aetna Better Health FIDA Plan

Aetna Better Health FIDA Plan Aetna Better Health FIDA Plan May 2016 Formulary Updates ASCOMP/COD - QL; PA FYAVOLV 5MCG; 1MG- PA METOPROLOL TABS 37.5MG, 75MG CIPRODEX LETAIRIS - QL; PA OFEV - QL; PA OTREXUP - ST PRALUENT - QL; PA RASUVO

More information

ANTIEMETICS STEP. Step Therapy Requirements Effective April 1, 2019

ANTIEMETICS STEP. Step Therapy Requirements Effective April 1, 2019 Step Therapy Requirements Effective April 1, 2019 ANTIEMETICS STEP Sancuso 3.1 mg/24 hour transdermal patch Zuplenz 4 mg oral soluble film Zuplenz 8 mg oral soluble film COVERAGE OF CERTAIN BRAND NAME

More information

Step Therapy Criteria

Step Therapy Criteria Tier 5 Formulary Step Therapy 2016 Updated: 05/24/2016 Effective: 06/01/2016 What is Step Therapy? Some prescription drugs require step therapy (ST). In some cases, the plan requires you to first try certain

More information

Relative Cost/Month. Less than $10. Loratadine Liquid* $10-$15 Cetirizine liquid 1mg/mL*

Relative Cost/Month. Less than $10. Loratadine Liquid* $10-$15 Cetirizine liquid 1mg/mL* Allergy Chlorpheniramine Tablet* Diphenhydramine Tablet* Diphenhydramine Liquid* Loratadine Tablet* Cetirizine Tablet* Loratadine 10mg ODT* Less than $10 Loratadine Liquid* $10-$15 Cetirizine liquid 1mg/mL*

More information

Fee-for-Service Pharmacy Provider Notice #216 ** March 2016 PDL Changes ** Existing Drug Classes

Fee-for-Service Pharmacy Provider Notice #216 ** March 2016 PDL Changes ** Existing Drug Classes Fee-for-Service Pharmacy Provider Notice #216 ** March 2016 PDL Changes ** December 19, 2016 Please be advised that the Department for Medicaid Services (DMS) is making changes to the Kentucky Medicaid

More information

ONZETRA XSAIL (sumatriptan) nasal powder

ONZETRA XSAIL (sumatriptan) nasal powder ONZETRA XSAIL (sumatriptan) nasal powder Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy

More information

Technivie. Technivie (ombitasvir, paritaprevir, ritonavir) and Ribavirin. Description

Technivie. Technivie (ombitasvir, paritaprevir, ritonavir) and Ribavirin. Description Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Technivie Page: 1 of 6 Last Review Date: March 18, 2016 Technivie Description Technivie (ombitasvir,

More information

HARVARD PILGRIM HEALTH CARE RECOMMENDED MEDICATION REQUEST GUIDELINES

HARVARD PILGRIM HEALTH CARE RECOMMENDED MEDICATION REQUEST GUIDELINES Generic Brand HICL GCN Exception/Other DEFLAZACORT EMFLAZA 11668 If the caller wishes to initiate a request then a MRF must be completed. This drug requires a written request for prior authorization. All

More information

Nancy Davis, RRT, AE-C

Nancy Davis, RRT, AE-C Nancy Davis, RRT, AE-C Asthma Statistics 25.6 million Americans diagnosed with asthma 6.8 million are children 10.5 million missed school days per year 14.2 lost work days for adults Approximately 10%

More information

XATMEP (methotrexate) oral solution

XATMEP (methotrexate) oral solution XATMEP (methotrexate) oral solution Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy

More information

San Francisco Health Plan (SFHP)

San Francisco Health Plan (SFHP) San Francisco Health Plan (SFHP) The following changes to SFHP formulary and prior authorization criteria were reviewed and approved by the SFHP Pharmacy and Therapeutics (P&T) Committee on 04/18/2018.

More information

AETNA BETTER HEALTH January 2017 Formulary Change(s)

AETNA BETTER HEALTH January 2017 Formulary Change(s) AETNA BETTER HEALTH January 2017 Formulary Change(s) The following updates will be made to the Aetna Better Health of MI formulary on March 1, 2017 Drug Name, Strength, Dosage Form ALFUZOSIN HCL ER 10

More information

Date: October 3, 2017 To: Participating Providers From: YourCare Health Plan Provider Relations Subject: 2018 Formulary Changes

Date: October 3, 2017 To: Participating Providers From: YourCare Health Plan Provider Relations Subject: 2018 Formulary Changes Date: October 3, 2017 To: Participating Providers From: YourCare Health Plan Provider Relations Subject: 2018 Formulary Changes 2018 Formulary-UM Changes What does this mean now, and for 2018? A number

More information

ALBUTEROL - SCORE{XE "ALBUTEROL - SCORE"}

ALBUTEROL - SCORE{XE ALBUTEROL - SCORE} Step Therapy ALBUTEROL - SCORE{XE "ALBUTEROL - SCORE"} Ventolin Hfa{XE "Ventolin Hfa"} Trial of ProAir Formulary ID# 00018097 Last Updated: 04/01/2018 1 ANTIDEPRESSANTS - SCORE{XE "ANTIDEPRESSANTS - SCORE"}

More information

COPD Medications Coverage Summary Non-Insured Health Benefits Coverage SABA Bricanyl turbuhaler Yes Yes

COPD Medications Coverage Summary Non-Insured Health Benefits Coverage SABA Bricanyl turbuhaler Yes Yes COPD Medications Coverage Summary Drug Non-Insured Health Benefits Coverage SABA Bricanyl turbuhaler Yes Yes Ventolin MDI + generics Yes Yes Ventolin Diskus NO NO Yukon Pharmacare/Chronic Disease Program

More information

Step Therapy Requirements. Effective: 12/01/2016

Step Therapy Requirements. Effective: 12/01/2016 Effective: 12/01/2016 H2986_PD_049 Updated 11/2016 ALPHA 1-PROTEINASE INHIBITOR GLASSIA PRIOR CLAIM FOR ARALAST NP OR ZEMAIRA WITHIN THE PAST 120 DAYS. ANALGESICS, NARCOTICS KADIAN MORPHINE SULFATE ER

More information

THEOPHYLLINE WITH INHALED CORTICOSTEROIDS (TWICS) TRIAL SELF MANAGMENT / ACTION PLANS GENUAIR INHALERS: POTENTIAL SAFETY ISSUE

THEOPHYLLINE WITH INHALED CORTICOSTEROIDS (TWICS) TRIAL SELF MANAGMENT / ACTION PLANS GENUAIR INHALERS: POTENTIAL SAFETY ISSUE I S S U E 4 M A R C H / A R P I L 2 0 1 6 Endorsed December 2014 I N S I D E T H I S I S S U E : Theophylline with Inhaled Corticosteroids (TWICS) Trial Genuair Inhaler: Potential Safety Issue 1 Self Management

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association New to Market Drugs Page 1 of 5 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: New to Market Drugs: Including (cannabidiol) Prime Therapeutics will review Prior

More information

New and Novel Medications for Respiratory Care

New and Novel Medications for Respiratory Care New and Novel Medications for Respiratory Care JASON MOORE, PHARM.D. BCCCP CLINICAL STAFF PHARMACIST STORMONT-VAIL HEALTH Objectives Quick overview of the newest FDA-approved repiratory-related medications

More information

REVISED RESPIRATORY MEDICATION USE QUESTIONNAIRE

REVISED RESPIRATORY MEDICATION USE QUESTIONNAIRE REVISED RESPIRATORY MEDICATION USE QUESTIONNAIRE ID NUMBER: 0a) Date of Collection / / 0b) Staff Code Instructions: This form should be completed during the participant s clinic visit. 1) Are you regularly

More information

Impact of a Comprehensive COPD Therapeutic Interchange Program on 30-Day Readmission Rates in Hospitalized Patients

Impact of a Comprehensive COPD Therapeutic Interchange Program on 30-Day Readmission Rates in Hospitalized Patients Impact of a Comprehensive COPD Therapeutic Interchange Program on 30-Day Readmission Rates in Hospitalized Patients Maren A. McGurran, PharmD, BCPS; Lisa M. Richter, PharmD, BCPS, BCCCP; Nathan D. Leedahl,

More information

FASENRA (benralizumab)

FASENRA (benralizumab) FASENRA (benralizumab) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs

More information

MANAGING ASTHMA. Nancy Davis, RRT, AE-C

MANAGING ASTHMA. Nancy Davis, RRT, AE-C MANAGING ASTHMA Nancy Davis, RRT, AE-C What is asthma? Asthma is a chronic respiratory disease characterized by episodes or attacks of inflammation and narrowing of small airways in response to asthma

More information

Formulary Medical Necessity Program

Formulary Medical Necessity Program BENEFIT APPLICATION Formulary Medical Necessity Program DRUG POLICY Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations

More information

South Carolina Department of Health and Human Services Post Office Box 8206 Columbia, South Carolina

South Carolina Department of Health and Human Services Post Office Box 8206 Columbia, South Carolina South Carolina Department of Health and Human Services Post Office Box 8206 Columbia, South Carolina 29202-8206 Pharmacy and Therapeutics (P&T) Committee Meeting MINUTES 1. Call to Order A meeting of the

More information

10/18/2012. Penn State University Children s Hospital JODIE STABINSKI CRNP MSN AE-C

10/18/2012. Penn State University Children s Hospital JODIE STABINSKI CRNP MSN AE-C Penn State University Children s Hospital JODIE STABINSKI CRNP MSN AE-C Daily: Long-Term Control Corticosteroids (inhaled and systemic) Long-acting beta 2 -agonists (Serevent, Foradil) Methylxanthines

More information

Prescribing Guide Standard Control Change Summary Report Effective (Standard Drug List Reflects Removals)

Prescribing Guide Standard Control Change Summary Report Effective (Standard Drug List Reflects Removals) This report highlights all changes (additions, deletions and removals) to the CVS Caremark Prescribing Guide Standard Control. ADDITIONS: Brand Agents: Austedo (deutetrabenazine) tablet Estring (estradiol)

More information