PHARMACY TIMES BY IEHP PHARMACEUTICAL SERVICES DEPARTMENT August 23, 2012

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PHARMACY TIMES BY IEHP PHARMACEUTICAL SERVICES DEPARTMENT August 23, 2012 We would like to inform you of the following changes to the 2012 IEHP Formulary that were approved by the Pharmacy and

1 PHARMACY TIMES BY IEHP PHARMACEUTICAL SERVICES DEPARTMENT August 23, 2012 We would like to inform you of the following changes to the 2012 IEHP Formulary that were approved by the Pharmacy and Therapeutics Subcommittee in August 2012: IEHP FORMULARY ADDITIONS/DELETIONS Drug Name Classification Medi-Cal/HF/HK DualChoice Formulary Lipitor (atorvastatin) Dyslipidemia Formulary Non-formulary Diabetic Meter & Supplies: Diabetes Formulary Formulary Fora Care Elelyso (taliglucerase alfa) Gaucher Disease Non-formulary; PA Formulary; PA Perjeta (pertuzumab) Oncology Non-formulary; PA Formulary; BvsD MenHibrix Vaccine Formulary Formulary; BvsD Please Note: Generics are covered when available. Non-formulary agents may be requested through the Pharmacy Exception Request (PER) process Bolded Items: formulary status change as of Aug 2012 P&T IEHP PRIOR AUTHORIZATION UPDATES Drug Name Classification Medi-Cal/HF/HK DualChoice Formulary Antidepressants Antidepressants See PA Criteria See PA Criteria Infant Formulas Nutritional See PA Criteria See PA Criteria Supplements Triptans Migraine See PA Criteria See PA Criteria Oxycodone IR Analgesics Failure or contraindication to formulary opioids and completion of treatment plan; Conversion to long acting tamper proof opioid recommended if around the clock dosing is required (ex. Avinza, Kadian) ---

2 IV iron supplementation Abilify (aripiprazole) Dificid (fidaxomicin) Singulair (montelukast) IV iron supplementation Antipsychotic Antibiotic Asthma See PA Criteria; note: no PA required if criteria is met for Dialysis Centers Medi-Cal: DHCS Carve out HF/HK: Use risperidone and quetiapine as first line therapy unless it is contraindicated. Trial of risperidone and quetiapine should be at least 2 months, or if patient develops abnormal behavior/thinking after the treatment. Failed/contraindicated to vancomycin AND diagnosis of clostridium difficile associated diarrhea (CDAD) Continuation from inpatient setting will be allowed Dx - Asthma: restricted to use as adjunct therapy for asthma only, concurrent OR failure/intolerance to inhaled corticosteroid required. Part B Failed/contraindicated to vancomycin AND diagnosis of clostridium difficile associated diarrhea (CDAD) Continuation from inpatient setting will be allowed --- Dx - Allergic rhinitis: Singulair may be medically necessary if oral non-sedating antihistamines and/or intranasal corticosteroids are ineffective. At least 2 of the allergic rhinitis medication products must be tried in the previous 12 months.

3 Zyprexa (olanzapine) Elelyso (taliglucerase alfa) Perjeta (pertuzumab) Dymista (azelastine; fluticasone) Stendra (avanafil) Fabior (tazarotene) Antipsychotic Gaucher Disease Oncology Allergy Erectile Dysfunction Acne Medi-Cal: DHCS Carve out HF/HK: Use risperidone and quetiapine as first line therapy unless it is contraindicated. Trial of risperidone and quetiapine should be at least 2 months, or if patient develops abnormal behavior/thinking after the treatment. Failure of generic Astelin AND combination antihistamine and nasal steroid Not Covered - ED drugs not covered For Dx of Acne, failure of topical formulary acne medications; facial wrinkles / hyperpigmentation are non-covered benefit Myrbetriq (mirabegron) OAB Failure of two (2) formulary OAB agents Belviq (lorcaserin) Weight Loss Failure of preferred agents (Phentermine, Alli) AND Members must meet the following criteria: BMI>27 kg/m2 with risk factors Or BMI>30 kg/m2; Members must attend weight management programs offered by IEHP Prepopik (sodium picosulfate, Mg oxide, citric acid) Misc Failure of formulary bowel prep Failure of generic Astelin AND combination antihistamine and nasal steroid Not Covered - ED drugs not covered For Dx of Acne, failure of topical formulary acne medications; facial wrinkles / hyperpigmentation are non-covered benefit Failure of two (2) formulary OAB agents Medicare: Non-covered benefit Failure of formulary bowel prep

4 Full Prior Authorization table available at: CLINICAL PRACTICE GUIDELINE UPDATE Clinical Practice Guideline Therapeutic Class Comment Gastroesophageal Reflux Disease NASPGHAN, ESPHAN GERD, Pediatric Update IMPORTANT INFORMATION ABOUT IEHP CLINICAL PRACTICE GUIDELINES IEHP publishes and distributes an IEHP Formulary Book to our Providers every year. The IEHP Formulary Book contains IEHP treatment guidelines for drug therapy of various medical conditions and policies regarding the use of specific drugs. These recommendations (listed below), which have been approved by the Pharmacy and Therapeutics Subcommittee and Quality Management Committee, are based on published consensus guidelines and reviews of the medical literatures, they do not favor any particular drug based solely on cost considerations. All guidelines for therapy are current as of the time of printing and are subject to change. The Clinical Practice Guidelines are reviewed at least once every two years, or when a new update is available prior to the two-year schedule. When a new Clinical Practice Guideline is available, IEHP communicates the changes to the Provider via this quarterly Formulary Change notice. The guidelines are general and may not cover all clinical situations; they should not be considered in any way as a substitute for sound clinical judgment. IEHP Clinical Practice Guidelines currently available: Attention Deficit Hyperactivity Disorder Guideline and Toolkit Anti-Infective Therapy Guide Adult and Pediatric Asthma Depression Diabetes Mellitus Diabetes Pregnancy Fibromyalgia Gastroesophageal Reflux Disease Hepatitis C Hyperlipidemia Hypertension Migraine Multiple Sclerosis Pulmonary Arterial Hypertension Pain Management Rheumatoid Arthritis Sexually Transmitted Diseases - Summary of CDC Treatment Guidelines Smoking Cessation Synagis Criteria Season 2010/2011

5 We welcome any recommendations and comments regarding the IEHP Formulary. For questions, suggestions, or if you would like a printed copy of the IEHP Formulary Book or Clinical Practice Guideline, please call us at (909) As a reminder, updated formulary information and Clinical Practice Guidelines are available at Sincerely, IEHP Pharmaceutical Services

PHARMACY TIMES BY IEHP PHARMACEUTICAL SERVICES DEPARTMENT May 31, 2012

PHARMACY TIMES BY IEHP PHARMACEUTICAL SERVICES DEPARTMENT May 31, 2012 We would like to inform you of the following changes to the 2012 IEHP Formulary that were approved by the Pharmacy and Therapeutics