Connecticut Medicaid P&T Meeting Minutes June 5, 2008

Transcription

1 Connecticut Medicaid P&T Meeting Minutes June 5, 2008 The meeting started at 6:30 pm Attendance Present Members: Carl Sherter, MD Kenneth Marcus, MD Lester Silberman, MD Peggy Manning Memoli, Pharm D Richard T. Carbray, Jr., RPh Steven Marcham RPh Lawrence Sobel, RPh Absent Members: Stella Cretella Bennett Enowitch, MD Charles Thompson, MD DSS: Evelyn Dudley Herman Kranc Robert Zavoski, MD MPH Jim Zakszewski Dan Butler EDS/Provider Synergies: Chris Andrews Ellen Arce Joy DeNardo Opening remarks: Dr. Sherter made the following announcements: Chris Andrews is still our Connecticut Clinical Account Manager from Provider Synergies. Dr. Lester Silberman is filling the vacancy for a Practicing Physician, Family Planning Specialist. Dr. Sherter introduced Dr. Silberman and asked him to give a brief biography. Dr. Silberman obliged and told committee members that he previously held the position of chief of OB-GYN at Danbury Hospital. He currently serves as the Medical Director for Planned Parenthood of CT. The election of officers for 2008 will be held tonight. The smoking cessation study would be discussed tonight. Election of Officers: Dr. Sherter announced that the committee needed to elect officers for the year. Steve Marcham motioned to re-elect the current slate of Dr. Carl Sherter as chairman and Dr. Peggy Memoli as vice-chair. Larry Sobel seconded that motion. The committee members voted and agreed that Dr. Sherter would be chairman and Dr. Memoli would be vice-chair for The motion passed unanimously. Approval of minutes: Committee members approved the meeting minutes from the March 20, 2008 meeting.

2 Smoking Cessation Study: The committee discussed the smoking cessation report, Plan for Treating Tobacco Use and Dependence, which was submitted to the Legislature in March The report summarized studies that conclude that smoking cessation products double the chances of successful smoking cessation. The committee members discussed the health benefits of smoking cessation and therefore the decreased medical costs. The committee members agreed that smoking cessation products should be covered by CT Medicaid. Steve Marcham motioned to add smoking cessation products as a class to the PDL, with Dr. Sherter seconding. The motion was passed unanimously. New Generics: Chris Andrews informed the committee members that there were no new generics to discuss. Therapeutic Class Reviews: Chris Andrews, from Provider Synergies, presented clinical data and financial analysis, as well as answered questions from committee members on the following eleven therapeutic classes. Outcomes and votes are recorded below by class: Analgesics, Narcotic Long-Acting that there were additional strengths now available for Kadian, Oxycontin, and Opana ER. The recommended change to this class would be the addition of fentanyl transdermal patches. Larry Sobel was concerned that by maintaining Oxycontin and oxycodone ER as non-preferred the committee may be limiting access to hospice and nursing home patients and serving as a policing agent. Dr. Sherter cited the ease of our Prior Authorization process for providers to obtain needed medication for their patients. Steve Marcham motioned to approve and accept Provider Synergies recommendations as presented with Dr. Marcus seconding. The motion was passed with Larry Sobel abstaining. Duragesic, fentanyl transdermal, Kadian, methadone, morphine ER Avinza, Opana ER, oxycodone ER, Oxycontin, Ultram ER Analgesics, Narcotic Short-Acting that the recommended changes to this class would be the addition of oxycodone/asa and oxycodone/ibuprofen. Steve Marcham motioned to approve and accept Provider Synergies recommendations as presented with Dr. Marcus seconding. The motion was passed unanimously. APAP/codeine, APAP/dihydrocodeine/caffeine, APAP/hydrocodone, APAP/oxycodone, APAP/pentazocine, APAP/propoxyphene, APAP/tramadol, ASA/codeine, ASA/oxycodone, butalbital compound/codeine, codeine, hydrocodone/ibuprofen, hydromorphone, meperidine, morphine IR, oxycodone/ibuprofen, oxycodone IR, propoxyphene, tramadol

3 Darvon-N, fentanyl buccal, Fentora, levorphanol, Opana, Panlor DC, pentazocine/naloxone Angiotensin Modulators that this class would now include the ACE inhibitors, ARBs (Angiotensin II Receptor Blockers) and Direct Renin Inhibitor. The recommended changes to this class would be the addition of ramipril and trandolapril (and the subsequent removal of their brand name products of Altace and Mavik respectively), and the removal of Cozaar and Hyzaar. Dr. Memoli questioned the reasoning behind the recommendation to remove Cozaar and Hyzaar. Chris Andrews cited that Cozaar and Hyzaar offered no clinical advantages over the other ARB products in this class to justify the price difference. Steve Marcham asked for clarification of the amount of savings that would be lost by keeping Cozaar and Hyzaar as preferred products, which Chris answered. Dr. Memoli motioned to approve and accept Provider Synergies recommendations with the addition of Cozaar and Hyzaar as preferred. Dr. Marcus seconded. The motion was passed unanimously. Avapro/Avalide, benazepril, benazepril/hctz, Benicar, Benicar HCT, captopril, captopril/hctz, Cozaar/Hyzaar, Diovan, Diovan HCT, enalapril, enalapril/hctz, fosinopril, fosinopril/hctz, lisinopril, lisinopril/hctz, Micardis, Micardis HCT, moexipril, moexipril/hctz, quinapril, quinapril/hctz, ramipril, trandolapril Aceon, Atacand/Atacand HCT, Tekturna/Tekturna HCT, Teveten/Teveten HCT Anticoagulants, Injectable that the recommended change to this class would be the removal of Innohep as preferred. Larry Sobel motioned to approve and accept Provider Synergies recommendations as presented with Dr. Marcus seconding. The motion was passed unanimously. Arixtra, Fragmin, Lovenox Innohep Atopic Dermatitis that the recommended change for this class would be the addition of Elidel as preferred. Dr. Silberman motioned to approve and accept Provider Synergies recommendations as presented with Larry Sobel seconding. The motion was passed unanimously. Elidel, Protopic None

4 Beta Blockers that Bystolic is the only new product in this class and that the recommended change for this class would be the addition of Coreg CR as preferred. Dr. Memoli questioned why Bystolic was not recommended as preferred, given the clinical information on its use in the African American population. Dr. Sherter pointed out that the current utilization was 1 prescription and cited the ease of our Prior Authorization process for providers to obtain needed medication for their patients. Dr. Marcus inquired when this class would be reviewed again. Dr. Sherter replied that this class would be reviewed again in one year. Steve Marcham motioned to approve and accept Provider Synergies recommendations as presented with Richard Carbray, Jr. seconding. The motion was passed with Dr. Marcus, Dr. Memoli, and Larry Sobel voting against. acebutolol, atenolol, betaxolol, bisoprolol, carvedilol, Coreg CR, labetalol, metoprolol/metoprolol XL, nadolol, pindolol, propranolol/propranolol LA, sotalol, timolol Bystolic, Innopran XL, Levatol, Toprol XL Hypoglycemics, Incretin Mimetics/Enhancers that the recommended change for this class would be the removal of Byetta, Janumet, Januvia, and Symlin as preferred. Dr. Memoli questioned why there were no products recommended as preferred. Chris Andrews cited the ADA treatment module pathway of first line treatment with metformin, then sulfonylurea, insulin, or TZD. He explained that by keeping these products as non-preferred, it would discourage their use as first line treatment. Dr. Sherter expressed concern about entering disease management, especially in a population that is already difficult to treat. Larry Sobel suggested that the committee keep Januvia and Byetta as preferred at the least, with Janumet as an option if it is cost neutral to Januvia plus metformin. Dr. Memoli suggested adding Janumet and Symlin as preferred as well as Januvia and Byetta. Dr. Memoli motioned to reject Provider Synergies recommendations as presented and recommended that the committee accept the recommendation to approve Byetta, Janumet, Januvia, and Symlin as preferred with Larry Sobel seconding. The motion was passed with Richard Carbray, Jr. voting against. Byetta, Janumet, Januvia, Symlin None

5 Hypoglycemics, TZDs that there were no changes recommended. Steve Marcham motioned to approve and accept Provider Synergies recommendations as presented with Dr. Marcus seconding. The motion was passed unanimously. Actoplus Met, Actos, Avandamet, Avandaryl, Avandia Duetact Lipotropics, Other that the recommended changes to this class would be the addition of Fenoglide, Lipofen, and Triglide and the removal of Antara and Zetia. Steve Marcham questioned whether the recommendation to remove Zetia was based more on recent therapeutic reasons or financial reasons. Chris Andrews replied that the financial reasons outweighed the recent therapeutic reasons in his recommendation. Dr. Sherter cited that the overall therapeutic reasons should outweigh the financial reasons and recommended keeping Zetia as preferred. Larry Sobel motioned to approve and accept Provider Synergies recommendations with the addition of Zetia as preferred with Dr. Silberman seconding. The motion was passed unanimously. cholestyramine, colestipol, fenofibrate, Fenoglide, gemfibrozil, Lipofen, Niaspan, Tricor, Triglide, Zetia Antara, Lovaza, niacin (Rx), Welchol Lipotropics, Statins that the recommended change in this class would be the addition of Simcor. Steve Marcham motioned to approve and accept Provider Synergies recommendations as presented with Larry Sobel seconding. The motion was passed unanimously. Caduet, Crestor, Lescol/Lescol XL, Lipitor, lovastatin, pravastatin, Simcor, simvastatin, Vytorin Advicor, Altoprev Multiple Sclerosis Agents that there were no changes recommended for this class. Steve Marcham motioned to approve and accept Provider Synergies recommendations as presented with Dr. Marcus seconding. The motion was passed unanimously. Avonex, Betaseron, Copaxone, Rebif None

6 Other Business: Larry Sobel asked if it was possible to have the country of origin for the medication added to the cost sheets. Chris Andrews replied that it is impossible to know where all components of each medication originate. Chris offered to add the manufacturer for all brand name products in the future. Chris Andrews asked the committee if they would consider adding the sedative hypnotics class to the PDL, or if the class was considered Mental Health Medications. Dr. Marcus replied that this class is not considered Mental Health Medications and the other committee members agreed. The sedative hypnotics will be reviewed at the September meeting. Recommendations for next class reviews: Provider Synergies recommended the following classes be reviewed at the next P&T meeting: Antifungals, Oral Antifungals, Topical Antimigraine Agents Antivirals Bladder Relaxant Preparations BPH Agents Cephalosporins and Related Agents Fluoroquinolones Glucocorticoids, Inhaled Hepatitis C Agents Hypoglycemics, Meglitinides Macrolides/Ketolides Sedative Hypnotics Schedule next meeting: Committee members agreed on Thursday, September 4, 2008 for the next P & T meeting. Meeting adjourned at 7:22pm