PHARMACY TIMES BY IEHP PHARMACEUTICAL SERVICES DEPARTMENT May 31, 2012

Transcription

1 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 Subcommittee in May 2012: IEHP FORMULARY ADDITIONS/DELETIONS Drug Name Classification Medi-Cal/HF/HK DualChoice Formulary Janumet XR Diabetes Formulary Non-formulary (sitagliptan/metformin) Levetiracetam 500mg/ml Anticonvulsant Non-formulary Formulary INJ Potiga (ezogabine) Anticonvulsant Non-formulary Formulary, PA for new starts Avonex Pen (interferon MS Non-formulary Formulary, PA Beta 1a) Intelence (etravirine) HIV Non-formulary; DHCS Carve out for Medi-Cal Formulary 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 May P&T IEHP PRIOR AUTHORIZATION UPDATES Drug Name Classification Medi-Cal/HF/HK DualChoice Formulary Bio-T-Gel (testosterone) Hormone Replacement alternatives and documented hypotestosterone (documented through generic alternatives labs) Sklice (vermectin) Dermatological alternatives; permethrin, malathion, and benzyl alcohol alternatives permethrin and malathion

2 Zioptan (tafluprost) Ophthalmic alternatives; Xalatan and Travatan Ultresa () GI Viokace () GI Korlym (mifepristone) Endocrine Dx: Diabetes Type 2 and Cushing s Syndrome 1. Failure of metformin, SU, and DPP4- Inhibitor combination 2. HbA1c score > 7 3. Failed surgery or is not a candidate for surgery Omontys (peginesatide) CKD FDA approved indication and Hgb < 10 g/dl Cosopt PF (dorzolamide/timolol) Ophthalmic Trial and failure of generic cosopt Giazo (basalazide) Colitis FDA approved indication Must be prescribed by GI specialist. Trial/failure of sulfasalazine; then Asacol Mitosol (mitomycin) Glaucoma Restricted to FDA Surfaxin (lucinactant) RDS Restricted to FDA Binosto (alendronate) Osteoporosis Trial and failure of alendronate then Boniva and a BMD (T Score -3.0) Suprenza (phentermine) Weight Loss BMI>27 kg/m2 with risk factors such as coronary heart disease, atherosclerotic disease, hypertension, type 2 diabetes mellitus, sleep apnea. Or BMI>30 kg/m2. Patients must attend or sign up for one of the weight management programs offered by IEHP alternatives; Xalatan and Travatan Dx: Diabetes Type 2 and Cushing s Syndrome 1. Failure of metformin, SU, and DPP4- Inhibitor combination 2. HbA1c score > 7 3. Failed surgery or is not a candidate for surgery BvsD, Restricted to FDA not otherwise excluded from Part D Trial and failure of generic cosopt Trial and failure of sulfasalazine or mesalamine Part B, restricted to FDA Part B, restricted to FDA Trial and failure of alendronate then Boniva or Actonel and a BMD (T Score -3.0) Part D Excluded Amyvid (florbetapir) Diagnostic Restricted to FDA Part B, restricted to FDA

3 approved indication approved indication Potiga (ezogabine) Anticonvulsant anticonvulsants. Adoption of REMS requirement PA for new start only. Adoption of REMS requirement and failure of formulary anticonvulsants. Natazia (estradiol/dienogest) Contraceptive Failure of generic formulary alternatives Failure of generic formulary alternatives Qnasl (beclomethasone) Allergy alternatives; fluticasone NS, flunisolide NS, and triamcinolone NS with combination therapy including oral alternatives; fluticasone NS, flunisolide NS, and triamcinolone NS with combination therapy including oral antihistamine antihistamine Viread (tenofovir) Hepatitis B See Hepatitis B Criteria See Hepatitis B Criteria Baraclude (entecavir) Pegasys (peg-interferon) Epivir (lamivudine) Tyzeka (telbivudine) Hepsera (adefovir) Intron A (IFN-α2b) Pradaxa (dabigatran) Xarelto (rivaroxaban) Pletal (cilostazol) Aggrenox (dypyrimidamole/aspirin) Effient (prasugrel) Brilinta (ticagrelor) Ticlid (ticlopidine) Fragmin (dalteparin) Lovenox (enoxaparin) Arixtra (heparin) Anticoagulants /anti platelets See Anticoagulant/anti platelet Criteria See Anticoagulant/anti platelet Criteria Full Prior Authorization table available at: CLINICAL PRACTICE GUIDELINE UPDATE Clinical Practice Guideline Therapeutic Class Comment Joslin Clinic: Guideline for Detection and Diabetes Renewal Management of Diabetes in Pregnancy American Diabetes Association: 2012 Clinical Diabetes Update Practice Recommendations Neurology: Evidence-based guideline update: Migraine Update NSAIDs and other complementary treatments for episodic migraine prevention in adults ACR: American College of Rheumatology 2008 RA Update

4 Recommendations for the Use of Nonbiologic and Biologic Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis Neurology: Evidence-based guideline: Intravenous immunoglobulin in the treatment of neuromuscular disorders National Kidney Foundation: K/DOQI CLINICAL PRACTICE GUIDELINES ACR: American College of Rheumatology 2012 Recommendations for the Use of Nonpharmacologic and Pharmacologic Therapies in Osteoarthritis of the Hand, Hip, and Knee IVIG CKD OA 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 - Adults Attention Deficit Hyperactivity Disorder - Pediatrics Attention Deficit Hyperactivity Disorder Toolkit Anti-Infective Therapy Guide Adult Anti-Infective Therapy Guide Pediatric Asthma Chronic Kidney Disease Depression Depression - Major Depressive Disorder Depression - Pediatrics Depression - Pediatrics Tool Kit Diabetes Mellitus - ADA Diabetes Mellitus - Joslin

5 Diabetes Pregnancy Diabetes Table Fibromyalgia Gastroesophageal Reflux Disease Hepatitis C Hepatitis C AASLD Detail Hepatitis C - Genotype 1 Hyperlipidemia Hypertension IVIG Migraine Multiple Sclerosis Osteoarthritis Pain Management Pain Quick Reference Pulmonary Arterial Hypertension Respiratory Syncytial Virus Rheumatoid Arthritis Sexually Transmitted Diseases - Summary of CDC Treatment Guidelines Smoking Cessation Synagis Criteria - Current Season Please visit the IEHP website for safety resource links that include Drug Safety and Recalls published at the FDA s website: 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