Prescribing Guide Standard Control Change Summary Report Effective (Standard Drug List Reflects Removals)
|
|
- Noel Stephens
- 6 years ago
- Views:
Transcription
1 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) vaginal ring Fiasp (insulin aspart) subcutaneous solution Fiasp FlexTouch (insulin aspart) subcutaneous solution pen-injector Kyleena (levonorgestrel) intrauterine device Central Nervous System/ Huntington's Disease Agents Estrogens/ Vaginal Antidiabetics/ Insulins Antidiabetics/ Insulins Contraceptives/ Progestin Intrauterine Devices Austedo is indicated for the treatment of: Chorea associated with Huntington s disease Tardive dyskinesia in adults. Estring is indicated for the treatment of moderate to severe symptoms of vulvar and vaginal atrophy due to menopause. Fiasp is indicated to improve glycemic control in adults with diabetes mellitus. Fiasp is indicated to improve glycemic control in adults with diabetes mellitus. Kyleena is indicated for prevention of pregnancy for up to 5 years. To provide an additional option for the treatment of chorea associated with Huntington s disease and tardive dyskinesia. To provide an additional option for the treatment of moderate to severe symptoms of vulvar and vaginal atrophy due to menopause. To provide an additional insulin option to improve glycemic control in adults with diabetes mellitus. To provide an additional insulin option to improve glycemic control in adults with diabetes mellitus. To provide an additional option for the prevention of pregnancy C Pg. 1 of 7
2 Odomzo (sonidegib) capsule Omnipod Insulin Infusion Pump insulin infusion disposable pump Skyla (levonorgestrel) intrauterine device Tolak (fluorouracil) cream Trelegy Ellipta (fluticasone furoate/umeclidinium/vil anterol) aerosol powder for inhalation Antineoplastic Agents/ Miscellaneous Antidiabetics/ Supplies Contraceptives/ Progestin Intrauterine Devices Topical/ Dermatology/ Actinic Keratosis Respiratory/ Anticholinergic / Beta Agonist/ Steroid Inhalant Combinations Odomzo is indicated for the treatment of adult patients with locally advanced basal cell carcinoma that has recurred following surgery or radiation therapy, or those who are not candidates for surgery or radiation therapy. Omnipod Insulin Infusion Pump is used to allow continuous subcutaneous insulin infusion in patients with insulin-dependent diabetes. Skyla is indicated to prevent pregnancy for up to 3 years. Tolak is indicated for the topical treatment of actinic keratosis lesions of the face, ears, and/or scalp. Trelegy Ellipta is indicated for the long-term, once-daily, maintenance treatment of patients with chronic obstructive pulmonary disease (COPD), including chronic bronchitis and/or emphysema, who are on a fixeddose combination of fluticasone To provide an option for the treatment of advanced basal cell carcinoma. To provide an option for continuous insulin delivery in insulin-dependent diabetes. To provide an additional option for the prevention of pregnancy. To provide an additional option for the treatment of actinic keratosis lesions. To provide an additional option for the maintenance treatment of patients with COPD C Pg. 2 of 7
3 Generic Agents: furoate and vilanterol for airflow obstruction and reducing exacerbations in whom additional treatment of airflow obstruction is desired or for patients who are already receiving umeclidinium and a fixed-dose combination of fluticasone furoate and vilanterol. lanthanum carbonate chewable tablet Phosphate Binder Agents Lanthanum carbonate is indicated to reduce serum phosphate in patients with end stage renal disease (ESRD). To provide an additional generic option to reduce serum phosphate levels. DELETIONS: Brand Agents: Brisdelle (paroxetine mesylate) capsule Central Nervous System/ Psychotherapeutic - Miscellaneous/ Vasomotor Symptom Agents Brisdelle is indicated for the treatment of moderate to severe vasomotor symptoms associated with menopause. Availability of a non-hormonal generic option for the treatment of moderate to severe vasomotor symptoms associated with menopause. The preferred option on the Prescribing Guide - Standard Control is paroxetine mesylate C Pg. 3 of 7
4 Juxtapid (lomitapide mesylate) capsule Renvela (sevelamer carbonate) powder for suspension, tablet Tamiflu (oseltamivir) capsule Cardiovascular/ Antilipemics/ Microsomal Triglyceride Transfer Protein Inhibitors Phosphate Binder Agents Anti-Infectives/ Antivirals/ Influenza Agents Juxtapid is indicated as an adjunct to a low-fat diet and other lipid-lowering treatments, including LDL apheresis where available, to reduce low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), apolipoprotein B (apo B), and non-high-density lipoprotein cholesterol (non-hdl-c) in patients with homozygous familial hypercholesterolemia (HoFH). Renvela is indicated for the control of serum phosphorus in adults and children 6 years of age and older with chronic kidney disease on dialysis. Tamiflu is indicated for: Treatment of acute, uncomplicated influenza A and B in patients 2 weeks of age and older who have been symptomatic for no more than 48 hours Prophylaxis of influenza A and B in patients 1 year and older. Availability of an additional option for the treatment of homozygous familial hypercholesterolemia. The preferred option on the Prescribing Guide - Standard Control is Repatha (evolocumab). Availability of additional options for control of serum phosphorus in adults with CKD on dialysis. Standard Control include calcium acetate, lanthanum carbonate, sevelamer carbonate, Phoslyra (calcium acetate), and Velphoro (sucroferric oxyhydroxide). Availability of additional options for the treatment and prophylaxis of influenza A and B. Standard Control include oseltamivir and Relenza (zanamivir) C Pg. 4 of 7
5 Tamiflu (oseltamivir) powder for suspension Tegretol XR (carbamazepine phosphate ext-rel) extended-release tablet Anti-Infectives/ Antivirals/ Tamiflu is indicated for: Availability of a generic option for the treatment and Influenza Agents Treatment of acute, uncomplicated prophylaxis of influenza A and B. influenza A and B in patients 2 weeks of age and older who have The preferred option on the Prescribing Guide - been symptomatic for no more than Standard Control is oseltamivir. 48 hours Prophylaxis of influenza A and B in Central Nervous System/ Anticonvulsants patients 1 year and older. Tegretol-XR is indicated for the treatment of epilepsy and the treatment of pain associated with true trigeminal neuralgia. Availability of additional options for the treatment of epilepsy and trigeminal neuralgia. Standard Control include carbamazepine, carbamazepine ext-rel, divalproex sodium, divalproex sodium ext-rel, gabapentin, lamotrigine, lamotrigine ext-rel, levetiracetam, levetiracetam extrel, oxcarbazepine, phenobarbital, phenytoin, phenytoin sodium extended, tiagabine, topiramate, valproic acid, zonisamide, Fycompa (perampanel), Oxtellar XR (oxcarbazepine ext-rel), Trokendi XR (topiramate ext-rel), and Vimpat (lacosamide) C Pg. 5 of 7
6 REMOVALS: Brand Agents: Alevicyn (emollient) gel Alevicyn (emollient) dermal spray Alevicyn Antipruritic SG (emollient) liquid Topical/ Dermatology/ Wound Care s Topical/ Dermatology/ Wound Care s Topical/ Dermatology/ Wound Care s Alevicyn gel is intended for management of itch and pain associated with dermal irritations and wounds, such as sores, injuries and ulcers of dermal tissue. Alevicyn dermal spray is intended for the cleansing, irrigation, moistening, debridement and removal of foreign material including microorganisms and debris from exudating wounds, acute and chronic dermal lesions including stage I-IV pressure ulcers, stasis ulcers, diabetic ulcers, post-surgical wounds, first- and second-degree burns, abrasions, minor irritations of the skin, diabetic foot ulcers, ingrown toe nails, grafted/donor sites and exit sites. Alevicyn Antipruritic SG is indicated to manage and relieve the burning, itching and pain experienced with various types of dermatoses, including radiation dermatitis and atopic dermatitis. Alevicyn Antipruritic SG may also be Availability of generic options for the management of itch and pain associated with dermal irritations and wounds. Standard Control include desonide and hydrocortisone. Availability of generic options for cleansing, irrigation, moistening, debridement and removal of foreign material from wounds. Standard Control include desonide and hydrocortisone. Availability of generic options to manage and relieve the burning, itching and pain experienced with various types of dermatoses C Pg. 6 of 7
7 used to relieve the pain of first and second degree burns. Alevicyn Antipruritic SG helps to relieve dry waxy skin by maintaining a moist wound and skin environment, which is beneficial to the healing process. Standard Control include desonide and hydrocortisone C Pg. 7 of 7
Advanced Control Formulary Change Summary Report Effective
This report highlights all changes (additions, deletions, and removals) to the CVS Caremark Advanced Control Formulary ADDITIONS: Brand Agents: Austedo (deutetrabenazine) tablet Cystagon (cysteamine bitartrate)
More informationEpilepsy 101. Overview of Treatment Kathryn A. O Hara RN. American Epilepsy Society
Epilepsy 101 Overview of Treatment Kathryn A. O Hara RN American Epilepsy Society Objectives Describe the main treatment options for epilepsy Identify factors essential in the selection of appropriate
More informationFormulary and Program Updates Effective 5/1/18
Formulary and Program Updates Effective 5/1/18 Pharmacy & Therapeutics Committee Meeting February 20, 2018 6:30 8:00 PM WELCOME New Committee Members: Peter Robie, MD General Internist practicing in Winston-Salem
More informationANTICONVULSANT STEP THERAPY
2019 First Choice VIP Care Plus Formulary Document: 2019 Step Therapy Formulary ID: 19391 Last Updated: 2/2019 Effective Date: 03-01-2019 ANTICONVULSANT STEP THERAPY APTIOM 200 MG APTIOM 400 MG APTIOM
More informationMay 2017 P&T Updates
May 2017 P&T Updates Commercial Triple Tier 4th Tier Applicable Traditional Prior Auth Alternatives 6 ml per AMPYRA 3 2 2 tablets per day, 30 day BYDUREON 3 2 4 vials per 28 days 5 mcg pen: 1.2 ml per
More informationVNSNY CHOICE FIDA Complete Step Therapy Requirements. Effective: 04/01/2019
VNSNY CHOICE FIDA Complete Step Therapy Requirements Effective: 04/01/2019 Updated 03/2019 AMANTADINE ER OSMOLEX ER 129 MG, EXTENDED RELEASE OSMOLEX ER 193 MG, EXTENDED RELEASE OSMOLEX ER 258 MG, EXTENDED
More informationVelphoro (sucroferric oxyhydroxide)
STRENGTH DOSAGE FORM ROUTE GPID 500mg chewable tablet oral 36003 MANUFACTURER Fresenius Medical Care North America INDICATION(S) For the control of serum phosphorus levels in patients with chronic kidney
More informationJuxtapid. Juxtapid (lomitapide) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Juxtapid Page: 1 of 6 Last Review Date: September 20, 2018 Juxtapid Description Juxtapid (lomitapide)
More informationAntiepileptics. Medications Comment Quantity Limit Carbamazepine. May be subject Preferred to quantity limit Epitol
Market DC Antiepileptics Override(s) Approval Duration Prior Authorization 1 year Step Therapy Quantity Limit *Indiana Medicaid See State Specific Mandate below *Maryland Medicaid See State Specific Mandate
More informationNew 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 informationAMANTADINE ER. Products Affected Step 2: OSMOLEX ER 129 MG TABLET, EXTENDED RELEASE OSMOLEX ER 193 MG TABLET, Details
AMANTADINE ER OSMOLEX ER 129 MG, EXTENDED RELEASE OSMOLEX ER 193 MG, EXTENDED RELEASE OSMOLEX ER 258 MG, EXTENDED RELEASE PRIOR CLAIM FOR AMANTADINE HCL IMMEDIATE RELEASE WITHIN THE PAST 120 DAYS. 1 ANTICONVULSANTS
More informationALLERGIC CONJUNCTIVITIS AGENTS
2018 5 Tier Standard- Keystone First VIP Choice Document: 2018 Step Therapy Formulary ID: 18390 Last Updated: 04/2018 Effective Date: 05-01-2018 ALLERGIC CONJUNCTIVITIS AGENTS epinastine 0.05 % eye drops
More informationANTICONVULSANTS. Details
ANTICONVULSANTS Aptiom 200 mg tablet Aptiom 400 mg tablet Aptiom 600 mg tablet Aptiom 800 mg tablet Banzel 200 mg tablet Banzel 40 mg/ml oral suspension Banzel 400 mg tablet Fycompa 0.5 mg/ml oral suspension
More informationQuarterly 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 informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Reference Number: CP.PMN.04 Effective Date: 11.15.17 Last Review Date: 05.18 Line of Business: Commercial, Medicaid Revision Log See Important Reminder at the end of this policy for important
More informationKent Kidney Care Centre: Medicines prescribed for people with chronic kidney disease
Kent Kidney Care Centre: Medicines prescribed for people with chronic kidney disease Information for patients The following pages offer you information on some of the medicines that you may need. It is
More informationAnticonvulsant Prior Authorization Request
Anticonvulsant Prior Authorization Request Commonwealth of Massachusetts MassHealth Drug Utilization Review Program P.O. Box 2586, Worcester, MA 01613-2586 Fax: 1-877-208-7428 Phone: 1-800-745-7318 MassHealth
More informationStep Therapy Requirements. Effective: 03/01/2015
Effective: 03/01/2015 Updated 02/2015 ANTI-INFLAMMATORY AGENTS - GI DIPENTUM PRIOR CLAIM FOR BALSALAZIDE OR APRISO WITHIN THE PAST 120 DAYS. ANTICONVULSANTS APTIOM BANZEL FYCOMPA OXTELLAR XR POTIGA QUDEXY
More informationKynamro. Kynamro (mipomersen) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.02 Subject: Kynamro Page: 1 of 5 Last Review Date: September 15, 2017 Kynamro Description Kynamro
More informationANTICONVULSANTS. Details
ANTICONVULSANTS APTIOM 200 MG TABLET APTIOM 400 MG TABLET APTIOM 600 MG TABLET APTIOM 800 MG TABLET BANZEL 200 MG TABLET BANZEL 40 MG/ML ORAL SUSPENSION BANZEL 400 MG TABLET FYCOMPA 0.5 MG/ML ORAL SUSPENSION
More informationSummary of Lothian Joint Formulary Amendments
Summary of Lothian Joint Formulary Amendments The purpose of this summary is to detail the main changes to the LJF sections and provide additional information on the reasons for some of the changes. The
More informationANTICONVULSANTS. Details
ANTICONVULSANTS Aptiom 200 mg tablet Aptiom 400 mg tablet Aptiom 600 mg tablet Aptiom 800 mg tablet Banzel 200 mg tablet Banzel 40 mg/ml oral suspension Banzel 400 mg tablet Fycompa 0.5 mg/ml oral suspension
More informationVNSNY CHOICE FIDA Complete Step Therapy Requirements. Effective: 01/01/2017
VNSNY CHOICE FIDA Complete Step Therapy Requirements Effective: 01/01/2017 Updated 12/23/2016 ANTICONVULSANTS Aptiom 200 mg tablet Potiga 200 mg tablet Aptiom 400 mg tablet Potiga 300 mg tablet Aptiom
More informationQuarterly 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 informationMedications for Epilepsy What I Need to Know
Medications for Epilepsy What I Need to Know Safiya Ladak, BSc.Phm. Toronto Western Hospital, UHN Clinical Pharmacist, Neurology and Neurosurgery June 4, 2016 Learning Objectives Treatment options for
More informationFirstCarolinaCare Insurance Company. Step Therapy Requirements
FirstCarolinaCare Insurance Company Step Therapy Requirements Effective: 12/01/2018 ANTICONVULSANTS APTIOM 200 MG APTIOM 400 MG APTIOM 600 MG APTIOM 800 MG BANZEL 200 MG BANZEL 40 MG/ML ORAL SUSPENSION
More informationSanta Clara Family Health Plan Cal MediConnect Formulary. List of Step Therapy Requirements Effective: 12/01/ E
Santa Clara Family Health Plan Cal MediConnect Formulary List of Step Therapy Requirements Effective: 12/01/2018 13027.12E ANTICONVULSANTS APTIOM 200 MG TABLET APTIOM 400 MG TABLET APTIOM 600 MG TABLET
More informationStep Therapy Requirements
Step Therapy Requirements Denver Health Medicare Choice (HMO SNP)/Medicare Select (HMO) Effective: 09/01/2017 Updated 08/2017 ANTICONVULSANTS Aptiom 200 mg tablet Aptiom 400 mg tablet Aptiom 600 mg tablet
More information2017 Step Therapy Criteria
FRESENIUS TOTAL HEALTH 2017 Step Therapy Updated 07/01/2017. For more recent information or other questions, please contact Fresenius Total Health Customer Service at 1-855-598-6774 / TTY 1-844-209-9094.
More informationLiterature Scan: Phosphate Binders
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationANTICONVULSANTS. Details
ANTICONVULSANTS APTIOM 200 MG APTIOM 400 MG APTIOM 600 MG APTIOM 800 MG BANZEL 200 MG BANZEL 40 MG/ML ORAL SUSPENSION BANZEL 400 MG FYCOMPA 0.5 MG/ML ORAL SUSPENSION FYCOMPA 10 MG FYCOMPA 12 MG FYCOMPA
More informationANGIOTENSIN RECEPTOR BLOCKERS STEP THERAPY
South Country Health Alliance 2017 Step Therapy Formulary ID: 17431 Last Updated: 10/20/2017 Effective Date: 11-01-2017 ANGIOTENSIN RECEPTOR BLOCKERS STEP THERAPY BENICAR 20 MG BENICAR 40 MG BENICAR 5
More informationELEVATE. Formulary Updates to Elevate Plans (Bronze HDHP/Standard, Silver Select/Standard & Gold Select/Standard)
ELEVATE Formulary Updates to Elevate Plans (Bronze HDHP/Standard, Silver Select/Standard & Gold Select/Standard) P&T/Formulary Committee Actions 4Q 2017 (Effective January 1, 2018) Marketplace Standard
More informationReport ADDITIONS: Product Brand Agents: Indication. Subcategory. Generic Agents: Gastrointestinal/ Antiemetics
This report highlights all changes (additions and deletions) to the CVS Caremark Performance Drug List. ADDITIONS: Brand Agents: Diclegis (doxylamine/ pyridoxine delayed release) Gastrointestinal/ Antiemetics
More informationPharmacy Medical Necessity Guidelines: Anticonvulsants/Mood Stabilizers
Pharmacy Medical Necessity Guidelines: Anticonvulsants/Mood Stabilizers Effective: December 18, 2017 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review
More informationAnti-Influenza Agents Quantity Limit Program Summary
Anti-Influenza Agents Quantity Limit Program Summary FDA APPROVED INDICATIONS DOSAGE 1,2 Agent Indication Dosage & Administration Relenza Treatment of influenza in Treatment of influenza: (zanamivir) patients
More informationQuarterly 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 informationKentucky 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 informationQUANTITY 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 informationAdvanced Control Formulary Change Summary Report Effective
This report highlights all changes (additions, deletions, and removals) to the CVS Caremark Advanced Control Formulary. ADDITIONS: Brand Agents: Mepron (atovaquone) suspension Mydayis (amphetaminedextroamphetamine)
More informationGeneric Name (Brand Name) Available Strengths Formulary Limits. Primidone (Mysoline) 50mg, 250mg -- $
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Epilepsy P&T DATE: 2/15/2017 THERAPEUTIC CLASS: Neurologic Disorders REVIEW HISTORY: 2/16 LOB AFFECTED: Medi-Cal (MONTH/YEAR)
More informationSelf Report Seizure Survey Summary 2017
Self Report Seizure Survey Summary 2017 Tetrasomy 18p 61 responses 33 had at least one seizure = 54% 8 had a seizure in the last year Valproate (Depakote) 7 Valproate (Depakote, Epilium) 2 Lamotrigene
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Lacosamide (Vimpat) Reference Number: CP.PMN.155 Effective Date: 10.01.18 Last Review Date: 07.13.18 Line of Business: Oregon Health Plan Revision Log See Important Reminder at the end
More informationVNSNY CHOICE FIDA Complete Step Therapy Requirements. Effective: 01/01/2017
Effective: 01/01/2017 Updated 11/2016 ANTI-INFLAMMATORY AGENTS - GI DIPENTUM PRIOR CLAIM FOR BALSALAZIDE OR APRISO WITHIN THE PAST 120 DAYS. ANTICONVULSANTS APTIOM BANZEL FYCOMPA GABITRIL OXTELLAR XR POTIGA
More informationHEALTH 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 informationClinical Policy: Clobazam (Onfi) Reference Number: CP.PMN.54 Effective Date: Last Review Date: Line of Business: HIM, Medicaid
Clinical Policy: (Onfi) Reference Number: CP.PMN.54 Effective Date: 11.01.12 Last Review Date: 08.18 Line of Business: HIM, Medicaid Revision Log See Important Reminder at the end of this policy for important
More informationJuxtapid (lomitapide)
Juxtapid (lomitapide) Policy Number: 5.01.599 Last Review: 06/2018 Origination: 07/2015 Next Review: 06/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for Juxtapid
More informationKynamro. Kynamro (mipomersen) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.40.02 Subject: Kynamro Page: 1 of 5 Last Review Date: December 2, 2016 Kynamro Description Kynamro (mipomersen)
More informationAdded, Removed or Changed. Date of Change. No Change
One mission: you s September 7, 2017 Blue Cross of Idaho reviews its formularies (covered drug lists) periodically to allow members access to new drugs and to provide safe, cost effective options for your
More informationStep Therapy Requirements
An Independent Licensee of the Blue Cross and Blue Shield Association Step Therapy Requirements Effective: 05/01/2018 Updated 4/2018 H0302_2_2014 CMS Accepted 05/05/2014 1 BETA-BLOCKERS BYSTOLIC 10 MG
More informationMedicines for anaemia and mineral bone disease
Patient Information: Medicines NHS Logo here Medicines for anaemia and mineral bone disease Health & care information you can trust The Information Standard Certified Member Working together for better
More informationMEDICAL ASSISTANCE BULLETIN
ISSUE DATE February 18, 2015 SUBJECT EFFECTIVE DATE January 21, 2015 MEDICAL ASSISTANCE BULLETIN NUMBER *See below BY Drug List (PDL) Update January 21, 2015 Pharmacy Services Vincent D. Gordon, Deputy
More informationBlue Cross and Blue Shield of Minnesota GenRx Formulary Updates
Blue Cross and Blue Shield of Minnesota GenRx Formulary Updates July 2018 TRADE NAME (generic name) or generic name ADVAIR DISKUS (fluticasone-salmeterol aer powder ba 100-50 mcg/dose) Brand Addition ADVAIR
More informationNon-Opioid Drugs to Treat Neuropathic Pain. March 2018
Non-Opioid Drugs to Treat Neuropathic Pain Final Report March 2018 This report is intended only for state employees in states participating in the Drug Effectiveness Review Project (DERP). Do not distribute
More informationTRELEGY 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 informationNMIH 206 NOTES TOPIC. Page 1 of 5
NMIH 206 NOTES TOPIC PAGE NUMBER PHARMACOKINETICS 2-15 INFECTIONS & VACCINATIONS 16-18 ANTICOAGULANT & CLOTTING TIMES 19-24 CARDIAC DRUGS: ANGININE & LANOXIN 25-27 ANAESTHETICS 28-31 NUTRITION 36-40 HYPOLIPIDAEMIC
More informationUPDATE Ohana QUEST Integration Medicaid
UPDATE Ohana QUEST Integration Medicaid Preferred Drug List June 29, 2015 Dear Provider: At the June 04, 2015 WellCare Pharmacy & Therapeutics Committee meeting, it was decided that the following changes
More informationClinical Policy: Clobazam (Onfi) Reference Number: CP.PMN.54 Effective Date: Last Review Date: Line of Business: HIM, Medicaid
Clinical Policy: (Onfi) Reference Number: CP.PMN.54 Effective Date: 11.01.12 Last Review Date: 11.18 Line of Business: HIM, Medicaid Revision Log See Important Reminder at the end of this policy for important
More informationCommon Repatha Documentation Requirements for Patients With Primary Hyperlipidemia and Established CVD 1,2
Established CVD Common Repatha Documentation Requirements for Patients With Primary Hyperlipidemia and Established CVD 1,2 Primary and Secondary Diagnosis Codes Primary Diagnosis: Primary hyperlipidemia
More informationUnitedHealthcare Pharmacy Clinical Pharmacy Programs
UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2018 P 3001-11 Program Step Therapy - Anticonvulsants Medication/Therapeutic Class Anticonvulsants Depakote, Depakote ER, Felbatol, Keppra,
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Lyrica) Reference Number: ERX.NPA.10 Effective Date: 06.01.15 Last Review Date: 08.17 Line of Business: Commercial [Prescription Drug Plan] Revision Log See Important Reminder at the
More informationPART 12 DRUGS TO BE PRESCRIBED IN CERTAIN CIRCUMSTANCES UNDER THE NHS PHARMACEUTICAL SERVICES SCHEDULE 2
SCHEDULE 2 DRUGS, MEDICINES AND OTHER SUBSTANCES TO BE ORDERED BY CONTRACTORS IN THE PROVISION OF PRIMARY MEDICAL SERVICES UNDER A GENERAL MEDICAL SERVICES CONTRACT ONLY IN CERTAIN CIRCUMSTANCES 1 Drug,
More informationOpinion 24 July 2013
The legally binding text is the original French version TRANSPARENCY COMMITTEE Opinion 24 July 2013 FYCOMPA 2 mg, film-coated tablet B/7 (CIP: 34009 267 760 0 8) B/28 (CIP: 34009 268 447 4 5) FYCOMPA 4
More informationUtibron Neohaler. (indacaterol, glycopyrrolate) New Product Slideshow
Utibron Neohaler (indacaterol, glycopyrrolate) New Product Slideshow Introduction Brand name: Utibron Neohaler Generic name: Indacaterol, glycopyrrolate Pharmacological class: Long-acting beta2- agonist
More informationPrescribing and Monitoring Anti-Epileptic Drugs
Prescribing and Monitoring Anti-Epileptic Drugs Mark Granner, MD Clinical Professor and Vice Chair for Clinical Programs Director, Iowa Comprehensive Epilepsy Program Department of Neurology University
More informationMenopausal Symptoms. Hormone Therapy Products Available in Canada for the Treatment of. Physician Desk Reference - 3rd Edition
Hormone Therapy Products Available in Canada for the Treatment of Menopausal Symptoms Physician Desk Reference - 3rd Edition A clinical resource provided to you by: The Society of Obstetricians and Gynaecologists
More informationEVOLOCUMAB Generic Brand HICL GCN Exception/Other EVOLOCUMAB REPATHA 42378
Generic Brand HICL GCN Exception/Other EVOLOCUMAB REPATHA 42378 This drug requires a written request for prior authorization. All requests for Repatha (evolocumab) require review by a pharmacist prior
More informationSeizure medications An overview
Seizure medications An overview Andrew Zillgitt, DO Staff Neurologist Comprehensive Epilepsy Center Department of Neurology Henry Ford Hospital None Disclosures Objectives A lot to review!!!!! Look at
More informationSwine Influenza Update #3. Triage, Assessment, and Care of Patients Presenting with Respiratory Symptoms
Updated 12:00 p.m. April 30, 2009 Swine Influenza Update #3 Introduction: This document revises our last update which was sent April 28 th, 2009. The most important revisions include the following: 1.
More informationAntiviral Treatment and Prophylaxis for seasonal Influenza QRG 2017/18
Antiviral Treatment and Prophylaxis for seasonal Influenza QRG 2017/18 Selection of antiviral therapy for treatment of influenza (definitions + doses on p.2) When indicated, treatment should be started
More informationMichigan Pharmacy and Therapeutics Committee September 9, 2014 at 6:00 PM Kellogg Center, East Lansing, Michigan
Michigan Pharmacy and Therapeutics Committee September 9, 2014 at 6:00 PM Kellogg Center, East Lansing, Michigan Agenda: Introductions Approval of Minutes of July 8, 2014 Meeting P & T Business Review
More informationCHRONIC OBSTRUCTIVE PULMONARY DISEASE
CHRONIC OBSTRUCTIVE PULMONARY DISEASE INCIDENCE UP TO 380,000 PEOPLE IN IRELAND HSE FIGURES 110,000 DIAGNOSED AND 200,000 UNDIAGNOSED. AFFECTS MORE MEN THAN WOMEN BUT RATES ARE RISING 1500 DEATHS PER YEAR
More informationCOMMON MEDICINES USED IN CKD CHRONIC KIDNEY DISEASE
CHRONIC KIDNEY DISEASE 1 This information is intended to help you understand why you need to take your medicines. There are multiple medicines that are used to control the symptoms related to CKD. You
More informationClinical Policy: Lomitapide (Juxtapid) Reference Number: ERX.SPA.170 Effective Date:
Clinical Policy: (Juxtapid) Reference Number: ERX.SPA.170 Effective Date: 01.11.17 Last Review Date: 11.17 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
More informationTEST ANTICONVULSANT THERAPY. Products Affected. Step 2: Network Health Insurance Corporation NetworkCares Step Therapy Criteria Last Updated 11/2018
TEST Network Health Insurance Corporation NetworkCares Step Therapy Last Updated 11/2018 ANTICONVULSANT THERAPY Aptiom Banzel Briviact Celontin Dilantin 30 Mg Capsule Equetro Fycompa 0.5 Mg/ml Oral Susp
More informationManagement of Epilepsy in Primary Care and the Community. Carrie Burke, Epilepsy Specialist Nurse
Management of Epilepsy in Primary Care and the Community Carrie Burke, Epilepsy Specialist Nurse Epilepsy & Seizures Epilepsy is a common neurological disorder characterised by recurring seizures (NICE,
More informationGranite 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 informationAppendix. TABLE E-1 Study Variables and Associated ICD-9-CM, HCPCS, and CPT Codes. Codes. (1) Fracture locations
Page 1 Appendix TABLE E-1 Study Variables and Associated ICD-9-CM, HCPCS, and CPT Codes (1) Fracture locations Vertebral fracture Codes ICD-9-CM Diagnosis codes: 733.13, 805.xx, 806.xx ICD-9-CM Procedure
More informationReview of Anticonvulsant Medications: Traditional and Alternative Uses. Andrea Michel, PharmD, CACP
Review of Anticonvulsant Medications: Traditional and Alternative Uses Andrea Michel, PharmD, CACP Objectives Review epidemiology of epilepsy Classify types of seizures Discuss non-pharmacologic and pharmacologic
More information2018 PDP Premier Step Therapy Document September 2018 Y0114_18_33144_I_009
2018 PDP Premier Step Therapy Document September 2018 Aggrenox Y0114_18_33144_I_009 aspirin 25 mg-dipyridamole 200 mg capsule,ext.release 12 hr multiphase drug may be given. Step 1 Drug(s): clopidigrel.
More informationNOTTINGHAMSHIRE AREA PRESCRIBING COMMITTEE SHARED CARE PROTOCOL AGREEMENT
NOTTINGHAMSHIRE AREA PRESCRIBING COMMITTEE SHARED CARE PROTOCOL AGREEMENT Phosphate Binders for the Treatment of Hyperphosphataemia in adults with Chronic Kidney Disease OBJECTIVES To outline referral
More informationSTEP THERAPY PROGRAM
STEP THERAPY PROGRAM Step Therapy Program Certain prescription drugs call for a more detailed assessment to help ensure that they represent reasonable treatment. For these drugs, Great-West s Special Authorization
More informationThe pages that follow contain information critical to protecting the health of your patients and the citizens of Colorado.
Health Alert Network Tri-County Health Department Serving Adams, Arapahoe and Douglas Counties Phone 303/220-9200 Fax 303/741-4173 www.tchd.org Follow us on Twitter @TCHDHealth and @TCHDEmergency John
More informationInfluenza Therapies. Considerations Prescription influenza therapies require prior authorization through pharmacy services.
Influenza Therapies Policy Number: 5.01.515 Last Review: 10/2017 Origination: 10/2002 Next Review: 10/2018 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for influenza
More informationSmoking and Nicotine Replacement Therapy (NRT) Lec:5
Smoking and Nicotine Replacement Therapy (NRT) Lec:5 Tobacco use remains the single largest preventable cause of mortality. Cigarette smoke is a complex mixture of an estimated 4800 compounds. Approximately
More informationSTEP THERAPY CRITERIA
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 under your medical or prescription
More informationEpilepsy Medications: The Basics
Epilepsy Medications: The Basics B R I A N A P P A V U, M D C L I N I C A L A S S I S T A N T P R O F E S S O R, D E P A R T M E N T O F C H I L D H E A L T H A N D N E U R O L O G Y, U N I V E R S I T
More informationUnitedHealthcare Pharmacy Clinical Pharmacy Programs
UnitedHealthcare Pharmacy Clinical Pharmacy Programs Program Number 2017 P 2004-10 Program Prior Authorization/Medical Necessity - Multisource Brand/Modified Release Anticonvulsants Medication/Therapeutic
More informationCalgary Long Term Care Formulary
Page 1 of 10 Calgary Long Term Care Formulary Pharmacy & Therapeutics November 2018 Highlights https://www.albertahealthservices.ca/info/page4071.aspx Page 2 of 10 Contents November 2018... 3 Formulary
More informationAdvanced Control Formulary Change Summary Report Effective
This report highlights all changes (additions, deletions, and removals) to the CVS Caremark Advanced Control Formulary. ADDITIONS: Brand Agents: Ajovy (fremanezumabvfrm) subcutaneous injection Aristada
More informationStep Therapy Requirements
An Independent Licensee of the Blue Cross and Blue Shield Association Step Therapy Requirements Effective: 12/01/2017 Updated 11/2017 H0302_2_2014 CMS Accepted 05/05/2014 1 ABILIFY Abilify 10 mg tablet
More informationModified release drug delivery system for antiepileptic drug (Formulation development and evaluation).
TITLE OF THE THESIS / RESEARCH: Modified release drug delivery system for antiepileptic drug (Formulation development and evaluation). INTRODUCTION: Epilepsy is a common chronic neurological disorder characterized
More informationPatient Guide Levonorgestrel and Ethinyl Estradiol Tablets USP (0.1 mg/0.02 mg) and Ethinyl Estradiol Tablets USP (0.
Patient Guide Levonorgestrel and Ethinyl Estradiol Tablets USP (0.1 mg/0.02 mg) and Ethinyl Estradiol Tablets USP (0.01 mg) Rx Only This product (like all oral contraceptives) is intended to prevent pregnancy.
More informationSimply Step Therapy Document September 2018 Y0114_18_33074_I_009
2018 2018 Simply Step Therapy Document September 2018 Aptiom APTIOM 200 MG TABLET APTIOM 400 MG TABLET Y0114_18_33074_I_009 APTIOM 600 MG TABLET APTIOM 800 MG TABLET Criteria If the patient has tried a
More information