UPMC for You Pharmacy and Therapeutics Committee Meeting April 8, 2013 meeting

Transcription

1 UPMC for You Pharmacy and Therapeutics Committee Meeting April 8, 2013 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 and fax vote were approved by the Committee. 3. New Business: Medication Reviews Drug Class Anti-Infective Anti-Diarrheal Anticoagulant Diabetes Cardiovascular Antipsychotic Anticonvulsant Nitrogen-Binding Agent Antineoplastic IVIG Otic Drug Name Cystaran (cysteamine) Sirturo (bedaquiline) Fulyzaq (crofelemer) Eliquis (apixaban) Nesina (alogliptin) Kynamro (mipomersen) Abilify Maintena (aripiprazole) Fycompa (perampanel) Ravicti (glycerol phenylbutyrate) Pomalyst (pomalidomide) Bivigam (immune globulin) Aurax (antipyrine/benzocaine) Formulary Coverage Recommendation with Quantity Limit

2 Drug Class Anaphylaxis Agent Hyaluronic Acid Gastrointestinal Agent Gastrointestinal Agent Antifungal Stimulant Gastrointestinal Agent Cough/Cold Anti-migraine Drug Name Auvi-Q (epinephrine) Gel-One (hyaluronic acid) Ilevro (nepafenac) Lotemax (loteprednol) Rescula (unoprostone) Delzicol (mesalamine) Giazo (balsalazide) Onmel (itraconazole) Quillivant XR (methylphenidate) Uceris (budesodine) Vituz (hydrocodone/chlorpeniramine) Zecuity (sumatriptan) Formulary Coverage Recommendation with Quantity Limit Do not add with Prior Authorization < 4 years of age and 18 years of age and Quantity Limit with Quantity Limit All voted in favor to approve the recommendations noted above. New policies RX.PA.194 Crofelemer (Fulyzaq)

3 RX.PA.195 Mipomersen (Kynamro) RX.PA.196 Perampanel (Fycompa) 4. Updates: Policy Revisions RX.PA.062 Interferons and Protease Inhibitors Updated to prefer Victrelis (boceprevir) over Incivek (telaprevir) and require PegIntron (interferon alfa-2b) before Pegasys (interferon alfa-2a). RX.PA.100 Eltrombopag (Promacta) Updated to include the new indication of treatment of thrombocytopenia in patients who have Hepatitis C to allow for the initiation and maintenance of interferon-based therapy. Patients will have to have platelet counts below 75,000 and be anticipating or currently on treatment with an interferon product. RX.PA.115 Tolvaptan (Samsca) Updated to clarify the requirements for specialist prescriber and past treatment. Patients must be seen by or in consultation with an endocrinologist or nephrologist and must have symptomatic hyponatremia that resisted correction with fluid restriction. RX.PA.143 Carglumic Acid (Carbaglu) Updated to require chart documentation of how the urea cycle disorder diagnosis was made and to change the initial approval duration from 1 year to 3 months to make sure the medication is working. RX.PA Anakinra (Kineret) Updated to include the newly-approved diagnosis of Neonatal-Onset Multisystem Inflammatory Disease (NOMID), to require prior trials of Enbrel and Humira for diagnosis of rheumatoid arthritis, and to require monitoring of absolute neutrophil count before and during treatment with Kineret RX.PA.086 Rilonacept (Arcalyst) Updated to separate approved diagnoses of Muckle-Wells Syndrome (MWS) and Familial Cold Autoinflammatory Syndrome (FCAS) as the criteria for diagnosis are different. The policy also now requires chart documentation of how the diagnosis was made, baseline and subsequent monitoring of lipid panel, and no evidence of infection.

4 RX.PA.123 Canakinumab (Ilaris) Updated to separate approved diagnoses of Muckle-Wells Syndrome (MWS) and Familial Cold Autoinflammatory Syndrome (FCAS) as the criteria for diagnosis are different. The policy also now requires chart documentation of how the diagnosis was made and no evidence of infection. RX.PA.018 Itraconazole (Sporanox & Onmel) Updated to include criteria for the new FDA-approved itraconazole tablet (Onmel) which requires members to have laboratory confirmation of the diagnosis as well as a prior trial of generic itraconazole before Onmel can be approved. In addition, the requirement of a prior trial of terbinafine was added for itraconazole capsules and oral solution (Sporanox) for the diagnosis of onychomycosis with foot pain. RX.PA Quetiapine (Seroquel) Medicaid & CHIP Updated to the prior drug trial requirements for Major Depressive Disorder to have only a 4- week trial of one SSRI or SNRI. RX.PA.071 Formulary SSRI Step Updated the four above policies to remove the word brand from the text as the policies apply (or may apply in the future) to generic medications. RX.PA.116 Angiotensin Receptor Blocker Step Medicaid & CHIP Updated to require only a trial of an angiotensin converting enzyme (ACE) inhibitor before a formulary angiotensin receptor blocker is approved. RX.PA.135 Tocilizumab (Actemra) Updated to add criteria for the indication of Systemic Juvenile Idiopathic Arthritis. RX.003 Prior Authorization Process Updated to include audit and staff training language for the prior authorization process. In addition, the process for sending out approval and denial letters to prescribers and members was clarified. RX.PA.133 Long-Acting Injectable Antipsychotics Updated to include criteria for Abilify Maintena. RX.PA.144 Sodium Phenylbutyrate (Buphenyl) & Glycerol Phenylbutyrate (Ravicti) Updated to include criteria for Ravicti.

5 RX.PA.067 Oral Oncology Agents Updated to include criteria for Stivarga and Pomalyst. Added new indication for Revlimid. RX.005 Quantity Limits The table below summarizes changes to the Quantity Limits policy: Drug Quantity Limit Rebetol (ribavirin) Ribapak (ribavirin) Ribasphere (ribavirin) Ribatab (ribavirin) Ribavirin Somavert (pegvisomant) Xeljanz (tofacitinib) Cometriq (cabozantinib) Iclusig (ponatinib) Conzip (tramadol) Abilify (aripiprazole) Suboxone (buprenorphine/naloxone) Capsules: 180 capsules per 30 days Solution: 900 ml per 30 days mg: 1 dosepack (56 tablets) per 28 days mg: 1 dosepack (56 tablets) per 28 days mg: 1 dosepack (56 tablets) per 28 days mg: 1 dosepack (56 tablets) per 28 days 200 mg tablet/capsule: 180 tablets/capsules per 30 days 400 mg: 90 tablets per 30 days 600 mg: 60 tablets per 30 days 400 mg tablet: 90 tablets per 30 days 600 mg tablet: 60 tablets per 30 days mg: 1 dosepack (56 tablets) per 28 days mg: 1 dosepack (56 tablets) per 28 days mg: 1 dosepack (56 tablets) per 28 day 200 mg tablet/capsule: 180 tablets/capsules per 30 days 400 mg tablet: 90 tablets per 30 days 600 mg: 60 tablets per 30 days 10 mg and 20 mg: 30 vials per 30 days 60 tablets per 30 days 60 mg/day pack: 84 capsules per 28 days 100 mg/day pack: 56 capsules per 28 days 140 mg/day pack: 112 capsules per 28 days 15 mg: 60 tablets per 30 days 45 mg: 30 tablets per 30 days 30 tablets per 30 days Tablets: 1 tablet per day Oral disintegrating tablet: 2 tablets per day 4 mg/1 mg: 60 film strips per 30 days 12 mg/3 mg: 30 film strips per 30 days

6 Topiramate tablets Topiramate sprinkle capsules Short-Acting and Intermediate-Acting Stimulants Ritalin (methylphenidate) Quillivant XR (methylphenidate) extended release suspension 3 tablets per day 15 mg and 25 mg sprinkle capsules: 180 capsules per 30 days Removing maximum dosing 5 mg/5 ml oral solution: 1800 ml per 30 days 10 mg/5 ml oral solution: 900 ml per 30 days 360 ml per 30 days Definitions: Must add: Drug will be added to the formulary. May add: Drug may be added to the formulary or may be non-formulary. Other drugs already on the formulary are considered equally effective from a clinical standpoint. Do not add: Drug will be non-formulary. NOTE: All recommendations are subject to DPW approval and final decision determination by UPMC for You.