Nucynta IR. Nucynta IR (tapentadol immediate-release) Description
|
|
- Barry Holt
- 5 years ago
- Views:
Transcription
1 Federal Employee Program 1310 G Street, N.W. Washington, D.C Fax Subject: Nucynta IR Page: 1 of 9 Last Review Date: December 8, 2017 Nucynta IR Description Nucynta IR (tapentadol immediate-release) Background Nucynta IR is a Schedule II controlled substances indicated for the management of moderate to severe pain in adults. Nucynta IR is specifically indicated to manage acute pain. The active ingredient, tapentadol, is a centrally-acting synthetic analgesic. Nucynta IR possess a high potential for abuse and is subject to misuse, addiction, and criminal diversion in a manner similar to other opioid agonists. All patients treated with opioids require careful monitoring for signs of abuse and addiction, because use of opioid analgesic products carries the risk of addiction even under appropriate medical use (1). Regulatory Status FDA-approved indications: Nucynta IR is an opioid analgesic indicated for the management of acute pain severe enough to require an opioid analgesic and for which alternative treatments are inadequate (1). Limitations of Use: (1) Because of the risks of addiction, abuse, and misuse with opioids, even at recommended doses, reserve Oxycodone IR for use in patients for whom alternative treatment options (e.g., non-opioid analgesics or non-opioid combination products): Have not been tolerated, or are not expected to be tolerated Have not provided adequate analgesia or are not expected to provide adequate analgesia
2 Subject: Nucynta IR Page: 2 of 9 Off Label Use: Nucynta immediate release is a centrally acting analgesic with established efficacy in acute pain, chronic pain, neuropathic pain, and pain with an inflammatory origin. Nucynta IR was as effective as oxycodone in managing chronic pain and was associated with a lower risk of GI adverse events (2). Nucynta IR have boxed warnings for the following (1): Respiratory depression is the chief hazard of opioid agonists, including Nucynta IR. Respiratory depression, if not immediately recognized and treated, may lead to respiratory arrest and death. To reduce the risk of respiratory depression, proper dosing and titration of Nucynta IR are essential. Nucynta IR are contraindicated in patients with respiratory depression and in patients with conditions that increase the risk of lifethreatening respiratory depression. All patients treated with opioids require careful monitoring for signs of abuse and addiction, since use of opioid analgesic products carries the risk of addiction even under appropriate medical use. Prolonged use of opioid agonists during pregnancy can result in neonatal opioid withdrawal syndrome, which may be life-threatening. Patients should not consume alcohol or any products containing alcohol while taking. CDC guidelines find that concurrent use of benzodiazepines and opioids might put patients at greater risk for potentially fatal overdose. Three studies of fatal overdose deaths found evidence of concurrent benzodiazepine use in 31% 61% of decedents (3). CDC guidelines finds that given uncertain benefits and substantial risks that opioids should not be considered first-line or routine therapy for chronic pain (i.e., pain continuing or expected to continue longer than 3 months or past the time of normal tissue healing) outside of active cancer, palliative, and end-of-life care (3). The FDA warns that opioids can interact with antidepressants and migraine medicines to cause a serious central nervous system reaction called serotonin syndrome, in which high levels of the chemical serotonin build up in the brain and cause toxicity (see Appendix 1 for list of drugs) (4). The safety and effectiveness of Nucynta IR in pediatric patients less than 18 years of age have not been established (1).
3 Subject: Nucynta IR Page: 3 of 9 Related policies Abstral, Actiq, Butrans, Duragesic, Extended Release Opioid Drugs, Fentanyl Powder, Fentora, Lazanda, Meperidine, Methadone, Morphine IR, Onsolis, Oxycodone IR, Subsys, Tramadol Policy This policy statement applies to clinical review performed for pre-service (Prior Approval, Precertification, Advanced Benefit Determination, etc.) and/or post-service claims. Nucynta IR may be considered medically necessary in patients 18 years of age and older who require management of moderate to severe pain and if the conditions below are met. Nucynta IR is considered investigational in patients less than 18 years of age and for all other indications. Prior-Approval Requirements Prior authorization is not required if prescribed by an oncologist and/or the member has paid pharmacy claims for an oncology medication(s) in the past 6 months Age 18 years of age or older Diagnoses The patient must have ONE of the following: 1. Moderate to Severe Acute Pain (short term) a. Prescriber agrees to discontinue therapy after 30 days 2. Moderate to Severe Chronic Pain a. Prescriber agrees to assess the benefits of pain control (i.e. Care Plan signs of abuse, severity of pain) after 3 months of therapy AND ALL of the following: a. NO dual therapy with other immediate release opioid analgesic(s) b. Alternative treatment options have been ineffective, not tolerated or inadequate for controlling the pain i. These include non-opioid analgesic c. Prescriber agrees to assess patient for serotonin syndrome
4 Subject: Nucynta IR Page: 4 of 9 d. NO dual therapy with opioid addiction treatment or methadone e. NO dual therapy with an anti-anxiety benzodiazepine(s) i. Alprazolam (Xanax) ii. Clonazepam (Klonopin) iii. Diazepam (Valium) iv. Lorazepam (Ativan) v. Oxazepam (Serax) vi. Chlordiazepoxide (Librium) vii. Clorazepate dipotassium (Tranxene) Prior Approval Renewal Requirements Age 18 years of age or older Diagnosis Patient must have the following: Policy Guidelines Pre - PA Allowance 1. Moderate to Severe Chronic pain AND ALL of the following: a. NO dual therapy with other immediate release opioid analgesic(s) b. Prescriber agrees to assess the benefits of pain control (i.e. Care Plan signs of abuse, severity of pain) after 3 months of therapy c. Prescriber agrees to assess patient for serotonin syndrome d. NO dual therapy with opioid addiction treatment or methadone e. NO dual therapy with an anti-anxiety benzodiazepine(s) i. Alprazolam (Xanax) ii. Clonazepam (Klonopin) iii. Diazepam (Valium) iv. Lorazepam (Ativan) v. Oxazepam (Serax) vi. Chlordiazepoxide (Librium) vii. Clorazepate dipotassium (Tranxene) Age 18 years of age or older
5 Subject: Nucynta IR Page: 5 of 9 Quantity Medication / Strength Nucynta tablets Quantity Limit per 90 days 360 dosage units per 90 days OR Prior - Approval Limits Quantity Acute Pain Medication / Strength Nucynta tab 50mg Nucynta tab 75mg Nucynta tab 100mg Quantity Limit for 30 days 150 tablets for 30 days OR 150 tablets for 30 days OR 150 tablets for 30 days Duration 1 month Quantity Chronic Pain Medication / Strength Nucynta tab 50mg Nucynta tab 75mg Nucynta tab 100mg Quantity Limit per 90 days 720 tablets per 90 days OR 540 tablets per 90 days OR 540 tablets per 90 days Duration 6 months Prior Approval Renewal Limits Quantity Chronic Pain Medication / Strength Nucynta tab 50mg Nucynta tab 75mg Nucynta tab 100mg Quantity Limit per 90 days 720 tablets per 90 days OR 540 tablets per 90 days OR 540 tablets per 90 days
6 Subject: Nucynta IR Page: 6 of 9 Duration 6 months Rationale Summary Nucynta IR are schedule II controlled substances prescribed to treat moderate to severe, acute and chronic pain. The safety and effectiveness of Nucynta IR in pediatric patients less than 18 years of age have not been established. Nucynta IR is contraindicated in patients with respiratory depression and in patients with conditions that increase the risk of life-threatening respiratory depression. To reduce the risk of respiratory depression, proper dosing and titration of Nucynta IR is essential. All patients treated with opioids require careful monitoring for signs of abuse and addiction, because use of opioid analgesic products carries the risk of addiction even under appropriate medical use (1). Prior approval is required to ensure the safe, clinically appropriate and cost effective use of Nucynta IR while maintaining optimal therapeutic outcomes. References 1. Nucynta IR [package insert]. Titusville, NJ: Janssen Pharmaceuticals, Inc.; December Fidman B, Nogid A. Role of Tapentadol Immediate Release (Nucynta) in the Management of Moderate-to-Severe Pain. P&Te June 2010; 35(6): Dowell D, Haegerich T, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain. CDC Guidelines FDA Safety Release. FDA Drug Safety Communication: FDA warns about several safety issues with opioid pain medicines; requires label changes. March 22, Policy History Date September 2014 April 2015 June 2015 March 2016 Action New addition to PA Change to allow the Nucynta IR for moderate to severe pain and standard allowance to 90 days and adding renewal limits on the Nucynta IR Annual review and reference update Annual editorial review Addition of requirement: alternative treatment options have been ineffective, not tolerated or inadequate for controlling the pain Policy code changed from to
7 Subject: Nucynta IR Page: 7 of 9 September 2016 March 2017 June 2017 September 2017 January 2018 Annual review Addition of no dual therapy with other immediate release opioid analgesic(s); prescriber agrees to assess the benefits of pain control (i.e. Care Plan signs of abuse, severity of pain) after 3 months of therapy; prescriber agrees to assess patient for serotonin syndrome; no dual therapy with opioid addiction treatment; no dual therapy with any anti-anxiety benzodiazepines: alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), oxazepam (Serax), chlordiazepoxide (Librium), clorazepate dipotassium (Tranxene) Annual editorial review Addition of age limit to renewal criteria Addition of no dual therapy with methadone Annual review Annual editorial review and reference update Removal of Oxycontin and Oxycodone ER and the revision of the quantity limits Addition of the Acute Pain indication and quantity limits Keywords This policy was approved by the FEP Pharmacy and Medical Policy Committee on December 8, 2017 and is effective on January 1, 2018.
8 Subject: Nucynta IR Page: 8 of 9 Appendix 1 - List of Serotonergic Medications Selective Serotonin Reuptake Inhibitors (SSRIs) paroxetine Paxil, Paxil CR, Pexeva, Brisdelle fluvoxamine Luvox, Luvox CR fluoxetine Prozac, Prozac Weekly, Sarafem, Selfemra, Symbyax sertraline Zoloft citalopram Celexa escitalopram Lexapro Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) venlafaxine Effexor XR desvenlafaxine Pristiq, Khedezla duloxetine Cymbalta milnacipran Savella Tricyclic Antidepressants (TCAs) amitriptyline No brand name currently marketed desipramine Norpramin clomipramine Anafranil imipramine Tofranil, Tofranil PM nortriptyline Pamelor, Aventyl protriptyline Vivactil doxepin Zonalon, Silenor trimipramine Surmontil Monoamine Oxidase Inhibitors (MAOIs) isocarboxazid Marplan phenelzine Nardil selegiline Emsam, Eldepryl, Zelapar tranylcypromine Parnate
9 Subject: Nucynta IR Page: 9 of 9 Other Psychiatric Medicines amoxapine No brand name currently marketed maprotiline No brand name currently marketed nefazodone No brand name currently marketed trazodone Oleptro buspirone No brand name currently marketed vilazodone Viibryd mirtazapine Remeron, Remeron Soltab lithium Lithobid Migraine Medicines almotriptan Axert frovatriptan Frova naratriptan Amerge rizatriptan Maxalt, Maxalt-MLT sumatriptan Imitrex, Imitrex Statdose, Alsuma, Sumavel Dosepro, Zecuity, Treximet zolmitriptan Zomig, Zomig-ZMT Antiemetics ondansetron granisetron dolasetron palonosetron Zofran, Zofran ODT, Zuplenz Kytril, Sancuso Anzemet Aloxi Other Serotonergic Medicines dextromethorphan linezolid cyclobenzaprine methylene blue St. John s wort tryptophan Bromfed-DM, Delsym, Mucinex DM, Nuedexta Zyvox Amrix
Pre - PA Allowance. Prior-Approval Requirements LEVORPHANOL TARTRATE. None
Pre - PA Allowance None Prior-Approval Requirements Prior authorization is not required if prescribed by an oncologist and/or the member has paid pharmacy claims for an oncology medication(s) in the past
More informationMORPHINE IR DRUG CLASS Morphine IR, Dilaudid IR (hydromorphone), Opana IR (oxymorphone)
Pre - PA Allowance Tablets & Suppositories Morphine sulfate tablets Morphine sulfate suppositories Oxymorphone tablets Hydromorphone tablets Hydromorphone suppositories 360 tablets per 90 days OR 360 suppositories
More informationHYSINGLA ER (hydrocodone bitartrate) Prior authorization is not required if prescribed by an oncologist.
Pre - PA Allowance None Prior authorization is not required if prescribed by an oncologist. Prior-Approval Requirements Age 18 years of age or older Diagnosis Patient must have the following: 1. Pain,
More informationDuragesic Patch (fentanyl patch) Prior authorization is not required if prescribed by an oncologist
Pre - PA Allowance Quantity 30 patches every 90 days Prior-Approval Requirements Prior authorization is not required if prescribed by an oncologist Age 2 years of age or older Diagnosis Patient must have
More informationLevorphanol. Levorphanol Tartrate. Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.59 Subject: Levorphanol Page: 1 of 8 Last Review Date: March 16, 2018 Levorphanol Description Levorphanol
More informationLevorphanol. Levorphanol Tartrate. Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.59 Subject: Levorphanol Page: 1 of 8 Last Review Date: March 17, 2017 Levorphanol Description Levorphanol
More information90 dosage units per 90 days OR. Extended-release Formulations Ultram ER 90 dosage units per 90 days OR
Pre - PA Allowance 12 years of age or older Quantity Immediate-release Formulation Ultracet 720 dosage units per 90 days OR Ultram 720 dosage units per 90 days Extended-release Formulations Ultram ER 90
More informationBELBUCA (buprenorphine buccal film)
RATIONALE FOR INCLUSION IN PA PROGRAM Background Belbuca is indicated for the management of chronic pain severe enough to require daily, aroundthe-clock, long-acting opioid treatment for which alternative
More informationButrans (buprenorphine patch) Description. Section: Prescription Drugs Effective Date: October 1, 2017
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Butrans Page: 1 of 9 Last Review Date: September 15, 2017 Butrans (buprenorphine patch) Description
More informationDuragesic patch. Duragesic patch (fentanyl patch) Description
1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.31 Subject: Duragesic patch Page: 1 of 9 Last Review Date: September 15, 2017 Duragesic patch Description Duragesic patch (fentanyl
More informationXartemis XR (oxycodone / acetaminophen extended release)
RATIONALE FOR INCLUSION IN PA PROGRAM Background Xartemis XR is a combination of oxycodone and acetaminophen in a dosage formulation to deliver both immediate pain relief, in less than an hour, and extended-release
More informationOXYCODONE IR (oxycodone)
RATIONALE FOR INCLUSION IN PA PROGRAM Background Oxycodone hydrochloride, a pure opioid agonist, is used in the treatment of moderate to severe pain (1-2). The precise mechanism of action is unknown; however,
More informationHysingla ER. Hysingla ER (hydrocodone bitartrate) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.38 Subject: Hysingla ER Page: 1 of 9 Last Review Date: September 15, 2017 Hysingla ER Description
More informationBelbuca (buprenorphine buccal film) Belbuca (buprenorphine buccal film) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Belbuca Page: 1 of 9 Last Review Date: September 15, 2017 Belbuca (buprenorphine buccal film)
More informationBelbuca (buprenorphine buccal film) Description. Section: Prescription Drugs Effective Date: October 1, 2016
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Belbuca Page: 1 of 9 Last Review Date: September 15, 2016 Belbuca (buprenorphine buccal film)
More informationDuragesic patch. Duragesic patch (fentanyl patch) Description
1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.31 Section: Prescription Drugs Effective Date: April1, 2017 Subject: Duragesic patch Page: 1 of 10 Last Review Date: March
More informationEmbeda. Embeda (morphine sulfate and naltrexone hydrochloride) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.39 Subject: Embeda Page: 1 of 8 Last Review Date: September 15, 2017 Embeda Description Embeda (morphine
More informationDemerol (meperidine oral tablet, oral solution), Meperitab (oral tablet)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Meperidine Page: 1 of 7 Last Review Date: September 15, 2017 Meperidine Description Demerol (meperidine
More informationDuragesic patch. Duragesic patch (fentanyl patch) Description. Section: Prescription Drugs Effective Date: January 1, 2019
1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Duragesic patch Page: 1 of 9 Last Review Date: November 30, 2018 Duragesic patch Description Duragesic patch (fentanyl
More informationMorphine IR Hydromorphone IR Oxymorphone IR. Morphine IR, Dilaudid IR (hydromorphone), Opana IR (oxymorphone),
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.33 Subject: Morphine IR Drug Class Page: 1 of 11 Last Review Date: December 8, 2017 Morphine IR Hydromorphone
More informationOxycodone. Oxycodone IR, Oxycodone ER, OxyContin, Xtampza ER. Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Oxycodone Page: 1 of 11 Last Review Date: March 17, 2017 Oxycodone Description Oxycodone IR, Oxycodone
More informationOxycodone. Oxycodone IR, Oxycodone ER, OxyContin, Xtampza ER. Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Oxycodone Page: 1 of 10 Last Review Date: September 15, 2016 Oxycodone Description Oxycodone IR,
More informationTarginiq ER (oxycodone/naloxone extended-release), Troxyca ER (oxycodone /naltrexone extended-release)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.44 Subject: Oxycodone Naloxone Page: 1 of 9 Last Review Date: December 2, 2016 Oxycodone Naloxone
More informationRATIONALE FOR INCLUSION IN PA PROGRAM
RATIONALE FOR INCLUSION IN PA PROGRAM Background Tramadol is a centrally acting synthetic opioid analgesic used to treat moderate to moderately severe chronic pain in adults. Along from analgesia, tramadol
More informationMethadone. Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.41 Subject: Methadone Page: 1 of 11 Last Review Date: September 15, 2017 Methadone Description Dolophine
More informationMethadone. Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.41 Subject: Methadone Page: 1 of 13 Last Review Date: March 16, 2018 Methadone Description Dolophine
More informationRATIONALE FOR INCLUSION IN PA PROGRAM
RATIONALE FOR INCLUSION IN PA PROGRAM Background Methadone hydrochloride is a long-acting opioid agonist at mu-opioid receptors that is used to manage pain that requires long-term, daily opioid treatment
More informationRATIONALE FOR INCLUSION IN PA PROGRAM
RATIONALE FOR INCLUSION IN PA PROGRAM Background hydromorphone (Exalgo, Dilaudid) and oxymorphone (Opana and Opana ER) are Schedule II narcotics prescribed to treat moderate to severe pain. Morphine produces
More informationMorphine Sulfate Hydromorphone Oxymorphone
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.33 Subject: Morphine Drug Class Page: 1 of 13 Last Review Date: September 15, 2016 Morphine Sulfate
More informationMorphine Sulfate Hydromorphone Oxymorphone
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.33 Subject: Morphine Drug Class Page: 1 of 12 Last Review Date: September 15, 2017 Morphine Sulfate
More informationExtended Release Opioid Drugs
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.61 Subject: Extended Release Opioid Drugs Page: 1 of 13 Last Review Date: December 8, 2017 Extended
More informationExtended Release Opioid Drugs
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.61 Subject: Extended Release Opioid Drugs Page: 1 of 14 Last Review Date: March 16, 2018 Extended
More informationExtended Release Opioid Drugs
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Section: Prescription Drugs Effective Date: January 1, 2019 Subject: Extended Release Opioid Drugs Page:
More informationBackground Apadaz (benzhydrocodone-acetaminophen), codeine-acetaminophen, dihydrocodeine-caffeineacetaminophen,
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.67 Subject: IR Opioid Combo Drugs Page: 1 of 13 Last Review Date: November 30, 2018 IR Opioid Combo
More informationNucynta IR/ Nucynta ER (tapentadol immediate-release and extendedrelease)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Nucynta Page: 1 of 7 Last Review Date: March 18, 2016 Nucynta Description Nucynta IR/ Nucynta
More informationPHYSICIAN REFERENCE ANTIDEPRESSANT DOSING GUIDELINES
PHYSICIAN REFERENCE ANTIDEPRESSANT DOSING GUIDELINES Table of Contents Print TABLE OF CONTENTS Drug Page Number Anafranil... 2 Asendin... 4 Celexa... 4 Cymbalta... 6 Desyrel... 8 Effexor...10 Elavil...14
More informationMedications and Children Disorders
Mental Health Comprehensive Services Providing Family Stability and Developing Life Coping Skills Medications and Children Disorders Psychiatric medications can be an effective part of the treatment for
More informationDemerol (meperidine oral tablet, oral solution), Meperitab (oral tablet)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subsection: Analgesics and Opioids Original Policy Date: May 8, 2015 Subject: Meperidine Page: 1 of 5 Last
More informationSoma (carisoprodol), Soma Compound (carisoprodol and aspirin), Soma Compound w/ Codeine (carisoprodol and aspirin and codeine)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.75.07 Subject: Soma Page: 1 of 7 Last Review Date: September 15, 2017 Soma Description Soma (carisoprodol),
More informationMethadone. Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.41 Subject: Methadone Page: 1 of 8 Last Review Date: March 18, 2016 Methadone Description Dolophine
More informationSoma (carisoprodol), Soma Compound (carisoprodol and aspirin), Soma Compound w/ Codeine (carisoprodol and aspirin and codeine)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.75.07 Subject: Page: 1 of 7 Last Review Date: September 15, 2016 Description (carisoprodol), Compound
More informationAntidepressant Medication Strategies We ve Come a Long Way or Have We? Who Writes Prescriptions for Psychotropic Medications. Biological Psychiatry
Antidepressant Medication Strategies We ve Come a Long Way or Have We? Joe Wegmann, PD, LCSW The PharmaTherapist Joe@ThePharmaTherapist.com 504.587.9798 www.pharmatherapist.com Are you receiving our free
More informationMajor Depressive Disorder
Major Depressive Disorder HEDIS Measures And Clinical Practice Guidelines Jennifer Highley, PMHNP-BC Behavioral Health West Point Healthcare Effectiveness Data and Information Set (HEDIS) Performance measures
More informationMorphine Sulfate Hydromorphone Oxymorphone
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.02.33 Subject: Morphine Drug Class Page: 1 of 8 Last Review Date: June 19, 2015 Morphine Sulfate Hydromorphone
More informationEmbeda. Embeda (morphine sulfate and naltrexone hydrochloride) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.39 Subject: Embeda Page: 1 of 6 Last Review Date: March 18, 2016 Embeda Description Embeda (morphine
More informationDuragesic patch. Duragesic patch (fentanyl patch) Description
1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.31 Subject: Duragesic patch Page: 1 of 6 Last Review Date: March 18, 2016 Duragesic patch Description Duragesic patch (fentanyl
More information20/0.8mg, 30/1.2mg, Films 90 MME/day Belbuca (buprenorphine) 75mcg, 150mcg, 300mcg, 450mcg 60 units per 90 days
Pre - PA Allowance Quantity Extended Release Tablets or Capsules 90 MME/day Medication Strength Avinza (morphine) 60mg, 75mg, 90mg Embeda (morphine /naltrexone) 50/2mg, 60/2.4mg, 80/3.2mg Exalgo (hydromorphone)
More informationBRIEF ANTIDEPRESSANT OVERVIEW. Casey Gallimore, Pharm.D., M.S.
BRIEF ANTIDEPRESSANT OVERVIEW Casey Gallimore, Pharm.D., M.S. Antidepressant Medication Classes First Generation Tricyclic Antidepressants (TCAs) Monoamine Oxidase Inhibitors (MAOIs) Second Generation
More informationUSF Health Psychiatry Clinic. New Patient Questionnaire Adult
USF Health Psychiatry Clinic New Patient Questionnaire Adult Please mail or fax the completed forms to the address/fax number on the bottom of this page. Completed forms must be received five (5) days
More informationMedications Guide: Public Speaking And Social Anxiety
AnxietyHub.org Dr. Cheryl Mathews Medications Guide: Public Speaking And Social Anxiety Copyright 2016 AnxietyHub Medications Specifically for Public Speaking and Social Anxiety This is not intended to
More informationLimitations of use: Subsys may be dispensed only to patients enrolled in the TIRF REMS Access program (1).
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.21 Subject: Subsys Page: 1 of 5 Last Review Date March 17, 2017 Subsys Description Subsys (fentanyl
More informationAppendix: Psychotropic Medication Reference Tables
Appendix: Psychotropic Medication Reference Tables How to Use these Tables These reference tables are designed to provide clinic staff with specific medication related criteria for the Polypharmacy, Cardiometabolic
More informationOpioid Step Policy. Description. Section: Prescription Drugs Effective Date: April 1, 2018
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Opioid Step Policy Page: 1 of 6 Last Review Date: March 16, 2018 Opioid Step Policy Description
More informationU T I L I Z A T I O N E D I T S
I N D I A N A H E A L T H C O V E R A G E P R O G R A M S U T I L I Z A T I O N E D I T S A P R I L 1 9, 2 0 1 2 s for s Refer to Provider Bulletin BT200709 for additional information regarding the Mental
More informationIMPORTANT NOTICE. Changes to dispensing of some Behavioral Health Medications for DC Healthcare Alliance members
IMPORTANT NOTICE Changes to dispensing of some Behavioral Health Medications for DC Healthcare Alliance members These changes apply only to members covered under the DC Healthcare Alliance program Alliance
More informationPage: 1 of 5. Sumatriptan Tablets and Nasal Spray (Imitrex) / sumatriptan and naproxen sodium (Treximet tablets)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 0 Subject: Sumatriptan (Imitrex / Treximet) Page: 1 of 5 Last Review Date: September 12, 2014 Sumatriptan
More informationPharmacotherapy of Anxiety Disorders (GAD, Panic, & SAD) Declaration of Interests
Pharmacotherapy of Anxiety Disorders (GAD, Panic, & SAD) University of Texas Health Science Center San Antonio Pharmacotherapy Education and Research Center (PERC) 7703 Floyd Curl Drive - MSC 6220 San
More informationClinical Policy: Vilazodone (Viibryd) Reference Number: CP.PMN.145 Effective Date: Last Review Date: Line of Business: HIM, Medicaid
Clinical Policy: (Viibryd) Reference Number: CP.PMN.145 Effective Date: 08.01.12 Last Review Date: 08.18 Line of Business: HIM, Medicaid Revision Log See Important Reminder at the end of this policy for
More informationEXTENDED RELEASE OPIOID DRUGS
RATIONALE FOR INCLUSION IN PA PROGRAM Background Hydrocodone (Hysingla ER, Vantrela ER, Zohydro ER), hydromorphone (Exalgo), morphine sulfate (Arymo ER, Avinza, Embeda, Kadian, MorphaBond, MS Contin),
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: (Trintellix) Reference Number: CP.PMN.65 Effective Date: 05.01.15 Last Review Date: 08.18 Line of Business: HIM, Medicaid Revision Log See Important Reminder at the end of this policy
More informationDealing with a Mental Health Crisis
Dealing with a Mental Health Crisis Information and Resources for First Responders P... PROFESSIONAL WHAT NAMI DOES NAMI Minnesota is a statewide 501(c)(3) grassroots nonprofit organization dedicated to
More informationStudy Guidelines for Quiz #1
Annex to Section J Page 1 Study Guidelines for Quiz #1 Theory and Principles of Psychopharmacology, Classifications and Neurotransmitters, Anxiolytics/Antianxiety/Minor Tranquilizers, Stimulants, Nursing
More informationSuboxone, Zubsolv, Bunavail (buprenorphine with naloxone sublingual tablets and film), Buprenorphine sublingual tablets
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.32 Subject: Suboxone Drug Class Page: 1 of 7 Last Review Date: June 24, 2016 Suboxone Drug Class Description
More informationClinical Policy: Levomilnacipran (Fetzima) Reference Number: HIM.PA.125 Effective Date: Last Review Date: 11.18
Clinical Policy: (Fetzima) Reference Number: HIM.PA.125 Effective Date: 12.01.17 Last Review Date: 11.18 Line of Business: HIM Revision Log See Important Reminder at the end of this policy for important
More informationPsychotropic Medications Archana Jhawar, PharmD, BCPP Clinical Faculty of UIC Pharmacy Practice Clinical Psychiatric Pharmacist Jesse Brown VA
Psychotropic Medications Archana Jhawar, PharmD, BCPP Clinical Faculty of UIC Pharmacy Practice Clinical Psychiatric Pharmacist Jesse Brown VA Goals of Medications Use least number at lowest dose to get
More informationTreatment of Major Depressive Disorder
Treatment of Major Depressive Disorder Sarah Mullowney, MD PGY3 Psychiatry Resident, University of Utah Paula Gibbs, MD Medical Director of 5 West at UUMC Clerkship Director MS III Psychiatric Rotation
More informationPATIENT FACE SHEET PATIENT NAME: PATIENT DOB: PATIENT PHONE #: INSURANCE: MEMBER ID: GROUP NUMBER: PATIENT ADDRESS
1 P a g e PATIENT FACE SHEET PATIENT NAME: PATIENT DOB: PATIENT PHONE #: INSURANCE: MEMBER ID: GROUP NUMBER: PATIENT ADDRESS PRIOR AUTHORIZATION #: (for office use only) INS. CONTACT NAME/ DIRECT NUMBER:
More informationChildren s Hospital Of Wisconsin
Children s Hospital Of Wisconsin Co-Management Guidelines To support collaborative care, we have developed guidelines for our community providers to utilize when referring to, and managing patients with,
More informationMAJOR DEPRESSION CLINICAL PRACTICE GUIDELINE
MAJOR DEPRESSION CLINICAL PRACTICE GUIDELINE Reviewed and Updated by the Behvioral Health Subcommittee 7/20/2017 Topic Purpose Access Assessment 7/2017 Recommendations SummaCare Health Plan bases its Clinical
More informationObjectives: Lifetime prevalence. Neurotransmitters of interest
Kelly Kll M. Rock, DNP, CRNP 11/5/11 Objectives: Identify lifetime prevalence of depressive and anxious disorders. Recognize the social and economic burden of depressive and anxious disorders. Understand
More informationMaxalt. Maxalt / Maxalt-MLT (rizatriptan) Description. Section: Prescription Drugs Effective Date: April 1, 2016
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Maxalt Page: 1 of 5 Last Review Date: March 18, 2016 Maxalt Description Maxalt / Maxalt-MLT (rizatriptan)
More informationDrug Effectiveness Review Project (DERP) Summary Report on Second-Generation Antidepressants and Antidepressants Literature Scan
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 informationPage: 1 of 6. Aimovig (erenumab-aooe) injection, Ajovy (fremanezumab-vfrm) injection, Emgality (galcanezumab-gnim)
Page: 1 of 6 Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Last Review Date: November 30, 2018 Description Aimovig (erenumab-aooe) injection, Ajovy (fremanezumab-vfrm)
More informationReview of Psychotrophic Medications. (An approved North Carolina Division of Health Services Regulation Continuing Education Course)
Review of Psychotrophic Medications (An approved North Carolina Division of Health Services Regulation Continuing Education Course) Common Psychiatric Disorders *Schizophrenia *Depression *Bipolar Disorder
More informationPrepared by: Elizabeth Vicens-Fernandez, LMHC, Ph.D.
Prepared by: Elizabeth Vicens-Fernandez, LMHC, Ph.D. Sources: National Institute of Mental Health (NIMH), the National Alliance on Mental Illness (NAMI), and from the American Psychological Association
More informationPOSITIVE YOUTH CONCEPTS Child and Adolescent Therapy 24 Front Street, Suite 302 Exeter, NH
Date: / / NEW CLIENT FORM Client s Name: Address: City State Zip D.O.B.: / / Age: Sex: ================================================================================== Guardian s Name: Custody: Physical
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Antidepressant Agents Page 1 of 14 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Antidepressant Agents Prime Therapeutics will review Prior Authorization requests.
More informationOverview and Update on Current Psychopharmacological Medications, Including New Medications in Clinical Trials
SPEAKER NOTES Overview and Update on Current Psychopharmacological Medications, Including New Medications in Clinical Trials Summarized by Thomas T. Thomas New psychotropic medications are coming on the
More informationHARVARD PILGRIM HEALTH CARE RECOMMENDED MEDICATION REQUEST GUIDELINES
Generic Brand HICL GCN Exception/Other BUPROPION HCL WELLBUTRIN, 01653 WELLBUTRIN SR, WELLBUTRIN XL BUPROPION HBR APLENZIN 17050 16996 26198 CITALOPRAM CELEXA 10321 GPID 16344 HYDROBROMIDE DESVENLAFAXINE
More informationPsychiatric Evaluation Intake Form
Psychiatric Evaluation Intake Form 1. Patient Contact Information Patient Name Preferred Name Last First MI Address Best contact phone number: Email address: Primary Care Physician Tel Fax Pharmacy Phone
More informationGuide to Psychiatric Medications for Children and Adolescents
Guide to Psychiatric Medications for Children and Adolescents by Glenn S. Hirsch, M.D. The following guide includes most of the medications used to treat child and adolescent mental disorders. It lists
More informationPsychiatric Evaluation Intake Form
Psychiatric Evaluation Intake Form 1. Patient Contact Information Date Patient Name Address Best contact phone number Email address Emergency contact Relationship Phone No Primary Care Physician Tel Fax
More informationIt is the policy of health plans affiliated with Centene Corporation that Seroquel XR is medically necessary when the following criteria are met:
Clinical Policy: (Seroquel XR) Reference Number: CP.PMN.64 Effective Date: 12.01.14 Last Review Date: 02.18 Line of Business: Commercial, Health Insurance Marketplace, Medicaid Revision Log See Important
More informationCommissioner for the Department for Medicaid Services Selections for Preferred Products
Commissioner for the Department for Medicaid Services Selections for Preferred Products This is a summary of the final Preferred Drug List (PDL) selections made by the Commissioner for the Department for
More informationMedical Policy An independent licensee of the Blue Cross Blue Shield Association
Antidepressant Agents Page 1 of 14 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Antidepressant Agents Prime Therapeutics will review Prior Authorization requests.
More informationBridges to Excellence Depression Care Recognition Program Guide
Bridges to Excellence Depression Care Recognition Program Guide The Altarum Bridges to Excellence 3520 Green Court, Suite 300 Ann Arbor, MI 48105 bte@altarum.org www.bridgestoexcellence.org Rev: 02/06/18
More informationGeneralized Anxiety Disorder ( DSM -IV) is characterized by excessive anxiety and worry (apprehensive expectation) that is persistent for at least 6
Generalized Anxiety Disorder ( DSM -IV) is characterized by excessive anxiety and worry (apprehensive expectation) that is persistent for at least 6 months and which the person finds difficult to control.
More informationAntidepressant Agents Step Therapy and Quantity Limit Program Summary
Antidepressant Agents Step Therapy and Quantity Limit Program Summary FDA APPROVED INDICATIONS AND DOSAGE 1-20,26,27,30,32-35,37-39,40,41,43 Drug MDD OCD PD GAD SAD PDD PTSD Bulimia Other Diagnos es Dosing
More informationDepression and Anxiety. What is Depression? What is Depression? By Christopher Okiishi, MD Spring Not just being sad A syndrome of symptoms
Depression and Anxiety By Christopher Okiishi, MD Spring 2016 What is Depression? Not just being sad A syndrome of symptoms Depressed mood Sleep disturbance Decreased interest in usual activities (anhedonia)
More informationAvailable Strengths Limits. 10 mg tablet -- $ mg tablet -- $ mg tablet -- $ mg tablet -- $72.41 Avoid use in members over
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Fibromyalgia P&T DATE: 5/9/2017 CLASS: Pain Management REVIEW HISTORY 9/15, 5/14, 11/12, 9/12, LOB: Medi-Cal (MONTH/YEAR)
More informationMental Health Medications. National Institute of Mental Health. U.S. Department of HealtH and HUman ServiceS National Institutes of Health
Mental Health Medications National Institute of Mental Health U.S. Department of HealtH and HUman ServiceS National Institutes of Health Contents Mental Health Medications...1 What are psychiatric medications?...1
More informationPSYCHIATRIC HISTORY 6. Are you currently seeing a therapist? (Name & contact phone#)
Cool Springs Psychiatric Group PATIENT HISTORY Patient Name Date of Birth Date form completed: *Please arrive on time and bring this form completed to your appointment to avoid any delay in seeing the
More informationParoxetine and the elderly
Paroxetine and the elderly The Borg System is 100 % Paroxetine and the elderly Doxepin >6mg/day (Silenor). Imipramine (Tofranil). Nortriptyline (Pamelor). Paroxetine (Paxil). Trimipramine (Surmontil).
More informationLinda Sobeski Farho, PharmD, BCPS Assistant Professor, Pharmacy Practice UNMC College of Pharmacy Critical Issues in Geriatrics June 24, 2010
Pharmacologic Treatment of Depression Linda Sobeski Farho, PharmD, BCPS Assistant Professor, Pharmacy Practice UNMC College of Pharmacy Critical Issues in Geriatrics June 24, 2010 1 Disclosure I have no
More informationRegulatory Status FDA approved indication: Migranal Nasal Spray is indicated for the acute treatment of migraine headaches with or without aura (1).
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.60 Subject: Migranal Nasal Spray Page: 1 of 5 Last Review Date: November 30, 2018 Migranal Nasal Spray
More informationHappy Daisy Ltd. New Client intake Form. What are the issues for which you are seeking care?
Happy Daisy Ltd. New Client intake Form Name Date Preferred name Pronouns Referred by Date of birth Age Race What are the issues for which you are seeking care? 1. 2. 3. Please check of any of the symptoms
More informationOPIOID IR COMBO DRUGS. Oxycodone-acetaminophen, Oxycodone-aspirin, Oxycodone-ibuprofen, Tramadolacetaminophen
RATIONALE FOR INCLUSION IN PA PROGRAM Background Apadaz (benzhydrocodone-acetaminophen), codeine-acetaminophen, dihydrocodeine-caffeineacetaminophen, hydrocodone-acetaminophen, hydrocodone-ibuprofen, oxycodoneacetaminophen,
More informationMonoamine oxidase inhibitors (MAOIs) have wellestablished
SECOND OF 2 PARTS A concise guide to monoamine oxidase inhibitors: How to avoid drug Use these strategies to maximize efficacy and minimize adverse effects when prescribing an MAOI Jonathan M. Meyer, MD
More informationIowa Medicaid Mental Health Advisory Group Meeting February 13, Tentative Agenda
CHESTER J. CULVER, GOVERNOR PATTY JUDGE, LT. GOVERNOR DEPARTMENT OF HUMAN SERVICES EUGENE I. GESSOW, DIRECTOR Iowa Medicaid Mental Health Advisory Group Meeting February 13, 2009 Location: Iowa Medicaid
More informationZomig. Zomig / Zomig-ZMT (zolmitriptan) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.22 Subject: Zomig Page: 1 of 5 Last Review Date: November 30, 2018 Zomig Description Zomig / Zomig-ZMT
More information