Connecticut Medicaid P&T Meeting Minutes September 4, 2008 The meeting started at 6:30 pm Attendance Present Members: Carl Sherter, MD Eric Einstein, MD Bennett Enowitch, MD Lester Silberman, MD Hilda Slivka, MD Charles Thompson, MD Peggy Manning Memoli, Pharm D Lawrence Sobel, RPh Stella Cretella Absent Members: Kenneth Marcus, MD Richard Carbray, Jr. RPh Steven Marcham, RPh DSS: Robert Zavoski, MD MPH Jason Gott EDS/Provider Synergies Chris Andrews Joy DeNardo Opening remarks: Dr. Sherter made the following announcements: Dr. Eric Einstein is filling the vacancy for a Practicing Physician, Geriatrician. Dr. Sherter introduced him and asked him to give a brief biography. Dr. Einstein told committee members that he has been in practice for 26 years as an internist in Georgetown, CT. He currently is the Medical Director for a nursing home in Norwalk, CT. Dr. Hilda Slivka is filling the vacancy for a Practicing Physician, Pediatrician. Dr. Sherter introduced her and asked her to give a brief biography. Dr. Slivka told committee members that she has been in practice for 24 years. She has worked in the pediatric clinic at St. Francis Hospital and in a private practice in Avon. For the past 17 years she has worked at Hartford Hospital and Connecticut Children s Medical Center. She currently works at Connecticut Children s Medical Center. Dr. Charles Thompson filled the vacancy for the Manufacturer Representative in February, 2008. Dr. Sherter introduced him and asked him to give a brief biography. Dr. Thompson noted that he is a pediatrician and a Medical Director in Infectious Diseases at Pfizer, Inc. He is also on the medical staff at Connecticut Children s Medical Center. Dr. Bennett Enowitch filled the vacancy for a Practicing Physician, Psychiatrist in February, 2008. Dr. Sherter introduced him and asked him to give a brief biography. Dr. Enowitch told committee members that he has been in practice for 39 years. He has a Masters Degree in Public Health. He currently works in private practice and consults for the Institute of Living.
The reply from the letter to the Commissioner about coverage for smoking cessation products would be discussed tonight. Smoking Cessation Letter to the Commissioner: At the June 5, 2008 P & T Committee meeting, the committee discussed the smoking cessation report, Plan for Treating Tobacco Use and Dependence, which was submitted to the Legislature in March 2006. As a result, the committee members agreed that smoking cessation products should be covered by CT Medicaid. Dr. Sherter submitted a letter to Commissioner Starkowski which informed him of the committee s opinion that smoking cessation products should be covered and urged him to lift the coverage restriction for smoking cessation products. Commissioner Starkowski replied in a letter that the tobacco settlement money has been exhausted and there is no money currently available in order to cover the smoking cessation products. The committee members agreed that even though the tobacco settlement money has been exhausted that they would like to add the Smoking Cessation Agents class to the PDL for the December 4, 2008 meeting. Approval of minutes: Committee members approved the meeting minutes from the June 5, 2008 meeting. New Generics: Chris Andrews informed the committee members about the following new generic product: The generic for Sular (nisoldipine) was recommended to be non-preferred. The committee motioned to approve and accepted Provider Synergies recommendation. The motion was passed Therapeutic Class Reviews: Chris Andrews, from Provider Synergies, presented clinical data and financial analysis, as well as answered questions from committee members on the following thirteen therapeutic classes. Outcomes and votes are recorded below by class: Antifungals, Oral that fluconazole is now indicated for urinary tract infections and itraconazole has a pulse dosing regimen for onychomycosis (fingernail). Lamisil is now available in a granule form for the treatment of tinea capitis in patients 4 years of age and older. The recommended change to this class would be the removal of Gris-Peg. Dr. Silberman motioned to approve and accept Provider Synergies recommendations as presented with Larry Sobel seconding. The motion was passed clotrimazole, fluconazole, griseofulvin suspension, ketoconazole, nystatin, terbinafine Ancoban, Grifulvin V, Gris-Peg, itraconazole, Lamisil granules, Noxafil, Vfend
Antifungals, Topical that Exelderm has been discontinued by the manufacturer and will be removed from the PDL. Extina (ketoconazole foam) and CNL-8 (ciclopirox solution) are new products. The recommended changes to this class would be the addition of ciclopirox gel, econazole, and ketoconazole cream and the removal of Exelderm and Mentax. Dr. Slivka questioned why clotrimazole cream was not listed on our products to review. Chris responded that these products were removed from PDL consideration and are not subject to PDL review. Larry Sobel motioned to approve and accept Provider Synergies recommendations as presented with Stella Cretella seconding. The motion was passed ciclopirox cream/gel/suspension, clotrimazole/betamethasone, econazole, ketoconazole cream/shampoo, Naftin, nystatin, nystatin/triamcinolone, Xolegel ciclopirox solution, CNL-8, Ertaczo, Exelderm, Extina, Loprox shampoo, Mentax, Oxistat, Vusion Antimigraine Agents that the only new product to this class is Treximet. The recommended changes to this class would be the addition of Frova and Treximet. Dr. Einstein questioned what alternatives there were on the PDL for those who could not swallow tablets. Chris noted that Imitrex was available in a nasal spray formulation. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented with Dr. Enowitch seconding. The motion was passed unanimously with Dr. Einstein abstaining. Frova, Imitrex tablets/nasal/injectable, Relpax, Treximet Amerge, Axert, Maxalt/Maxalt MLT, Zomig/Zomig MLT tablets/nasal Antivirals, Oral that the CDC influenza guidelines have not changed and that vaccination is the primary means of prevention. Tamiflu is now available in 2 new strengths. The recommended change to this class would be the removal of Tamiflu as preferred. Dr. Sherter recommended keeping Tamiflu as preferred and Dr. Silberman agreed. Dr. Silberman motioned to approve and accept Provider Synergies recommendations with the addition of Tamiflu as preferred with Stella Cretella seconding. The motion was passed acyclovir, amantadine, rimantadine, Tamiflu, Valtrex Famvir, Relenza
Bladder Relaxant Preparations that Sanctura XR is the only new product in this class. The recommended change for this class would be the removal of Enablex and Sanctura as preferred. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented with Dr. Enowitch seconding. The motion was passed Detrol/Detrol LA, oxybutynin, Oxytrol, VESIcare Enablex, oxybutynin ER, Sanctura, Sanctura XR BPH Agents that the CombaT study concluded that combination therapy with Avodart and Flomax was more efficacious for symptom improvement than monotherapy with either agent. There were no recommended changes for this class. Larry Sobel motioned to approve and accept Provider Synergies recommendations as presented with Dr. Silberman seconding. The motion was passed Avodart, doxazosin, finasteride, Flomax, terazosin, Uroxatral Cardura XL Cephalosporins and Related Antibiotics that Keflex was now available in 750mg strength and that Suprax was now available in tablet form. The recommended change for this class would be the removal of Cedax and the addition of cefpodoxime. Dr. Enowitch motioned to approve and accept Provider Synergies recommendations as presented with Dr. Thompson seconding. The motion was passed amoxicillin/clavulanate tablets/suspension, cefaclor, cefdinir, cefpodoxime, cefprozil, cefuroxime, cephalexin, Spectracef, Suprax Augmentin XR, Cedax, cefadroxil, Raniclor Fluoroquinolones, Oral that there were additional warnings added to all fluoroquinolones, but that there were reported cases of hepatotoxicity with Levaquin use. The recommended changes to this class would be the addition of Factive as preferred. Dr. Slivka noted the development of resistance to ciprofloxacin in children and the need for Levaquin; however she stated that a prior authorization can be obtained for those cases. Chris noted that the only fluoroquinolone that is currently recommended for pediatric use is ciprofloxacin. Dr. Slivka recommended that the Cipro suspension be added as preferred for the pediatric population. Dr. Slivka motioned to approve and accept Provider Synergies
recommendations with the addition of Cipro suspension as preferred with Dr. Enowitch seconding. The motion was passed Avelox, Cipro suspension, ciprofloxacin, Factive, ofloxacin ciprofloxacin ER, Levaquin, Noroxin, Proquin XR Glucocorticoids, Inhaled that Flovent was now available in powdered form. The recommended changes to this class would be the addition of Symbicort as preferred and the removal of Asmanex and Pulmicort Flexhaler. Dr. Sherter recommended that Pulmicort Respules be added as preferred due to its significant use in the pediatric population. Dr. Slivka motioned to approve and accept Provider Synergies recommendations with the addition of Pulmicort Respules as preferred with Larry Sobel seconding. The motion was passed Advair/Advair HFA, Aerobid/Aerobid-M, Azmacort, Flovent/Flovent HFA, Pulmicort respules, QVAR, Symbicort Asmanex, Pulmicort flexhaler Hepatitis C Agents that Copegus was now available as generic ribavirin. There were no recommended changes in this class. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented with Dr. Silberman seconding. The motion was passed Pegasys, Peg-Intron, Peg-Intron RediPen, ribavirin Infergen Hypoglycemics, Meglitinides that the 2008 American Diabetes Association Consensus Algorithm for the treatment of type 2 diabetes does not list the meglitinides. There were no changes recommended for this class. Larry Sobel motioned to approve and accept Provider Synergies recommendations as presented with Stella Cretella seconding. The motion was passed Prandin, Starlix None
Macrolides & Ketolides that there is no new clinical information for this class. The recommended changes for this class are the addition of clarithromycin ER and Zmax. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented with Dr. Enowitch seconding. The motion was passed unanimously with Larry Sobel abstaining. azithromycin, clarithromycin/clarithromycin ER, erythromycin, Zmax Ketek Sedative Hypnotics that this was a new drug class being added to the PDL. He also noted that chloral hydrate was available in an oral and rectal form. The recommendations are that chloral hydrate, Doral, estazolam, flurazepam, Lunesta, Restoril 7.5mg strength only, temazepam, triazolam, and zolpidem are preferred and Ambien CR, Rozerem, and zaleplon are non-preferred. Stella Cretella motioned to approve and accept Provider Synergies recommendations with Larry Sobel seconding. The motion was passed chloral hydrate, Doral, estazolam, flurazepam, Lunesta, Restoril 7.5mg, temazepam, triazolam, zolpidem Ambien CR, Rozerem, zaleplon Other Business: Chris Andrews asked the committee to review the following drug classes to determine which of these classes they would consider to be Mental Health Medications and which of the classes that they determined to not be Mental Health Medications they would like to review: Alzheimer s Agents Anticonvulsants Antidepressants Antiparkinson s Agents Antipsychotics, Atypical Stimulants and Related Agents Dr. Enowitch noted that the Anticonvulsants class is considered Mental Health Medication because many of these agents provide adjunct therapy for psychiatric patients and the other committee members agreed. Dr. Memoli suggested that the committee only review the Alzheimer s Agents at the next meeting and the other committee members agreed.
Recommendations for next class reviews: Provider Synergies recommended the following classes be reviewed at the next P&T meeting: ACE Inhibitor/CCB Combinations Antibiotics, GI Antibiotics, Vaginal Bronchodilators, Anticholinergic Bronchodilators, Beta Agonist Hypoglycemics, Insulins and Related Leukotriene Receptor Antagonists Ophthalmic Antibiotics Ophthalmics, Allergic Conjunctivitis Ophthalmics, Glaucoma Phosphate Binders Platelet Aggregation Inhibitors Schedule next meeting: Committee members agreed on Thursday, December 4, 2008 for the next P & T meeting. Meeting adjourned at 7:54pm