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. 106-30242C 013118 Pg. 1 of 7
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. 106-30242C 013118 Pg. 2 of 7
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. 106-30242C 013118 Pg. 3 of 7
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). 106-30242C 013118 Pg. 4 of 7
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). 106-30242C 013118 Pg. 5 of 7
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 106-30242C 013118 Pg. 6 of 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. 106-30242C 013118 Pg. 7 of 7