Page 1 of 14 Calgary Long Term Care Formulary Pharmacy & Therapeutics Highlights https://www.albertahealthservices.ca/info/page4071.aspx
Page 2 of 14 Contents... 3 Formulary Changes (Additions, Changes, Deletions)... 3 Other Formulary Updates... 4 November 2017... 5 Formulary Changes (Additions, Changes)... 5 Other Formulary Updates... 6 June 2017... 6 Formulary Changes (Additions, Changes)... 6 Other Formulary Updates... 7 March 2017... 8 Formulary Changes (Additions, Changes)... 8 Other Formulary Updates... 8 December 2016... 10 Added Product(s)... 10 Not Listed, Delisted or Discontinued Drug Products Removed from Formulary... 11 Other Formulary Updates... 11 June 2016... 12 Added Product(s)... 12 Not Listed, Delisted or Discontinued Drug Products Removed from Formulary... 12 Other Formulary Updates... 13
Page 3 of 14 Formulary Changes (Additions, Changes, Deletions) The following drug product(s) were added to the Calgary Zone Long Term Care Formulary. When available, the lowest cost alternative (LCA) product is considered the benefit and should be dispensed. Product Description desmopressin acetate insulin detemir (Levemir) insulin glargine (Basaglar) insulin glargine (Lantus) insulin human biosynthetic regular (Novolin ge Toronto) insulin human biosynthetic isophane (Novolin ge NPH) insulin human biosynthetic regular / insulin human biosynthetic isophane (Novolin ge 30/70) Strength Dosage Form Route of Listing/Comments 10 mcg/dose nasal spray inhaled (nasal) Strength updated in Formulary listing and RS-11 from 0.1mg/ml to 10mcg/dose. 100 unit/ml injectable subcutaneous Delisted from Formulary effective July 1, 2018. 100 unit/ml injectable subcutaneous pre-filled pen Added to Formulary 100 unit/ml injectable subcutaneous Moved from RS-44 to RS-11 pre-filled pen RS-44 deleted. Transition period of 6 months (by Oct 1, 2018). 100 unit/ml injectable subcutaneous 100 unit/ml injectable subcutaneous 30 unit/ml * 70 unit/ml injectable subcutaneous Delisted from Formulary effective July 1, 2018. Autosubstitution will apply (ASL-01) midazolam 5 mg/ml injectable subcutaneous do not list eligible for nonformulary review
Page 4 of 14 morphine 2 mg/ml injectable subcutaneous Added to Formulary Restricted Misc. (RS-11). Other Formulary Updates Contact Information Long Term Care Providers list updated Formulary Formulary Medication Listing list updated Automatic Substitution o ASL-01 updates auto-substitution for Novolin ge Toronto, Novolin ge NPH and Novolin 30/70 Due to manufacturer shortage of amcinonide, betamethasone dipropionate 0.05% may be used as the auto-substitution for high potency corticosteroid creams/ointments or lotions in the interim. Clarification provided for auto-substitution PRN and daily use of diclofenac topical gels High Cost / Special Authorization o Influenza Antiviral Agents: Oseltamivir updated o Oseltamivir (SA-03) updated o Pregabalin (SA-28) updated o Direct Oral Anticoagulants (SA-29) new Restricted Use Medications o For all insulin products, the pre-filled disposable pens are considered the formulary listing. Insulin cartridges and vials are restricted to: a) a pre-filled pen is not available in the product line; or b) in situations where the LTC facility has approved the vial or cartridge as their site's preference through the site's P&T committee. o For all insulin products, resident-specific dispensing is preferred over supplying as wardstock. Any exceptions should be approved through the LTC facility's P&T committee.
o Page 5 of 14 RS-44 Basal Insulin (Glargine and Detemir) deleted. Lantus continues to be restricted and its restriction can now be found in RS-11 Miscellaneous. Basaglar is added to the formulary without restrictions. Levemir will be de-listed effective July 1, 2018. It will be eligible for non-formulary review. Antimicrobial Stewardship Under Resources link to Spectrum provided Education Under Other Topics of Interest Proton Pump Inhibitor Deprescribing and References. Thank you to AHS Drug Utilization and Stewardship for preparing this Drug and Therapeutics Backgrounder and for permission to share with the Calgary Zone LTC Formulary program. November 2017 Formulary Changes (Additions, Changes) The following drug product(s) were added to the Calgary Zone Long Term Care Formulary. When available, the lowest cost alternative (LCA) product is considered the benefit and should be dispensed. Product Strength Dosage Form Route of Listing/Comments Description Cholecalciferol 10 000 units and 50 000 Tablet/capsule Oral Formulary (vitamin D3) units Clodronate 400 mg Capsule Oral Formulary (restrictions removed) Alfacalcidol 0.25 mcg, 1 mcg Capsule Oral Formulary Tiotropium bromide (Spiriva Respimat) 2.5 mcg/dose Inhalation solution Inhaled (oral) Formulary Tiotropium bromide / olodaterol hydrochloride 2.5mcg/dose*2.5mcg/dose Inhalation solution Inhaled (oral) Formulary
(Inspiolto Respimat) Page 6 of 14 Other Formulary Updates Contact Information Long Term Care Providers list updated Antimicrobial Stewardship Antimicrobial Statements from P&T minor updates, including links and antibiogram summary AS-01: Antimicrobial Statements minor updates AS-02: Extended Use of Antimicrobials for Urinary Tract Infections minor updates AS-03: Antimicrobial Use in Conjunctivitis minor updates AS-04: Antibiogram Comparison: LTC vs. Community minor updates, including links and antibiogram Under Resources links updated June 2017 Formulary Changes (Additions, Changes) The following drug product(s) were added to the Calgary Zone Long Term Care Formulary. When available, the lowest cost alternative (LCA) product is considered the benefit and should be dispensed. Product Description Strength Dosage Form Route of Listing/Comments Pregabalin 25 mg, 50 mg, 75 mg, 150 mg, 225 mg and 300 Capsule Oral Special Authorization See SA-28 mg Apixaban 2.5 mg & 5 mg Tablet Oral
Dabigatran Rivaroxaban 75 mg, 110 mg & 150 mg 10 mg, 15 mg & 20 mg Page 7 of 14 Capsule Oral Special Tablet Oral Authorization See SA-29-draft Other Formulary Updates Contact Information Long Term Care Providers list updated. Formulary Policies and Procedures Wardstock/Statbox Lists under Statbox optional: pantoprazole magnesium 40 mg added and rabeprazole 10 mg removed Automatic Substitution Automatic Substitution List-01 minor corrections. High Cost Drugs/Special Authorization Direct Oral Anticoagulants (DOACs) Apixaban, dabigatran and rivaroxaban (SA-29): o Listing under Special Authorization with criteria for funding. o The DOAC form (draft version) will be made available through cc.drugmanagement@albertahealthservices.ca or by the pharmacy service providers o The form is to be submitted only once following admission or prior to new starts provided funding criteria are met. If the clinical situation does not meet criteria, the applicant may submit a non-formulary request. o Criteria for warfarin trial is included for atrial fibrillation funding. o Additional criteria for funding includes review of drug selection, dose, risks and benefits, and alignment with resident s goals. Pregabalin (SA-28): o Listing under Special Authorization with criteria for funding. o The pregabalin form is to be submitted only once following admission or following new starts provided funding criteria are met. o Establishes gabapentin as Formulary First-Line agent/step therapy
o Page 8 of 14 Additional criteria for funding includes that non-pharmacological pain management strategies be in place and pregabalin be reviewed for ongoing effectiveness with regular medication reviews March 2017 Formulary Changes (Additions, Changes) The following drug product(s) were added to the Calgary Zone Long Term Care Formulary. When available, the lowest cost alternative (LCA) product is considered the benefit and should be dispensed. Product Description Strength Dosage Form Route of Tamsulosin HCL 0.4 mg CR capsule, ER Oral Tablet Comment Removed RS-07 criteria. Tamsulosin has no restrictions on Formulary-open listing Pantoprazole Mg 40 mg EC tablet Oral Unrestricted, ASL-05 Rabeprazole Na 10 mg EC tablet Oral Unrestricted, ASL-05 Other Formulary Updates Contact Information Long Term Care Providers list updated. High Cost Drugs/Special Authorization Gradually as forms are updated or new forms are introduced, the terminology High Cost Drugs will be changed to Special Authorization Restricted Use Medications Proton Pump Inhibitors (RS-04) o Updated content to align with ASL-05: Proton Pump Inhibitors
o o o o Page 9 of 14 Restrictions on duration of use and medical indication have been removed Pantoprazole magnesium 40 mg EC tablets and rabeprazole 10 mg EC tablets are listed with no restrictions Restrictions on select PPIs/dosage form (i.e. delayed release capsules and oral disintegrating tablets) remain Auto-substitution still applies see updated ASL-05 Tamsulosin hydrochloride (RS-07) deleted. Tamsulosin 0.4 mg CR or ER has no Formulary restrictions. Metronidazole (RS-47) o Bug fix Inhaled Medication Assessment Tool (under RS-29) o Pharmacists are to continue completing inhaler assessments using this tool, however it will no longer be a requirement to submit the form to Calgary Zone (i.e. cc.drugmanagement@albertahealthservices.ca). The completed assessment should be kept with the pharmacist s assessments and care plan, and results communicated to the care team.
Page 10 of 14 December 2016 Added Product(s) The following drug product(s) were added to the Calgary Zone Long Term Care Formulary. When available, the lowest cost alternative (LCA) product is considered the benefit and should be dispensed. Product Description Strength Dosage Form Route of Humalog Mix (Insulin 25 (25% * 75%) Lispro / Insulin Lispro & 50 (50% * protamine) 50%) Comment For Injection Subcutaneous Restricted Use Medications Lansoprazole 15 mg DR capsule Oral Low strength preferred PPI for patients with difficulty swallowing PPI Autosubstitution (ASL-05) Metronidazole 500 mg Capsules For topical use (use 250mg tablets for oral use) Restricted Use Medications (RS-47) Mirabegron 25 mg & 50 mg ER tablets Oral Restricted Use Medications (RS-46) Pantoprazole magnesium 40 mg EC tablets Oral Standard strength preferred PPI PPI Autosubstitution. (ASL-05) Trazodone 100 mg Tablets Oral Regular listing Urea (Urisec ) 10% & 22% Cream Topical Regular listing (20% product no longer available)
Page 11 of 14 Not Listed, Delisted or Discontinued Drug Products Removed from Formulary The following drug products were removed or will not be added to the Calgary Zone Long Term Care Formulary. Product Description Strength Dosage Form Route of Comment Lansoprazole 30 mg DR capsule Oral Not listed Omeprazole 10 mg DR capsule oral Delisted (by March 31, 2017) no longer preferred low strength PPI for residents with difficulty swallowing Rabeprazole 20 mg EC Tablets Oral Delisted (by March 31, 2017) no longer preferred standard strength PPI Trazodone 75 mg Tablets Oral Not listed use half of 150 mg tablets Trazodone 200 mg Tablets Oral Removed from listing not available Other Formulary Updates Contact Information Long Term Care Providers list updated. Restricted Use Medications Metronidazole (RS-47): o Added metronidazole 500 mg capsule for topical use with restrictions o New procedure for Kroll users (pilot) Mirabegron (RS-46): o Added mirabegron 25 mg and 50 mg ER tablets for Overactive Bladder with Step Therapy and restrictions apply
o New procedure for Kroll users (pilot) Page 12 of 14 Auto-substitutions Automatic Substitution List -01 o updated with more detailed information on inhaled nasal steroid substitutions ASL-05: Proton Pump inhibitors o Preferred LCA PPIs updated. Applies to standard and low strengths, and for residents with difficulty swallowing, NPO, and on enteral feeding tubes. Please see chart for details. June 2016 Added Product(s) Regular Formulary Listing The following drug product(s) were added to the Calgary Zone Long Term Care Formulary under regular benefits. When available, the lowest cost alternative (LCA) product is considered the benefit and should be dispensed. Product Description Strength Dosage Form Route of Comment nitrofurantoin macrocrystals (Tevanitrofurantoin) 50 mg & 100 mg capsules oral Temporarily added during nitrofurantoin nitrofurantoin macrocrystals/monohydrate (MacroBID) shortage 100 mg capsules oral Temporarily added during nitrofurantoin shortage Not Listed, Delisted or Discontinued Drug Products Removed from Formulary The following drug products were removed or will not be added to the Calgary Zone Long Term Care Formulary.
Product Description Strength Dosage Form Route of Ofloxacin 200 mg, 300 mg, & 400 mg Page 13 of 14 Comment tablets oral Removed discontinued by manufacturer Clotrimazole 200 mg tablet (topical) vaginal Delisted Clotrimazole 2% cream topical (not vaginal) Removed 2% topical cream is not commercially available (2% vaginal cream is ) Other Formulary Updates Formulary Policies and Procedures FPP-01 --> Request for Addition to LTC Formulary Form minor updates: email address; web links; requirement for form to be submitted by either medical staff or other health care professionals practicing directly with residents in Calgary Zone LTC Restricted Use Medications The following Restricted Use Medication criteria have been updated: Fluconazole (RS-23): protocols and dosing updated Fluoroquinolones (RS-02): protocol criteria and duration updated; antimicrobial stewardship elements added Macrolides (RS-30): antimicrobial stewardship elements added Terbinafine cream (RS-17): conditions for use updated Education Under Psychiatry Functional Assessment Staging (FAST) Form has been removed as it is not a current practice tool
Page 14 of 14 Use of Cholinesterase Inhibitors (Anti-Dementia Drugs) in Care Centre Settings Self Study Module has been removed as is not aligned with current coverage criteria and it uses older tools HS Sedation (anxiolytic, Sedative and Hypnotic Drugs) has been removed as it is not aligned with coverage criteria