PA Start Date Therapeutic Class P&T Review Date 1/1/16 TOP$ (Single Drug Reviews) include:
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1 Maryland Department of Health and Mental Hygiene PDL Prior Authorization Implementation Schedule PA Start Therapeutic Class P&T Review 1/1/16 11/5/15 Acne Agents, Topical (Epiduo Forte Gel W/Pump) Androgenic Agents (Natesto) Angiotensin Modulators (Entresto) Antifungals, Oral (Cresemba) Antimigraine Agents, Triptans (Zecuity) Growth Hormone (Zovacton Vial) Hepatitis C Agents (Daklinza, Technivie) Hypoglycemics, SGLT2 (Synjardy) Lipotropics, Other (Praluent, Repatha) Phosphate Binders (Fosrenol Powder Pack) 7/1/15 TOP$ (New Classes) include: Hepatitis B Agents 5/7/15 Antiparkinson s Agents (Rytary) COPD Agents (Incruse Ellipta, Spiriva Respimat) Cytokine and CAM Antagonists (Cosentyx) Glucocorticoids, Inhaled (Arnuity Ellipta, Asmanex HFA) Ophthalmics, Anti-Inflammatories (Iluvien) Ophthalmics for Allergic Conjunctivitis (Pazeo) Sedative-Hypnotics (Belsomra) Stimulants and Related Agents (Evekeo) 1/1/15 Acne Agents, Topical (Ovace Plus Lotion, Retin-A Micro 0.08% Pump) Analgesics, Narcotics (Short Acting) (Xartemis XR) Androgenic Agents (Vogelxo Gel) Antifungals, Topical (Jublia) Antivirals, Oral (Sitavig) Beta Blockers (Hemangeol) Hypoglycemics, Incretin Mimetics and Enhancers (Bydureon pens, Tanzeum) Hypoglycemics, SGLT2 (Invokamet, Jardiance) Opiate Dependence Treatments (Evzio) PAH Agents, Oral and Inhaled (Orenitram ER) Platelet Aggregation Inhibitors (Zontivity) 7/1/14 TOP$ (New Classes) include: Hypoglycemics, SGLT2 Irritable Bowel Syndrome Opiate Dependence Agents 11/6/14 5/1/14
2 PA Start Therapeutic Class P&T Review Anticonvulsants (Aptiom, Fycompa) Antidepressants, Other (Brintellix, Fetzima, Khedezla) Antipsychotics (Adasuve, Versacloz) COPD Agents (Anoro Ellipta) Cytokine and CAM Antagonists (Actemra Syringe) Glucocorticoids, Inhaled (Aerospan, Breo Ellipta) NSAIDs (Pennsaid Pump, Zorvolex) 1/1/14 11/7/13 Acne Agents, Topical (Ovace Plus Cream ER) Antibiotics, Inhaled (Tobi Podhaler) Antiemetic/Antivertigo Agents (Diclegis) Calcium Channel Blockers (Nymalize) Liptotropics, Statins (Liptruzet) Multiple Sclerosis Agents (Tecfidera) 7/1/13 5/2/13 Antidepressants, Other (ForfivoXL) COPD Agents (Tudorza Pressair) Cytokine and CAM Antagonists (Xeljanz) Neuropathic Pain (Lyrica Solution) Ophthalmics, Anti-Inflammatories (Ilevro, Lotemax Gel) Stimulants and Related Agents (Quillivant, XR, Kapvay ER Dose Pack) 1/1/13 TOP$ (New Classes) include: 11/8/12 Neuropathic Pain Analgesics, Narcotics Short Acting (Primlev, Subsys) Antiparasitics, Topical (Sklice) Erythropoiesis Stimulating Proteins (Omontys) Hypoglycemics, Incretin Mimetics/Enhancers (Janumet XR) 7/1/12 Anticonvulsants (Onfi) NSAIDs (Duexis) 5/10/12 1/1/12 TOP$ (New Classes) include: Antihypertensives, Sympatholytics Ophthalmic Antibiotic/Steroid Combinations Androgenic Agents (Axiron) Angiotensin Modulators (Edarbi) Antibiotics, GI (Dificid) Anticoagulants (Xarelto) Hepatitis C Agents (Ribapak, Incivek, Victrelis) Hypoglycemics, Incretin Mimetics/ Enhancers (Tradjenta) 11/3/11
3 PA Start Therapeutic Class P&T Review 7/1/11 5/24/11 Antidepressants, Other (Oleptro ER) Antihistamines, Minimally Sedating (Claritin Liqui-Gels) Antipsychotics (Latuda) Glucocorticoids, Inhaled (Dulera) Ophthalmics, Antibiotics (Moxeza and Zymaxid) Ophthalmics for Allergic Conjunctivitis (Lastacaft) Ophthalmics, Anti-Inflammatories (Bromday) Sedative Hypnotics (Silenor and Zolpimist) Stimulants and Related Agents (Kapvay) 10/1/10 TOP$ (New Classes) include: Antibiotics, Inhaled Bile Salts Acne Agents, Topical (SE BPO) Analgesics, Narcotics Long (Exalgo) Analgesics, Narcotics Short (Rybix ODT) Immunosuppressives, Oral (Zortress) MS Agents (Ampyra) Proton Pump Inhibitors (Zegerid OTC) 8/19/10 4/1/10 TOP$ (New Classes) include: Colony Stimulating Factors Fibromyalgia Agents Immunosuppressives, Oral Antifungals, Oral (Terbinex) Anti-Hyperuricemics (Colcrys) Antiparasitics, Topical (Ulesfia) Antipsychotics (Saphris; Invega Sustenna) Cytokine and CAM Antagonists (Simponi; Stelara) Hypoglycemics, Incretins (Onglyza) NSAIDs (Zipsor) Ophthalmics for Allergic Conjunctivitis (Bepreve) Ophthalmics, Anti-Inflammatories (Acuvail; Ozurdex) Ophthalmics, Antibiotics (Besivance) Pancreatic Enzymes (Zenpep) Platelet Aggregation Inhibitors (Effient) Stimulants and Related Agents (Intuniv; Nuvigil) 3/2/10
4 PA Start Therapeutic Class P&T Review 10/1/09 TOP$ (New Classes) include: 8/20/09 Antihyperuricemics Antifungals, Topical Tetracyclines Analgesics, Short-Acting Narcotics (Dilaudid Liquid) Anticonvulsants (Banzel; Vimpat) Bladder Relaxants (Toviaz) BPH Agents (Rapaflo) Hypoglycemics, Meglitinides (Prandimet) Lipotropics, Other (Trilipix) Phosphate Binders (Eliphos) Proton Pump Inhibitors (Kapidex; Prilosec Suspension) Ulcerative Colitis Agents (Apriso;sfRowasa) 4/1/09 TOP$ (New Class) includes: 2/5/09 PAH Agents, Oral Antidepressants, Other (Venlafaxine ER) Antiemetics (Sancuso) Antifungals, Topical (Xolegel Corepak; Xolegel Duo) Anti-Parkinson s Agents (Requip XL) Glucocorticoids, Inhaled (Alvesco) Intranasal Rhinitis Agents (Patanase) 10/1/08 TOP$ (New Classes) include: Analgesics/Anesthetics, Topical Antibiotics, Vaginal Antiparasitics, Topical Pancreatic Enzymes Acne Agents, Topical (Atralin) Antihistamines, Minimally Sedating (Allegra ODT; cetirizine; cetirizine D; cetirizine syrup) Beta Blockers (Bystolic) Lipotropics, Other (Fenoglide) Lipotropics, Statins (Simcor) Phosphate Binders (Renvela) 8/21/08
5 PA Start Therapeutic Class P&T Review 4/1/08 TOP$ (New Classes) include: 2/14/08 Antibiotics, GI Impetigo Agents, Topical Skeletal Muscle Relaxants Alzheimer s Agents (Exelon Patch) Antifungals, Topical (Extina) Anti-Parkinson s Agents (Neupro Patch) Bronchodilators, Long-Acting Beta Agonists (Brovana and Perforomist) Glucocorticoids, Inhaled (Symbicort) Intranasal Rhinitis Agents (Veramyst) Leukotriene Modifiers (Zyflo CR) Ophthalmics, Fluoroquinolones and Macrolides (AzaSite) Stimulants and Related Agents (Vyvanse) 10/2/07 TOP$ (New Classes) include: 8/9/07 Hepatitis B Agents Ophthalmics, NSAIDs Atypical Antipsychotics (to be implemented 1/1/08) Acne Agents, Topical (Ziana) Analgesics, Short-Acting Narcotics (Fentora) Antihistamines, Minimally Sedating (Allegra Syrup and Claritin Chewable OTC) Beta Blockers (Coreg CR) Growth Hormones (Omnitrope) Proton Pump Inhibitors (Nexium Suspension) Ulcerative Colitis Agents (Lialda) 4/3/07 Antifungals, Oral (Noxafil) Antifungals, Topical (Xolegel) Anti-Parkinson s Agents (Azilect and Zelapar) Hypoglycemics, Insulins and Related Agents (Exubera) Stimulants and Related Agents (Daytrana) 2/8/07 10/3/06 TOP$ (New Class) includes: Androgenic Agents Analgesic Narcotics (Ultram ER) Hypoglycemics, TZDs (Avandaryl) Proton Pump Inhibitors (Zegerid- Oral Solid Forms) 4/4/06 TOP$ (New Classes) include: Acne Agents, Topical Anticonvulsants 8/17/06 2/9/06
6 PA Start Therapeutic Class P&T Review Bone Resorption Suppressants (Actonel with Calcium; Fortical) Fluoroquinolones, Oral (Proquin XR) Glucocorticoids, Inhaled (Asmanex) 10/6/05 TOP$ (New Classes) include: 8/18/05 Alzheimer s Agents Anti-Parkinson s Agents Atopic Dermatitis Hypoglycemics, Metformins Ophthalmics, Glaucoma Agents Platelet Aggregation Inhibitors Analgesics, Narcotics (Combunox) Sedative Hypnotics (Lunesta) 7/6/05 TOP$ (New Classes) include: 3/8/05 Anticoagulants, Injectable Growth Hormones (CLINICAL PA also) Sedative Hypnotics Ulcerative Colitis Agents 1/23/05 Bronchodilators, Anticholinergics 12/2/04 11/3/04 Antidepressants (SSRIs)- Symbyax ONLY 9/23/04 Antimigraine Triptans- Relpax ONLY 7/21/04 Antidepressants, SSRIs Pexeva; Antivirals 6/10/04 Valtrex; Beta Blockers Innopran XL; Disease Modifying Antirheumatic Drugs; Erectile Dysfunction Agents; Erythropoietins; Hepatitis C Agents; Multiple Sclerosis Agents; NSAIDs Prevacid Naprapac; Ophthalmics, Allergic Conjunctivitis -- Elestat 5/19/04 Antihistamines, Minimally Sedating; Phosphate 3/18/04 Binders 5/12/04 Antidepressants, Other; Beta Blockers Inderal LA 3/18/04 and Innopran XL; Bladder Relaxants; Lipotropics, Statins Crestor; Ophthalmics, Allergic Conjunctivitis; Ophthalmics, Antibiotics; Otics, Antibiotics 2/4/04 Antidepressants, SSRIs; Antiemetics; Beta-Agonist 12/11/04 Bronchodilators; Claudication Agents; Hypoglycemics, Meglitinides; Stimulants and Related Agents 1/21/04 Antifungals, Oral; Cephalosporins and Related 10/23/03 Antibiotics; Antifungals, Topical; Hypoglycemics, Insulins 1/7/04 Antimigraine Agents, Triptans; Analgesics, Narcotic; 10/23/03 Bone Resorption Suppression and Related Agents; Estrogen Agents, Combination; Estrogen Agents, Oral and Transdermal 12/17/03 Macrolides; Antivirals; Hypoglycemics, 10/23/03 Thiazolidinediones; Fluoroquinolones 12/03/03 ACE Inhibitors; Calcium Channel Blocking Agents; 9/10/03
7 PA Start Therapeutic Class P&T Review Lipotropics, Statins 11/19/03 Angiotensin Receptor Blockers; Nasal 9/10/03 Corticosteroids; NSAIDs/COX II Inhibitors 11/05/03 ACE Inhibitor/Calcium Channel Blocker Combination; Benign Prostatic Hyperplasia; Beta Blockers; Inhaled Corticosteroids; Leukotriene Receptor Antagonists; Lipotropics, Other; Proton Pump Inhibitors 9/10/03
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