Drug Formulary Update, July 2014 Commercial and State Programs
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1 Drug ormulary Update, July 2014 Commercial and State Programs Updates to the HealthPartners Drug ormularies are listed below. Changes start July 1 unless noted otherwise. Updates apply to all Commercial groups (PreferredRx, GenericsPlusRx, EnhancedRx, and Generics AdvantageRx), and to HealthPartners Minnesota Health Care Programs (Medicaid and Minnesota Care State Programs ) Drug ormulary. Please see for details. Replacements Replacements result from the formulary review cycle, done once every 3 years. Clinical reviews of effectiveness and safety are the primary consideration, and lower cost products are preferred when efficacy and safety are similar. Additional notices are sent to affected providers and members, and members are given additional time to make changes. SYMBICORT (budesonide/ formoterol) PROAIR HA (albuterol) JANUVIA (sitagliptin) and JANUMET Symbicort, a combination inhaler for asthma and COPD, has been removed from Commercial formularies, and prior authorization has been added. or asthma, Symbicort is reserved for patients who have tried and failed or who have medical contraindications to Advair and Dulera. or COPD, Symbicort is reserved for patients who have tried and failed or who have medical contraindications to Advair and Breo. Members currently using Symbicort will be asked to change to preferred products by September 1. ProAir HA, an albuterol inhaler for asthma, has been removed from formulary. Ventolin HA remains on formulary as the preferred albuterol inhaler. Members will be asked to use Ventolin HA starting on July 1. Januvia and Janumet (sitagliptin/ metformin), oral medications for diabetes, have been removed from Commercial formularies. Tradjenta (linagliptin) and Jentadueto (linagliptin/ metformin) have been added as replacements. Members currently using Januvia and Janumet will be asked to change to Tradjenta and Jentadueto by September 1. RELX (eletriptan) Relpax, for migraine headaches, has been removed from the formulary. Members currently using Relpax will be asked to change to preferred products by September 1. Preferred alternatives include sumatriptan and rizatriptan., on formulary, Prior Authorization ST, Step Therapy QL, Quantity Limit, Non ormulary
2 Drug ormulary Update, p. 2 of 7 ormulary Changes ACTHAR (corticotropin) ADCIRCA (tadalafil) Prior authorization criteria have been updated. Acthar is considered a specialty medication by HealthPartners. Adcirca has been removed from formulary. Sildenafil 20mg is generic and preferred. Members currently using Adcirca are encouraged to change to sildenafil. Adcirca is considered a specialty medication by HealthPartners. ADEMS (riociguat) Adempas, an oral medication for pulmonary arterial hypertension, has been added with prior authorization. Adempas is considered a specialty medication by HealthPartners. amcinonide Amcinonide lotion, cream, and ointment have been removed from the formulary. AMITIZA (lubiprostone) AMPYRA (dalfampridine) APTIOM (eslicarbazepine) * Step therapy has been removed for Commercial formularies. * Amitiza is on the State Programs Drug ormulary with step therapy, step from polyethylene glycol 3350 (Miralax generic). Prior authorization criteria have been updated. Ampyra is considered a specialty medication by HealthPartners. Aptiom, a seizure medication, has been added with prior authorization. Aption is reserved for prescribing by Neurology, for DA approved indications. ATELVIA (risedronate) Atelvia, for osteoporosis, has been removed from the formulary. members. Members are asked to change to preferred products by September 1 st. Preferred products include alendronate and Actonel. benzoyl peroxide Benzoyl peroxide has been removed from the formulary. It is available as an OTC product. Additional communications are being sent to affected members. Members currently receiving prescriptions will be asked to use OTC forms starting September 1. BEPREVE (bepotastine) BREO ELLIPTA (fluticasone/ vilanterol) Bepreve, for allergic conjunctivitis, has been removed from the formulary. * Breo, a combination inhaler for COPD, has been added to Commercial formularies. Breo remains non formulary for the State Programs Drug ormulary. CELEBREX (celecoxib) Step therapy criteria have been removed.
3 Drug ormulary Update, p. 3 of 7 COXONE (glatiramer) 40mg CORDRAN (flurandrenolide) COSOPT P (timolol/ dorzolamide) Copaxone 40mg is non formulary with prior authorization, reserved for prescribing by Neurology, for patients with relapsing remitting forms of multiple sclerosis and currently using Copaxone 20 mg with a documented medical necessity requiring fewer weekly injections. Copaxone 20mg is preferred. Copaxone is considered a specialty medication by HealthPartners. Prior authorization has been added. Cordran tape is reserved for patients with lichen simplex chronicus. members. Members and providers are asked to change to preferred products or submit a prior authorization request by September 1. Prior authorization has been added. Cosopt P is reserved for patients with sensitivities to preservatives in preferred products. Members currently using Cosopt P have been grandfathered, and are not being asked to make changes. diflorasone Diflorasone cream and ointment have been removed from the formulary. dihydroergotamine injection (DHE) DUAVEE (conjugated estrogens/ bazedoxifene) DULERA (mometasone/ formoterol) * Prior authorization has been added. Dihydroergotamine injection is reserved for patients with an inadequate response to a triptan medication such as sumatriptan and rizatriptan. Members currently using dihydroergotamine have been grandfathered, and are not being asked to make changes. Duavee was not added, and remains non formulary. Prior authorization has been added for Commercial formularies. Dulera, a combination inhaler for asthma, is reserved for patients who have tried and failed or who have medical contraindications to Advair. Members currently using Dulera have been grandfathered, and are not being asked to make changes. * Dulera remains on the State Programs Drug ormulary with no prior authorization. famotidine suspension * amotidine has been removed from the formulary. Preferred alternatives include ranitidine suspension. * amotidine remains excluded for GenericsPlusRx, for older children and adults.
4 Drug ormulary Update, p. 4 of 7 fluocinolone luocinolone solution and shampoo (Capex) have been removed from the formulary. members. Members will be asked to change to preferred products by September 1. YCOM (perampanel) ycompa, a seizure medication, has been added with prior authorization, reserved for prescribing by Neurology, for DA approved indications. HALOG (halcinonide) Halog has been removed from the formulary. members. Members are asked to use preferred products by September 1. HETLIOZ (tasimelteon) Hetlioz, a melatonin receptor agonist for sleep wake disorder, is reserved for medically necessary DA approved indications. IMBRUVICA (ibrutinib) Prior authorization criteria have been updated. Imbruvica is considered a specialty medication by HealthPartners. JANUVIA (sitagliptin) and JANUMET JENTADUETO (linagliptin/ metformin) * Januvia and Janumet (sitagliptin/ metformin), oral medications for diabetes, have been removed from Commercial formularies. Linagliptin (Tradjenta) and Jentadueto (linagliptin/ metformin) are being added as replacements for the Commercial formularies. * State Programs: No changes have been made. Januvia, Janumet, Tradjenta, and Jentadueto are on the State Programs Drug ormulary. Additional notices are sent to providers and members affected by this replacement. Commercial members currently using Januvia and Janumet will be asked to change to Tradjenta and Jentadueto by September 1. Linagliptin (Tradjenta) and Jentadueto (linagliptin/ metformin) have been added to formulary. LINZESS (linaclotide) * Prior authorization criteria have been removed for Commercial formularies. * State Programs: Linzess will change to step therapy, from polyethylene glycol 3350 (Miralax generic). MONUROL (fosfomycin) MUGARD osfomycin, an antibiotic, has been added to formulary. Mugard is non formulary with prior authorization, reserved for the prevention of mucositis in patients with head and neck cancer. NATIN (naftifine) Naftin cream has been removed from the formulary. members. Members are asked to use preferred products by September 1.
5 Drug ormulary Update, p. 5 of 7 NAMENDA XR (memantine XR) NOXAIL (posaconazole) Namenda XR has been added with prior authorization. Both regular Namenda and Namenda XR are on formulary with the same prior authorization, reserved for patients with moderate to severe Alzheimer s disease, or for patients with Alzheimer s disease who do not tolerate donepezil. The drug company is planning to stop making regular Namenda in August Generics for regular Namenda are expected in April 2015, and patients will be asked to switch to this generic when available. Prior authorization has been added. Noxafil is reserved for prescribing by Infectious Disease providers. Members currently using Noxafil have been grandfathered, and are not being asked to make changes. OLYSIO (simeprevir) Olysio, for hepatitis C, has been added with prior authorization. Olysio is considered a specialty medication by HealthPartners. OI (clobazam) Prior authorization criteria have been removed. OPSUMIT (macitentan) ORENITRAM (treprostinil) OTEZLA (apremilast) OTREXUP (methotrexate) PHOSLYRA (calcium acetate) Opsumit has been added with prior authorization. Opsumit is considered a specialty medication by HealthPartners. Orenitram, an oral medication for pulmonary arterial hypertension, is nonformulary with prior authorization. Orenitram is considered a specialty medication by HealthPartners. Otezla, for psoriatic arthritis, is non formulary with prior authorization. Otezla is considered a specialty medication by HealthPartners. Otrexup, an auto injector, was not added, and remains non formulary. Phoslyra has been added as a cost neutral line extension. POTIGA (ezogabine) Prior authorization has been removed. PRITIN (rifapentine) Prior authorization criteria have been updated. Priftin is reserved for prescribing by Infectious Disease providers, or for sites providing directly observed therapy or equivalent. PROAIR HA (albuterol) ProAir HA (albuterol), a rescue inhaler for asthma, is being removed from the formulary. Ventolin HA remains on formulary as the preferred albuterol inhaler. Additional communications are being sent to affected members, and members will be asked to use Ventolin HA starting on July 1. RELX (eletriptan) Relpax (eletriptan), for migraine headaches, is being removed from the formulary. Preferred alternatives include sumatriptan and rizatriptan.
6 Drug ormulary Update, p. 6 of 7 SOVALDI (sofosbuvir) Sovaldi, for hepatitis C, has been added with prior authorization. Sovaldi is considered a specialty medication by HealthPartners. STELARA (ustekinumab) SYMBICORT (budesonide/ formoterol) TECIDERA (dimethyl fumarate) TRADJENTA (linagliptin) tretinoin micro (RETIN A MICRO) VELPHORO (sucroferric oxyhydride) Stelara, for psoriasis and psoriatic arthritis, is non formulary with prior authorization. In office administration is preferred due to the monitoring that should be occurring at the same frequency as the injection. Stelara is considered a specialty medication by HealthPartners. * Symbicort, a combination inhaler for asthma and COPD, has been removed from Commercial formularies, and prior authorization has been added. or asthma, Symbicort is reserved for patients who have tried and failed or who have medical contraindications to Advair and Dulera. or COPD, Symbicort is reserved for patients who have tried and failed or who have medical contraindications to Advair and Breo. Members currently using Symbicort will be asked to change to preferred products by September 1. * Symbicort remains on the State Programs ormulary with no prior authorization. Tecfidera, an oral option for multiple sclerosis, has been added to formulary. Tecfidera is considered a specialty medication by HealthPartners. Linagliptin (Tradjenta) and Jentadueto (linagliptin/ metformin) have been added to formulary. Prior authorization has been added. Tretinoin Micro is reserved after tretinoin (Retin A generic). Velphoro, a phosphate binder for patients with chronic kidney disease on dialysis, is non formulary. voriconazole (VEND) Prior authorization has been added, reserved for prescribing by Infectious Disease providers. Members currently using voriconazole have been grandfathered, and are not being asked to make changes. XTANDI (enzalutamide) Prior authorization criteria have been updated to define failures as symptoms of progressive disease or a sustained increase in PSA of 25 30% over at least two months. Xtandi is considered a specialty medication by HealthPartners. ZIOPTAN (tafluprost) Prior authorization has been added. Zioptan is reserved for patients with sensitivities to preservatives in preferred products. Members currently using Zioptan have been grandfathered, and are not being asked to make changes.
7 Drug ormulary Update, p. 7 of 7 ZOHYDRO ER (hydrocodone ER) Zohydro is non formulary, reserved for patients with inadequate pain control with two long acting alternatives (e.g. morphine ER and OxyContin) and medically necessary reasons for Zohydro. ZYTIGA (abiraterone) Prior authorization criteria have been updated to define failures as symptoms of progressive disease or a sustained increase in PSA of 25 30% over at least two months. Zytiga is considered a specialty medication by HealthPartners. ormulary Information and Requests ormulary Information is available at HealthPartners.com/ Provider/ Pharmacy Services, including the Drug ormularies. Pharmacy Customer Service is available to providers (physicians and pharmacies) by fax, phone, and mail. ax submission of coverage requests is preferred: or Telephone service is available: or HealthPartners Pharmacy Customer Service is available from 8AM 6PM CST, Monday through riday. After hours calls are answered by our Pharmacy Benefit Manager. Mail: HealthPartners Pharmacy Services, rd Avenue South, PO Box 1309, Mpls, MN
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