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- Definitions
- Additions to the Preferred Drug List
- Deletions from the Preferred Drug List
- Medications Reviewed but Not Added
- Legal Disclaimer
July 2009 Preferred Drug List (Formulary) Updates
The HealthPartners Pharmacy and Therapeutics Committee updates the preferred drug list every three months. This listing represents additions and changes implemented April 1, 2009 unless otherwise stated. All drug additions and changes are the same for the HealthPartners Medicare Drug Formulary unless otherwise stated in this Update.
This summary was written for health care providers and has been slightly modified for the general public.
Our HealthPartners preferred drug list information is available at www.healthpartners.com/formulary/medicare.do and also within the ePocrates database at no charge to users. The electronic ePocrates database is downloaded from www.ePocrates.com. Providers and members are encouraged to use and share this information. The ePocrates drug information service is available for most handheld devices such as Palm Pilots.
The 2009 Medicare Drug Formulary will be available on July 1, 2009 at www.healthpartners.com/formulary/medicare.do. Visit www.healthpartners.com/medicare for additional information.
DEFINITIONS
The following terms have been used:
Age Limit: You'll see this term next to medications that are available to patients within a specific age group. Patients outside of this age group need to meet specific criteria before the medication will be approved.
Cost: All cost information reflects the average wholesale price (AWP). Costs to consumers may vary because of different strengths, forms, quantities and pharmacy benefits.
Physician-Edit: This term means that a medication is reserved for prescribing by certain physician specialists.
Prior Approval: This term means that specific criteria must be met before the medication will be approved. Typically, your provider submits these requests to HealthPartners.
Quantity Limit: This term means that a limit has been set on the amount of medication you will receive each time you fill a prescription for that medication.
Step Therapy: This term means that your doctor will need to prescribe one medication before trying another. Prior approval is needed if HealthPartners does not have a record of the first prescription.
GENERIC UPDATE
Most members have a lower co-pay for generic medications. Members who choose to continue using brand-name medications when a generic is available may pay a higher amount. These brand medications will be deleted from the Medicare Formulary in 2009 pending CMS approval. Refer to the 2009 HealthPartners Medicare Formulary on our website to determine the current formulary status for these brands. Recent generics for preferred (formulary) products include:
Generic Update: Recently-available generics are listed below. Most members have a lower co-pay for generic medications.
- carbamazepine sustained release 200mg & 400mg (Tegretol XR), for seizures.
- mycophenolate mofetil (Cellcept), an immunosuppressant.
- topiramate tablet and sprinkle (Topamax), for seizures, migraine headache, and chronic pain.
- amphetamine/dextroamphetamine extended release (Adderall XR), for ADHD.
ADDITIONS TO THE PREFERRED DRUG LIST (FORMULARY)
calcitriol ointment (Vectical)
Medication Category: Dermatologic (Skin) Medications - HealthPartners Preferred Drug List (Formulary)
Keratoplastic Agents - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list with prior approval
Vectical is added to the preferred drug list with prior approval and will be reserved for patients who have tried and failed or who have medical contraindications to a potent topical steroid on the formulary. Initial approvals are for 3 months, then indefinitely for patients with a positive response.
Vectical is a topical ointment for psoriasis.
Effective Date: HealthPartners Preferred Drug List & 2009 Medicare Drug Formulary July 1, 2009
Everolimus (Afinitor)
Medication Category: Cancer Drugs - HealthPartners Preferred Drug List (Formulary)
Antineoplastic Agents - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list
Afinitor is an oral medication for advanced renal cell carcinoma.
Effective Date: HealthPartners Preferred Drug List & 2009 Medicare Drug Formulary July 1, 2009
Febuxostat (Uloric)
Medication Category: Miscellaneous Products - HealthPartners Preferred Drug List (Formulary)
Miscellaneous Therapeutic Agents - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list with prior approval
Uloric is added to the preferred drug list with prior approval for patients who do not tolerate allopurinol.
Uloric is a xanthine oxidase inhibitor for treating gout.
Effective Date: HealthPartners Preferred Drug List & 2009 Medicare Drug Formulary July 1, 2009
Lacosamide (Vimpat)
Medication Category: Anticonvulsants - HealthPartners Preferred Drug List (Formulary)
Anticonvulsants - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list with step therapy
Vimpat is added to the preferred drug list with step therapy and is reserved for patients who have tried and failed two other seizure medications on the formulary.
Vimpat is a seizure medication indicated as add-on therapy.
Effective Date: HealthPartners Preferred Drug List & 2009 Medicare Drug Formulary July 1, 2009
DELETIONS FROM THE PREFERRED DRUG LIST
Calcipotriene cream (Dovonex cream)
Vectical ointment is preferred over Dovonex cream for psoriasis. Members currently using Dovonex cream will be grandfathered to continue therapy on Dovonex.
Effective Date: HealthPartners Preferred Drug List - Delete Dovonex cream September 1, 2009.
Medicare Drug Formulary No Change until 2010 and pending CMS approval for the 2010 contract year.
Temazepam 7.5mg.
Temazepam 7.5mg capsules are much more costly than other strengths. Unique needs for this strength will be reviewed as formulary exceptions. Temazepam 15mg and 30mg remain on formulary. An additional notice will be sent to affected members and to their providers, allowing time to discuss changes and to request approvals if necessary.
Effective Date: HealthPartners Preferred Drug List - Delete temazepam 7.5mg September 1, 2009.
Medicare Drug Formulary No Change. Temazepam is not covered because it is in an excluded class (benzodiazepine) under Medicare Part D.
MEDICATIONS REVIEWED BUT NOT ADDED
Azelastine nasal (Astepro)
Astepro is a new formulation of azelastine, a nasal antihistamine spray for allergic rhinitis. The taste may be preferred by some patients, but significant benefits over Astelin nasal spray have not been shown.
Bupropion (Aplenzin)
Aplenzin is a once-daily form of bupropion for depression. Significant benefits over generic bupropion extended release have not
been shown.
Dexlansoprazole (Kapidex)
Dexlansoprazole is a single enantiomer product, similar to lansoprazole (Prevacid). Significant benefits over preferred products such as omeprazole and Prevacid have not shown. Prevacid generics are expected soon (November 2009).
Fesoterodine (Toviaz)
Toviaz is an anti-muscarinic medication for over-active bladder. Significant benefits over preferred products such as oxybutynin, Detrol LA, and Sanctura XR have not been shown.
Mesalamine ER (Apriso)
Apriso is indicated for ulcerative colitis. Significant benefits over preferred products such as Asacol and Pentasa have not been
shown.
Prandimet (metformin/ Prandin)
Prandimet is a combination of repaglinide (Prandin) and metformin for diabetes. Significant benefits have not been shown.
Silodosin (Rapaflo)
Rapaflo is an alpha-blocker for benign prostatic hypertrophy (BPH). Significant benefits over preferred products such as Flomax, Uroxatral, doxazosin, and terazosin have not been shown.
LEGAL DISCLAIMER
The information regarding HealthPartners preferred drug list and coverage criteria is regularly updated and is therefore subject to change without notice. HealthPartners reserves the right to make such changes without specific notice to members.
Various plan documents (including the Membership Contract or Summary Plan Description) determine governing contractual provisions, including exclusions, limitations and other coverage rules relating to specific health plans. The changes and the criteria described in this document apply to most, but not all, plans offered by HealthPartners. We strive to ensure that the contents of this site are correct and complete, but to verify benefits and preferred drug list contents, please check the applicable contract or SPD, or call HealthPartners Member Services at 952-883-5000. In the event of a conflict between specific plan documents and this general information, the plan documents will govern.
This document is derived from highly technical information used to educate medical personnel about changes to the HealthPartners preferred drug list. This document does not constitute medical advice.
These criteria in no way imply that any patient should not receive specific services based on the recommendation of a provider. The providers treating patients are responsible for medical advice and treatment of patients.
In those cases where interpretation of some or all of the parts of these criteria is required, HealthPartners medical personnel determine how the criteria, or specific parts of these criteria, apply to specific situations.
This information is not an offer of coverage, solicitation of coverage, summary of coverage or guarantee of coverage. All products and coverage criteria are subject to applicable laws and regulations. Coverage is contingent on all the applicable terms, conditions, limitations and exclusions of appropriate health plan documents.
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