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October 2005 Preferred Drug List Updates
The HealthPartners Pharmacy and Therapeutics Committee updates the preferred drug list every three months. This listing represents changes implemented October 1, 2005.
This summary was written for health care providers and has been slightly modified for the general public.
Our HealthPartners preferred drug list information is also available within the ePocrates database at no charge to users. This electronic 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.
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.
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.
Additions to the Preferred Drug List
Benazepril / Hydrochlorothiazide (Lotensin HCT®)
Medication Category: Cardiovascular Drugs
Preferred Drug List Status: On the preferred drug list without restrictions
Benazepril/Hydrochlorothiazide is an ACE-inhibitor and diuretic combination used for high blood pressure. A generic is available.
Bosentan (Tracleer®)
Medication Category: Cardiovascular Drugs
Preferred Drug List Status: On the preferred drug list with prior approval
Tracleer® is restricted to its FDA-approved indication of pulmonary arterial hypertension (high blood pressure in the lungs).
Buprenorphine/ Naloxone (Suboxone®)
Medication Category: Miscellaneous Products
Preferred Drug List Status: On the preferred drug list without restrictions
Prior approval restrictions have been removed. Suboxone® is used for treating opioid dependence. Prescribing is limited by federal regulations to certified physicians.
Clarithromycin (Biaxin®)
Medication Category: Anti-Infective Medications
Preferred Drug List Status: On the preferred drug list without restrictions
Clarithromycin tablets are now available generically. Biaxin® is still fairly costly (about $60-$65 per 10 days). Biaxin® XL is not included on the preferred drug list.
Fexofenadine (Allegra® & Allegra®-D)
Medication Category: Respiratory Drugs
Preferred Drug List Status: On the preferred drug list without restriction
Prior approval restrictions have been removed. Loratadine (e.g. Claritin®, Claritin®-D and generics), an over-the-counter product, is still the preferred non-sedating antihistamine. Loratadine and Loratadine / Pseudoephedrine are effective and much less costly than Allegra® and Allegra®-D (less than $5 per month, versus about $70).
Sildenafil (Revatio®)
Medication Category: Cardiovascular Drugs
Preferred Drug List Status: On the preferred drug list with prior approval
Revatio® is restricted to its FDA-approved indication of pulmonary arterial hypertension (high blood pressure in the lungs).
Sodium oxybate (Xyrem®)
Medication Category: Central Nervous System Drugs
Preferred Drug List Status: On the preferred drug list with prior approval
Xyrem® is restricted to its FDA-approved indication of narcolepsy (extreme sleepiness) with cataplexy (muscle weakness).
Tipranavir (Aptivus®)
Medication Category: Anti-Infective Medications
Preferred Drug List Status: On the preferred drug list with a physician-edit
Aptivus®, an antiviral medication, is reserved for prescribing by HIV specialists.
Tri-Norinyl® (ethinyl estradiol / norethindrone)
Medication Category: Contraceptives (Oral and Topical)
Preferred Drug List Status: On the preferred drug list without restrictions
This oral contraceptive is now available generically.
Zolpidem modified-release (Ambien® CR)
Medication Category: Central Nervous System Drugs
Preferred Drug List Status: On the preferred drug list without restrictions
Ambien® CR, a medication for sleep, provides a slightly prolonged duration of effect in comparison to Ambien®. Costs are identical to Ambien®.
Changes to the Preferred Drug List
Adalimumab (Humira®) prior authorization criteria have been modified. The three month and yearly reviews have been deleted, and a dose-limit has been added based on FDA-approved dosages. Doses are limited to 40mg every other week. Humira® is reserved for patients not responding to etanercept (Enbrel®).
Anakinra (Kineret®) prior authorization criteria have been modified. The three month and yearly reviews have been deleted, and a dose-limit has been added based on FDA-approved dosages. Doses are limited to 100mg daily. Kineret® is reserved for patients not responding to etanercept (Enbrel®).
Cetirizine (Zyrtec® and Zyrtec®-D) tablets will change to a step-edit status, to fexofenadine or fexofenadine / pseudoephedrine. If there is a previous claim in the pharmacy database for fexofenadine (Allegra®) or fexofenadrine with pseudoephedrine (Allegra®-D), then Zyrtec® or Zyrtec®-D will process automatically, without needing a prior approval. Zyrtec® chewable tablets and syrup remain available for young children (there are no restrictions for children less than two years of age).
Etanercept (Enbrel®) for Psoriasis prior authorization criteria have been modified. A dose-limit has been added, per FDA-approved prescribing information. Doses are limited to 50mg twice a week for three months, followed by 50mg each week. Three month and yearly reviews remain for Enbrel® use in psoriasis.
Etanercept (Enbrel®) for Rheumatoid Arthritis, prior authorization criteria have been modified. The three month and yearly reviews have been deleted, and a dose-limit has been added based on FDA-approved dosages. Doses are limited to 50mg per week.
Lidocaine patch (Lidoderm®) has changed to a physician-edit status and is reserved for prescribing by pain management specialists. Lidoderm® will continue to be available with prior approval for post-herpetic neuralgia.
Deletions from the Preferred Drug List
Gefitinib (Iressa®). This decision follows FDA action to limit Iressa® to patients currently benefiting from treatment. Current patients will be grandfathered to allow continued therapy. Unique needs for starting patients on Iressa® will be reviewed as exceptions.
Lente and Ultra Lente insulin. These insulins are being removed from the market at the end of the year. Current members have been grandfathered, but should be converted to an insulin on the preferred drug list.
Medications Reviewed But Not Added
Azithromycin extended release oral suspension (Zmax®). There does not appear to be a significant clinical need for this antibiotic formulation, and generic azithromycin is expected soon (November 2005).
Eszopiclone (Lunesta®). Although FDA-approved indications allow chronic dosing for insomnia, clinical advantages over zolpidem (Ambien®) are not clear.
Exenatide (Byetta®). The role of Byetta® relative to insulin is not clear. Unique needs for this injectable diabetes product will be reviewed as exceptions. Byetta® will be revisited in the fourth quarter.
Oseltamivir (Tamiflu®). Rimantadine and amantadine are generally preferred over Tamiflu® for influenza. Tamiflu® may be added if significant resistance is seen locally.
Pramlintide (Symlin®). Effects appear small, and safety concerns are significant. Unique needs for this injectable diabetes product will be reviewed as an exception.
Ramelteon (Rozerem®). More data is needed for this melatonin-like medication for sleep.
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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