July 2006 Preferred Drug List Updates
The HealthPartners Pharmacy and Therapeutics Committee updates the preferred drug list every three months. This listing represents changes implemented July 1, 2006.
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
Insulin detemir (Levemir®)
Medication Category: Diabetes Products
Preferred Drug List Status: On the preferred drug list without restriction
Levemir® is a long-acting insulin and is similar to Lantus® (insulin glargine).
Lenalidomide (Revlimid®)
Medication Category: Cancer Drugs
Preferred Drug List Status: On the preferred drug list without restriction
Revlimid® is FDA-approved for myelodysplastic syndrome (MDS), a disorder of the bone marrow.
Sutininib (Sutent®)
Medication Category: Cancer Drugs
Preferred Drug List Status: On the preferred drug list without restriction
Sutent® is a new medication used primarily for renal cancer.
Thalomide (Thalomid®)
Medication Category: Cancer Drugs
Preferred Drug List Status: On the preferred drug list without restriction
Thalomid® is used for multiple myeloma (cancer of the bone marrow).
Changes to the Preferred Drug List
Sildenafil (Revatio®) is considered a specialty medication and must be obtained through CuraScript.
Bosentan (Tracleer®) is considered a specialty medication and must be obtained through CuraScript or PharmaCare Specialty Services.
Triphasil®/TrivoraTM generic /EnpresseTM generic. Previously only brand-name TriphasilTM was covered. Generics for TriphasilTM are now preferred.
Deletions from the Preferred Drug List
Furazolidone (Furoxone®). This antibiotic is no longer available in the marketplace.
Oseltamivir (Tamiflu®). There is little or no need for Tamiflu® during the summer. HealthPartners will re-evaluate Tamiflu for the 2006/ 2007 flu season after CDC guidelines are available.
Paroxetine mesylate (Pexeva®). Pexeva® is a different salt form of paroxetine and is similar to generic paroxetine hydrochloride. Pexeva® will be deleted as of August 1, 2006 from the preferred drug list and as of January 1, 2007 for the Medicare formulary. Members currently using Pexeva will be grandfathered.
Medications Reviewed But Not Added
Insulin glulisine (Apidra®) - not added. There is little clinical demand for Apidra. Novolog®, also a rapid-acting insulin, is available on the preferred drug list.
IGF-1 growth factors (mecasermin, Increlex and iPlex) - not added. Increlex® and iPlex® are reserved as non-formulary medications for patients failing therapy with growth hormone.
Ranolazine (Ranexa®) - not added. The place in therapy was not clear, clinical data is limited, and there is little experience. Ranolazine will continue to be available through the non-formulary exception process.
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.
