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January 2007 Preferred Drug List Updates
January 2007
The HealthPartners Pharmacy and Therapeutics Committee updates the preferred drug list every three months. This listing represents changes implemented January 1, 2007. All drug additions and changes are the same for the HealthPartners Medicare 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 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.
GENERIC UPDATE
Several medications are now available as generics, and most members will pay a lower generic co-pay for these medications. Members who choose to continue using brand-name medications when a generic is available may pay a higher co-pay. Recent generics include:- azithromycin (Zithromax) suspension. Generics for both the suspension and the tablets are now available.
- finasteride (Proscar)
- fluticasone nasal spray (Flonase)
- lamotrigine (Lamictal) 5mg and 25mg chewable tablets (not the regular tablets)
- metronidazole vaginal gel (Metrogel)
- oxybutynin XL (Ditropan XL)
- jolessa & quasense (Seasonale)
- sertraline (Zoloft)
- simvastatin (Zocor)
- tranylcypromine (Parnate)
- venlafaxine (Effexor) immediate-release tablets (not Effexor XR)
Omeprazole generics are now preferred. Prilosec OTC will no longer be covered for members with Medicare Part D coverage starting on January 1, 2007 and no longer covered for all other members starting on February 1, 2007. Prilosec OTC prescriptions should be changed to generic prescription omeprazole.
ADDITIONS TO THE PREFERRED DRUG LIST
Amiloride (Midamor®) & Amiloride / HCTZ (Moduretic®)
Medication Category: Cardiovascular Drugs / Cardiovascular Agents for Medicare Part D
Preferred Drug List Status: On the preferred drug list without restriction
Amiloride and Amilioride/Hydrochlorothiazide are low cost generic diuretic options.
Atovaquone (Mepron®)
Medication Category: Anti-Infectives / Antiparasitics for Medicare Part D
Preferred Drug List Status: On the preferred drug list without restriction
Mepron® is an anti-infective sometimes used for patients with HIV infection.
Calcipotriene-Betamethasone (Taclonex®)
Medication Category: Dermatologic Medications / Dermatological Agents for Medicare Part D
Preferred Drug List Status: On the preferred drug list with prior approval
Taclonex® is reserved for patients with an inadequate response to other formulary options for psoriasis.
Clobetasol propionate spray (Clobex® spray)
Medication Category: Dermatologic Medications / Dermatological Agents for Medicare Part D
Preferred Drug List Status: On the preferred drug list with prior approval
Clobex® spray is a topical steroid used for psoriasis and is reserved for patients who have tried and failed other potent topical steroids on the preferred drug list.
Entacapone & Carbidopa-Levodopa combination (Stalevo®)
Medication Category: Parkinson's Drugs / Antiparkinson's Agents for Medicare Part D
Preferred Drug List Status: On the preferred drug list without restriction
Stalevo® is combination of entacapone (Comtan®) and carbidopa/levodopa (Sinemet®) for Parkinson's disease.
Glimepiride (Amaryl®)
Medication Category: Diabetes Products / Blood Glucose Regulators for Medicare Part D
Preferred Drug List Status: On the preferred drug list without restriction
Glimepiride is a low-cost generic sulfonylurea for diabetes.
Lactulose
Medication Category: Gastrointestinal Drugs / Gastrointestinal Agents for Medicare Part D
Preferred Drug List Status: On the preferred drug list without restriction
Lactulose is a low-cost generic medication used for constipation.
HealthPartners Medicare Formulary (Part D) prior approval restrictions have been removed.
Meloxicam (Mobic®)
Medication Category: Arthritis Drugs and Pain Medications / Analgesics (Pain) and Anti-inflammatories for Medicare Part D
Preferred Drug List Status: On the preferred drug list without restriction
Meloxicam is a low-cost generic non-steroidal anti-inflammatory.
Mometasone topical (Elocon®)
Medication Category: Dermatologic Medications / Dermatological Agents for Medicare Part D
Preferred Drug List Status: On the preferred drug list without restriction
Mometasone is a generic topical steroid anti-inflammatory used.
Posaconazole (Noxafil®)
Medication Category: Anti-Infectives / Antifungals for Medicare Part D
Preferred Drug List Status: On the preferred drug list with physician-edit
This oral antifungal will be reserved for prescribing by infectious disease providers.
Propranolol XL (Innopran XL)®
Medication Category: Migraine Drugs / Antimigraine Agents for Medicare Part D
Preferred Drug List Status: On the preferred drug list with step therapy
Innopran XL® is reserved for patients diagnosed with migraine headaches who have tried another migraine medication on the preferred drug list. Inderal LA®, another long-acting propranolol medication, is also included on the preferred drug list with the same step therapy criteria.
Rifabutin (Mycobutin®)
Medication Category: Anti-Infectives / Antimycobacterials for Medicare Part D
Preferred Drug List Status: On the preferred drug list without restriction
Mycobutin® is an anti-infective sometimes used for patients with HIV infection.
Sitagliptin (Januvia®)
Medication Category: Diabetes Products / Blood Glucose Regulators for Medicare Part D
Preferred Drug List Status: On the preferred drug list with prior approval
This new diabetes medication will be available with prior approval for patients with an inadequate response to metformin or sulfonylureas (such as glimepiride, glipizide or glyburide), or with medical contraindications to their use.
Januvia® is the first in a new class of medications called dipeptidyl peptidase-4 (DPP-4) inhibitors. Studies show a lowering of HgbA1c by 0.6-0.8 mg/dL, a relatively small effect, and the rate of hypoglycemia (low blood glucose) appears similar to placebo. Studies addressing diabetic complications and long-term safety are not available. Cost comparisons - Januvia® costs approximately $155 per month, metformin is about $18 per month and sulfonylureas are an average of about $15. Prescribing information is available at, www.merck.com.
Valganciclovir (Valcyte®)
Medication Category: Anti-Infectives / Antivirals for Medicare Part D
Preferred Drug List Status: On the preferred drug list without restriction
This antiviral is used for treating cytomegalovirus (CMV) infections.
Voriconazole (Vfend®)
Medication Category: Anti-Infectives / Antifungals for Medicare Part D
Preferred Drug List Status: On the preferred drug list with physician-edit
This oral antifungal will be reserved for prescribing by infectious disease providers.
Vorinostat (Zolinza®)
Medication Category: Cancer Drugs / Antineoplastics (Cancer Drugs) for Medicare Part D
Preferred Drug List Status: On the preferred drug list with prior approval
Zolinza® is reserved for treatment of cutaneous T-cell lymphoma with inadequate control despite two systemic therapies.
ADDITIONS TO THE PREFERRED DRUG LIST (LINE EXTENSIONS)
Aripiprazole oral solution (Abilify®). Abilify® now available in an oral solution dosage form.
Travaprost (Travatan Z®). Travatan Z® is a benzalkonium chloride (BAK) free formulation of travaprost ophthalmic. Travatan (with BAK) remains on the preferred drug list.
CHANGES TO THE PREFERRED DRUG LIST
Calcitonin nasal (Miacalcin, Fortical®). Prior approval restrictions for this osteoporosis medication have been removed. Miacalcin® / Fortical® are now on the preferred drug list without restriction.
Cetirizine & Cetirizine / Pseudoephedrine (Zyrtec® & Zyrtec-D®). Step therapy and age restrictions have been removed for this low-sedating antihistamine (and in combination with a decongestant). Zyrtec® and Zyrtec-D® are now on the preferred drug list without restriction.
Ciprofloxacin / Hydrocortisone otic (Cipro HC® otic). Physician-edit and step therapy restrictions have been removed for this anti-infective/steroid combination ear drop. Cipro HC® is now on the preferred drug list without restriction.
Efalizumab (Raptiva®). The requirement of an annual review to continue use for psoriasis has been deleted. All other prior approval criteria remain the same.
Erlotinib (Tarceva®). Prior approval restrictions have been removed for this oncology medication. Tarceva® is now on the preferred drug list without restriction.
Escitalopram (Lexapro®). Step therapy criteria have changed. This antidepressant is reserved for patients with an inadequate response to a generic formulary SSRI antidepressant (such as citalopram or fluoxetine or paroxetine hcl or sertraline), or for members previously stable on this medication.
Etanercept (Enbrel®). The requirement of an annual review to continue use for psoriasis has been deleted. All other prior approval criteria remain the same for both dermatology and rheumatology use.
Exenatide (Byetta®). Restrictions for this diabetes medication have been reduced from prior approval to step therapy. Byetta® is reserved for patients with Type II diabetes who have an inadequate response to metformin or a sulfonylurea, or with medical contraindications to their use.
Ezetimibe (Zetia®). Step therapy restrictions have been removed for this cholesterol medication. Zetia® is now on the preferred drug list without restriction.
Imatinib (Gleevec®). Prior approval restrictions have been removed for this oncology medication. Gleevec® is now on the preferred drug list without restriction.
Levonorgestrel (Plan B®). An age-edit will be added for this emergency oral contraceptive pill. Coverage will follow the current prescription / over-the-counter (OTC) status. A prescription is required by law and coverage under the prescription drug benefit will continue for individuals 17 years of age and younger. Plan B® can be purchased over-the-counter (prescription not required) for individuals 18 years of age and older. This change will take effect on March 1, 2007 for Medicare Part D and February 1, 2007 for all other coverages.
Plan B will remain covered under the prescription drug benefit for all patient age groups who are covered under a prepaid medical assistance program.
Oral Contraceptives (Desogen® & Lo/Ovral®). Previously only brand-name Desogen® & Lo/Ovral® were covered. As of January 1, 2007, generics for Desogen® (such as ApriTM, ReclipsenTM and SoliaTM) & Lo/Ovral® (such as Low-OgestrelTM & CryselleTM) are now preferred.
HealthPartners Medicare Formulary (Part D) No change. Generics for Desogen® & Lo/Ovral® are already preferred on the HealthPartners Medicare Formulary.
Oxybutynin extended release (Ditropan XL®). Step therapy restrictions have been removed for this medication used for over-active bladder. Oxybutynin extended release is now on the preferred drug list without restriction.
HealthPartners Medicare Formulary (Part D) No change. Ditropan XL® is already on the HealthPartners Medicare Formulary without restrictions.
Other low-cost generic options for over-active bladder are available on the preferred drug list such as oxybutynin immediate release and hyoscyamine. A generic for Ditropan XL® (oxybutynin extended release) is also now available on the market.
Ramipril (Altace®). Prior approval restrictions have been removed for this ACE-inhibitor. Altace® is now on the preferred drug list without restriction. Several low-cost generic ACE-inhibitor options (such as benazepril, captopril, enalapril, lisinopril) are available on the preferred drug list.
Temozolamide (Temodar®). Prior approval restrictions have been removed for this oncology medication. Temodar® is now on the preferred drug list without restriction.
HealthPartners Medicare Formulary - Temodar® is not on the HealthPartners Medicare Formulary because it is always covered under Medicare Part B benefits.
Tolterodine (Detrol® / Detrol LA®). Step therapy restrictions have been removed for this medication used for over-active bladder. Detrol® / Detrol LA® is now on the preferred drug list without restriction.
HealthPartners Medicare Formulary (Part D) No change. Detrol® / Detrol LA® is already on the HealthPartners Medicare Formulary without restrictions.
Other low-cost generic options are available on the preferred drug list such as oxybutynin immediate release, oxybutynin extended release and hyoscyamine.
MEDICATION REVIEWED BUT NOT ADDED
Doxycycline (Oracea®). Oracea® is a low-dose doxycycline medication used for rosacea. Doxycycline is available as a generic in a similar dose on the preferred drug list.
Pioglitazone / Glimepiride (Duetact®). Individual products Actos® (piogliazone) and generic glimepiride (Amaryl®) are both available on the preferred drug list.
Rosiglitazone / Glimepiride (Avandaryl®). Individual products Avandia® (rosiglitazone) and generic glimepiride (Amaryl®) are both available on the preferred drug list.
DELETIONS TO THE PREFERRED DRUG LIST
Methyltestosterone / Esterified Estrogens (Estratest® / Estratest® H.S.). Estratest® is commonly used for treating vasomotor symptoms and decreased libido. There is little evidence of effectiveness in the medical literature and there is some safety concern. A recent analysis found that women using estrogen and testosterone have a significantly increased risk of invasive breast cancer versus women using estrogen alone. The overall risk was not large, about 1% for this estrogen and testosterone group, and not significantly different than the combination estrogen and progestin group.
FDA review of Estratest® has been very limited. Combination products have been available for many years, since before the FDA required effectiveness data, and have essentially been grandfathered (allowed to stay on the market without evidence of effectiveness). A more recent FDA review concluded that the addition of testosterone to estrogen products did not provide beneficial effects.
Current members will be grandfathered, allowing them to continue therapy, and a letter discussing benefits and risks will be sent to their providers. Conservative use is recommended, along with discussions with patients about risks and benefits. Estratest® will no longer be covered for new patients starting on February 1, 2007.
HealthPartners Medicare Formulary No change because Estratest® has always been excluded from coverage under Part D due to the lack of effectiveness data.
Omeprazole magnesium (Prilosec OTC®). Omeprazole prescription generics are now preferred. Prilosec OTC® will no longer be covered for members with Part D coverage starting on January 1, 2007 and starting February 1, 2007 for all other members. Prilosec OTC® prescriptions should be changed to generic prescription omeprazole.
MEDICAL POLICIES
Shingles vaccine (Zostavax®) is approved to prevent herpes zoster (shingles) in individuals 60 years of age and above. It will be covered as a standard medical benefit. Zostavax® will not be covered for individuals less than 60 years of age.
For Medicare Part D - Zostavax® is included on the HealthPartners Medicare Formulary. It is covered only for individuals 60 years of age and above and must be billed as a pharmacy benefit. Patients are responsible for payment of the vaccine based on their Part D prescription drug benefit.
Infliximab (Remicade®). Prior approval will be added, similar to current criteria for ambulatory medications with the same indications. Remicade® is an IV infusion product with several uses.
For rheumatoid arthritis Remicade® is reserved for Rheumatology providers and for patients with an inadequate response to methotrexate or with medical contraindications to its use.
For inflammatory bowel disease, Remicade® is reserved for GI providers, and for patients with an inadequate response to standard therapy.
For psoriasis, Remicade® is reserved for Dermatology providers, and for patients with an inadequate response to UVB phototherapy OR systemic therapy (methotrexate, cyclosporine, or Soriatane®).
Prior approval requests must be submitted to pharmacy services for patients starting Remicade® beginning on March 1, 2007. Patients currently using Remicade® will be grandfathered, allowing them to continue therapy.
Abatacept (Orencia®) & Rituximab (Rituxan®). Prior approval will be added for Orencia® and Rituxan® for their use in rheumatoid arthritis. Both are second-line infusible products for rheumatoid arthritis and will be reserved for rheumatology providers and for patients with an inadequate response to methotrexate or with medical contraindications to its use.
No prior approval is needed for Rituxan® when used by oncologists for FDA-approved indications.
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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