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October 2003 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, 2003.
This summary was written for health care providers and has been slightly modified for the general public.
Our HealthPartners Drug Formulary information is also available within the ePocrates™ database at no charge to providers. This electronic database is downloaded from
http://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.
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
Omeprazole (Prilosec®, Prilosec OTC®)
Medication Category: Gastrointestinal Drugs
Status: On preferred drug list without restrictions
Omeprazole is now the preferred proton-pump inhibitor on the drug list.
Atazanavir (Reyataz®) and Emtricitabine (Emtriva®)
Medication Category: Anti-Infectives (Antiviral agents)
Status: On preferred drug list without restrictions
Reyataz® and Emtriva® are antiviral medications used in the treatment of HIV.
Buprenorphine/Naloxone (Suboxone®)
Medication Category: Pain Medications
Status: On preferred drug list with prior approval (PA). Suboxone® is reserved for patients with small to medium methadone requirements, or methadone intolerance or contraindications. The duration of approvals will be for 24 weeks.
This new medication to treat opiate addiction is more costly than methadone, but provides greater access to treatment. An FDA risk management program is in place to limit abuse. More information is available at
http://www.fda.gov/bbs/topics/ANSWERS/2002/ANS01165.html
Diazepam rectal solution (Diastat®)
Medication Category: Anticonvulsants
Status: On preferred drug list without restrictions
Eletriptan (Relpax®)
Medication Category: Migraine Drugs
Status: On preferred drug list without restrictions
The efficacy and safety of Relpax® appear similar to other triptans, such as Maxalt® and Imitrex®, and is less costly ($95 AWP per package of 6 tablets for both the 20mg and 40mg strengths). Prescribing information is available at
http://www.relpax.com/pdf/pi_final.pdf
. Almotriptan (Axert®) has been deleted from the preferred drug list and sumatriptan (Imitrex®) and rizatriptan (Maxalt®) remain on the preferred drug list.
Gefitinib (Iressa®)
Medication Category: Cancer Drugs
Status: On preferred drug list with prior approval (PA). This new cancer drug is reserved for its FDA-approved indications: for patients with locally advanced or metastatic non-small cell lung cancer after failure of both platinum-based and docetaxel chemtherapies. Initial approvals will be for six weeks.
Nuvaring®
Status: On preferred drug list without restrictions
Medication Category: Contraceptives
Nuvaring® is a contraceptive available as a vaginal ring insert. It is more costly than preferred drug list oral contraceptives ($40 AWP/month) and is recommended only for compliance concerns.
The following generic products have been added to the preferred drug list:
- Bumetanide (Bumex®) - Cardiovasculars
- Diclofenac immediate release only (Voltaren®) - Arthritis Drugs or Pain Medications
- Enalapril (Vasotec®) - Cardiovasculars
- Guanfacine (Tenex®) - Cardiovasculars
- Ketorolac (Toradol®) - (Quantity Limit of 20 tablets per month) - Pain Medications
- Nadolol (Corgard®) - Cardiovasculars
- Nifedipine extended release (Adalat CC®) - Cardiovasculars
- Timolol ophthalmic gel (Timoptic XE®) - Ophthalmics
Additions to the Preferred Drug List (Line Extensions)
Methylphenidate (Metadate CD®) 10mg and 30mg. All strengths are on preferred drug list.
Prempro® Low Dose. All strengths of Prempro® are on preferred drug list.
Premarin® 0.45mg. All strengths of Premarin are on preferred drug list.
Prior Approval & Step-Edit Criteria Changes
The following drugs no longer require prior approval:
- Alendronate (Fosamax®). Recommended only for low bone density (t-score less than or equal to minus 1.5), or fragility-related fracture, or long-term steroid treatment
- Copegus®
- Entacapone (Comtan®)
- Naltrexone (Revia®)
- Ortho-Evra®. More costly than preferred oral contraceptives ($39 AWP/month) and recommended only for compliance concerns
- Peg-Intron®
- Pegasys®
- Pulmozyme®
- Rebetol®
- Rebetron®
- Riluzole (Rilutek®)
- Sevelamer (Renagel®)
- Tizanadine (Zanaflex®)
Rabeprazole (Aciphex®) and pantoprazole (Protonix®). Step-therapy criteria will be added October 15, 2003. Aciphex® and Protonix® will be reserved for patient failures on omeprazole (Prilosec®, Prilosec OTC®). Patients currently using Aciphex® or Protonix® will be grandfathered, but are encouraged to change to omeprazole.
Ezetimibe (Zetia®). Step-therapy criteria have been added. Zetia® prescriptions will process as covered if a patient has had prior use of maximum statin dose (80mg Zocor® or Lipitor®).
Medications Reviewed but Not Added
The usual reason for not adding a medication to the preferred drug list is that it does not have significant advantages in its effectiveness, its safety or side effects, or its value.
Omalizumab(Xolair®). This injectable asthma medication has unclear benefits, safety concerns and is costly.
Deletions from the Preferred Drug List
Almotriptan (Axert®) is deleted from the preferred drug list effective November 1, 2003. Axert® costs have increased more than 50%. Eletriptan (Relpax®) has been added to preferred drug list and rizatriptan (Maxalt®) and sumatriptan (Imitrex®) remain on the preferred drug list. Please encourage patients to use these preferred alternatives.
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. 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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