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- Definitions
- Additions to the Preferred Drug List (Formulary)
- Legal Disclaimer
The HealthPartners Pharmacy and Therapeutics Committee updates the preferred drug list every three months. This listing represents additions and changes implemented October 1, 2008 unless otherwise stated. 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 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 2008 Medicare Formulary is available at www.healthpartners.com/formulary/medicare.do. The 2009 Medicare Formulary will be available in October. 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.
SPECIALTY UPDATE
HealthPartners will be changing its specialty pharmacy vendor from CuraScript to SpecialtyScripts Pharmacy on October 1, 2008.
SpecialtyScripts Pharmacy, a business of Cardinal Health, will manage the service and delivery of most specialty medications on behalf of HealthPartners.
SpecialtyScripts Pharmacy is dedicated to the delivery of extraordinary patient care while providing a fast, reliable, and convenient way to deliver specialty medications at a reduced overall cost. Members will have access to free delivery, a refill reminder program, and customized care management programs. In addition, SpecialtyScripts is building a local pharmacy operations center in Minnesota to open in mid-2009.
For more information, please visit specialtyscripts.com, call 866-294-1760, or fax 866-371-0822.
A list of specialty medications is available at healthpartners.com/portal/480.html.
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:
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calcipotriene (Dovonex) scalp solution
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divalproex (Depakote) enteric coated tablet (usually given BID - TID)
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dronabinol (Marinol) capsules
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eplerenone (Inspra) tablet
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galantamine (Razadyne) regular tablets
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lamotrigine (Lamictal) regular tablets
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risperidone (Risperdal) regular tablets and solution
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Yasmin (ethinyl estradiol/ drospirenone)
ADDITIONS TO THE PREFERRED DRUG LIST (FORMULARY)
Methylnaltrexone (Relistor)
Medication Category: Miscellaneous Products
Preferred Drug List Status: On the preferred drug list with prior approval
Relistor is reserved for FDA-approved indications. It is a subcutaneous injection used for the treatment of opioid-induced constipation in patients with advanced illness who are receiving palliative care, when response to laxative therapy has not been sufficient.
HealthPartners Medicare Formulary: Relistor will be added with prior approval on January 1, 2009.
Multi-vitamins with fluoride
Medication Category: Miscellaneous Products
Preferred Drug List Status: On the preferred drug list without restriction
Multiple vitamins with fluoride are available as a low cost generic in both a drop and tablet dosage form.
HealthPartners Medicare Formulary: Multivitamins with fluoride will not be added to the HealthPartners Medicare Formulary
Pegvisomant (Somavert)
Medication Category: Endocrine Drugs / Hormonal Agents, Suppressant (Pituitary) for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list with prior approval
Somavert is reserved for FDA-approved indications. It is used in the treatment of acromegaly (a hormonal disorder that results from too much growth hormone in the body) in patients who have had an inadequate response to surgery and/or radiation therapy and/or other medical therapies, or for whom these therapies are not appropriate.
Somavert is considered a specialty drug and must be obtained from SpecialtyScripts. Members with Part D coverage are encouraged to obtain Somavert from SpecialtyScripts.
HealthPartners Medicare Formulary: Somavert is already on the HealthPartners Medicare Formulary with prior approval.
Phenylephrine eye drops
Medication Category: Eyes, Ears and Nose / Not added to the HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list without restriction
This is a low-cost generic eye drop that may be used to control inflammation of the middle part of the eye (uveitis) or to dilate (enlarge) the pupil of the eye before and after surgeries or prior to certain eye examinations.
HealthPartners Medicare Formulary: Phenylephrine eye drops will not be added to the HealthPartners Medicare Formulary
MEDICATIONS REVIEWED BUT NOT ADDED
Diclofenac gel (Voltaren gel). Voltaren gel is a topical non-steroidal anti-inflammatory drug (NSAID) used for the treatment of joint pain in the hands, wrists, elbows, knees, ankles, or feet caused by osteoarthritis. Significant efficacy and safety advantages over current products have not been shown. Unique situations and needs can be requested as a formulary exception.
Diclofenac patch (Flector patch). Flector patch is a topical non-steroidal anti-inflammatory drug (NSAID) used for the treatment of acute (short-term) pain caused by minor sprains, strains and bruises. Significant efficacy and safety advantages over current products have not been shown. Unique situations and needs can be requested as a formulary exception.
Olopatadine nasal (Patanase). Patanase is a nasal spray used for the relief of the symptoms of seasonal allergic rhinitis (inflammation of the nasal passage). Significant efficacy and safety advantages over current products have not been shown. Unique situations and needs can be requested as a formulary exception.
Sumatriptan / Naproxen sodium combination (Treximet). Treximet is used for the acute (short-term) treatment of migraine headaches. The individual products sumatriptan (Imitrex) and naproxen sodium are available on the preferred drug list. Significant advantages of the combination product over dosing these products separately have not been shown. A generic for Imitrex (sumatriptan) is expected within a few months.
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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