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January 2004 Preferred Drug List Updates
The HealthPartners Pharmacy and Therapeutics Committee updates the preferred drug list every three months. This listing represents changes implemented January 1, 2004.
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 users. 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
Letrozole(Femara®)
Medication Category: Cancer Drugs
Status: On preferred drug list without restrictions
Femara® is an aromatase inhibitor used to prevent breast cancer. A recent study shows some benefits for patients who have finished the standard five years of treatment with tamoxifen.
Azelaic acid 15% (Finacea®)
Medication Category: Dermatologic (Skin) Medications
Status: On preferred drug list without restrictions
Finacea® is a gel used for treating rosacea. It may have some unique properties and appears slightly less costly than other options such as Metrogel®.
Fosamprenavir calcium (Lexiva®)
Medication Category: Anti-Infectives (Antiviral agents)
Status: On preferred drug list without restrictions
Lexiva® is an antiviral medication used in the treatment of HIV.
Aprepitant® (Emend®).
Medication Category: Central Nervous System Drugs (Antinausea)
Status: On preferred drug list with prior approval (PA). Reserved for use by oncologists for patients receiving high emetogenic cancer chemotherapy such as high-dose cisplatin and with significant nausea that is poorly controlled despite standard therapy.
Emend® is a new anti-nausea drug. It is used with other drugs for nausea and vomiting in patients with chemotherapy-induced nausea.
Additions to the Preferred Drug List (Line Extensions)
Prempro 0.3mg/1.5mg. All strengths of Prempro® are now on the preferred drug list.
Prior Approval & Step-Edit Criteria Changes
Pioglitazone hcl (Actos®) and Rosiglitazone maleate (Avandia®). Step-therapy criteria have been added. Actos® and Avandia® prescriptions will process as covered if a patient has had prior use of metformin (Glucophage®), or a sulfonylurea (such as glipizide or glyburide), or insulin.
Fenofibrate (Tricor®). Step-therapy criteria have been changed. Tricor® prescriptions will process as covered if a patient has had prior use of gemfibrozil OR a statin such as 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.
Xanax XR®. This once-daily form of alprazolam for panic disorder and anxiety is rarely needed and is much more costly than generic alprazolam.
Bupropion extended release (Wellbutrin XL®). The immediate release (currently available as a generic) and the sustained-release (Wellbutrin SR® -soon to be available generically) dosage forms of bupropion are on the preferred drug list.
Pegfilgrastim (Neulasta®). Neulasta® is a long-acting form of filgrastim (Neupogen®), used to maintain white blood cells and prevent infection in patients receiving chemotherapy. The effects of Neulasta® and Neupogen® are similar. Neulasta® is more convenient (fewer shots) and more costly. In-clinic administration is preferred and unique situations requiring home administration will be managed as preferred drug list exceptions.
Rosuvastatin (Crestor®). Crestor® is a new lipid drug, most similar to atorvastatin (Lipitor®). Crestor® is not a unique drug, with efficacy similar to current products.
Seasonale® is a long-cycle oral contraceptive, designed to reduce the number of menstrual cycles from 13 per year to four. Seasonale® is not a unique product (the ingredients are identical to Nordette®), and this concept of providing active drug for 12 weeks followed by seven days of inactive drug can be done with current products.
Stalevo® is a combination product of entacapone (Comtan®) and levodopa/carbidopa (Sinemet®) and is used for Parkinson's disease. Both of the individual products are on the preferred drug list.
Deletions from the Preferred Drug List
None.
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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