|
|
|
|
July 2005 Preferred Drug List Updates
This update represents changes implemented July 1, 2005.
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
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.
Announcement
HealthPartners has completed a review of our entire Preferred Drug List. The most significant changes are summarized in the table below with a complete description of all changes on the following pages. No changes were made to any category or drug not listed in this Update. Changes are effective July 1, 2005 unless otherwise specified below.
Significant Preferred Drug List Changes
| Deletions and Restrictions |
Additions |
Transition Plans |
Preferred Products |
| rabeprazole (Aciphex) has been deleted |
lansoprazole (Prevacid Solutab)
Solutab only added with step therapy to omeprazole (Prilosec OTC) |
Current patients have been grandfathered until Sept 30.
Transitions to preferred drug list alternatives will be required unless clinically contraindicated.
Patient-specific letters will be sent to providers. |
omeprazole (Prilosec OTC)
lansoprazole (Prevacid Solutab) with step therapy to omeprazole (Prilosec OTC)
pantoprazole (Protonix) with step therapy to omeprazole (Prilosec OTC) |
escitalopram (Lexapro), now requires step therapy to citalopram.
venlafaxine (Effexor/Effexor XR), now requires step therapy to generic antidepressants
paroxetine CR (Paxil CR) has been deleted |
paroxetine mesylate (Pexeva) |
Current patients have been grandfathered indefinitely.
Converting patients on Lexapro and Paxil CR is encouraged if appropriate, but is not required, and will be supported with patient-specific letters to providers. |
fluoxetine
citalopram
paroxetine hydrochloride
paroxetine mesylate (Pexeva) |
| Lilly insulins (Humulin, Humalog, Humalog Mix) have been deleted |
Novo Nordisk insulins (Novolin, Novolog, Novolog Mix) |
Humulin vials have been grandfathered until July 15. Humulin vials can be changed to Novolin vials at pharmacies.
Humalog and Humulin pens have been grandfathered until Sept 30 to allow for teaching and new prescriptions.
Transitions are required unless clinically contraindicated.
Letters will be sent to providers and patients. |
Novo Nordisk insulin (Novolin, Novolog, Novolog Mix)
insulin glargine (Lantus) |
| tamsulosin (Flomax) has been deleted |
alfuzosin (Uroxatral) |
Current patients have been grandfathered until Sept 30.
Transitions will be required unless clinically contraindicated.
Patient-specific letters will be sent to providers. |
alfuzosin (Uroxatral) |
| cetirizine (Zyrtec)/Zyrtec D), prior approval change, use after loratadine OTC AND Allegra |
n/a |
Current patients have been grandfathered indefinitely.
Converting patients from Zyrtec/Zyrtec D to Allegra/Allegra-D is encouraged but not required. |
loratadine/loratadine-D OTC
fexofenadine (Allegra/Allegra-D) with prior approval, use after loratadine/loratadine-D OTC |
| latanoprost (Xalatan) has been deleted |
travoprost (Travatan) |
Current patients have been grandfathered until Sept 30.
Transitions will be required unless clinically contraindicated.
Patient-specific letters will be sent to providers. |
bimatoprost (Lumigan)
travoprost (Travatan) |
Additions to the Preferred Drug List
Acarbose (Precose)
Medication Category: Diabetes Products
Preferred Drug List Status: On the preferred drug list without restrictions
This alpha glucosidase inhibitor is usually a 2nd-line oral diabetes medication.
Alfuzosin (Uroxatral)
Medication Category: Miscellaneous Products
Preferred Drug List Status: On the preferred drug list without restrictions
Uroxatral, prescribed for enlargement of the prostate gland (benign prostatic hyperplasia or BPH), will replace tamsulosin (Flomax). Patients currently receiving Flomax have been grandfathered until September 30. Transitions will be required (either a transition or a response indicating that Flomax is medically necessary) with patient-specific letters mailed to providers (the CIMS Program).
Uroxatral and Flomax are selective alpha-blockers. All alpha-blockers appear to have similar effectiveness, and the selective products generally cause less lowering of blood pressure than non-selective products. Uroxatral is less costly than Flomax.
Uroxatral is given as a 10mg dose, taken once daily, with food. Dose titrations are not needed, and no dosage adjustments are needed in the elderly and for those with renal impairment. Uroxatral drug interactions include CYP3A4 inhibitors, and it is contraindicated with potent inhibitors like ketoconazole, itraconazole and ritonavir.
For more information, Uroxatral PI (www.sanofi-synthelabo.us), Medical Letter (January 5 2004), AUA BPH Guidelines, 2003 (www.auanet.org).
Azelastine ophthalmic (Optivar)
Medication Category: Eyes, Ears and Nose
Preferred Drug List Status: On the preferred drug list without restrictions
Optivar is used for the treatment of itching of the eye related to allergies. Other preferred allergy eye drops are Alamast, cromolyn sodium, Elestat and Patanol.
Betamethasone aerosol foam (Luxiq) & Clobetasol aerosol foam (Olux)
Medication Category: Dermatologic (Skin) Medications
Preferred Drug List Status: On the preferred drug list with prior approval
Luxiq and Olux are restricted for patients who have failed another preferred drug list topical corticosteroid formulation intended for the scalp. Both products are topical steroid foam products used for psoriasis.
Betaxolol ophthalmic solution
Medication Category: Eyes, Ears and Nose
Preferred Drug List Status: On the preferred drug list without restrictions
Betaxolol ophthalmic solution is a low-cost generic beta-blocker used for glaucoma.
Cetrorelix injectable (Cetrotide), Choriogonadotropin alfa injectable (Ovidrel) & Ganirelix injectable
Medication Category: Obstetrical and Gynecological Drugs
Preferred Drug List Status: On the preferred drug list per member infertility benefits
Cetrotide is an infertility medication. Infertility medications are on the HealthPartners specialty drug list and should be obtained from CuraScript when self-administered (this does not apply to in-clinic administration). CuraScript can be reached at 877-696-5247.
Epinastine ophthalmic (Elestat)
Medication Category: Eyes, Ears and Nose
Preferred Drug List Status: On the preferred drug list without restrictions
Elestat is used for the treatment of itching of the eye related to allergies. Other preferred allergy eye drops are Alamast, cromolyn sodium, Optivar and Patanol.
Estradiol once weekly patch (Climara)
Medication Category: Obstetrical and Gynecological Drugs
Preferred Drug List Status: On the preferred drug list without restrictions
Climara once weekly estrogen replacement patches were added to the preferred drug list.
Estradiol/Levonorgestrel weekly patch (Climara Pro)
Medication Category: Obstetrical and Gynecological Drugs
Preferred Drug List Status: On the preferred drug list without restrictions
Climara Pro once weekly estrogen/progestin replacement patches were added to the preferred drug list.
Galantamine (Razadyne--previously called Reminyl)
Medication Category: Central Nervous System Drugs
Preferred Drug List Status: On the preferred drug list with prior approval
Razadyne/ Reminyl is restricted for patients with Alzheimers Disease who do not tolerate donepezil (Aricept).
Growth Hormone (Norditropin)
Medication Category: Endocrine Drugs
Preferred Drug List Status: On the preferred growth hormone drug list with prior approval per member medical benefits for growth hormone.
Norditropin is added to the preferred growth hormone drug list with prior approval. Nutropin and Nutropin AQ remain on the preferred growth hormone drug list with prior approval and Humatrope has been deleted. Growth Hormone is included on the HealthPartners specialty drug list and must be obtained from HealthPartners Riverside Pharmacy when self-administered (this does not apply to in-clinic administration). HealthPartners Riverside Pharmacy can be reached at 612-371-1641.
Lansoprazole (Prevacid Solutab only)
Medication Category: Gastrointestinal Drugs
Preferred Drug List Status: On the preferred drug list with step therapy
Prevacid Solutab only was added to the preferred drug list with step therapy and is reserved for patients who have not responded to treatment with Prilosec OTC. Protonix remains on the preferred drug list with the same step therapy criteria as Prevacid Solutab, and Aciphex has been deleted. Prevacid capsules and granule packets are NOT included on the preferred drug list.
The efficacy and side effects of proton-pump-inhibitors are similar. Prevacid is approved for children down to age one. Prevacid Solutab is placed on the tongue and allowed to disintegrate, with or without water, until the particles can be swallowed. The tablet typically disintegrates in less than 1 minute.
For more information, Prevacid PI (http://pitap.abbott.com/prevacid.pdf), ICSI Dyspepsia and GERD Guideline, July 2004 (www.icsi.org/Dyspepsia & GERD).
Levofloxacin (Levaquin)
Medication Category: Anti-Infective Medications
Preferred Drug List Status: On the preferred drug list without restrictions
Levaquin is a quinolone antibiotic. Ciprofloxacin (generic) and moxifloxacin (Avelox) remain on the preferred drug list.
Linezolid (Zyvox)
Medication Category: Anti-Infective Medications
Preferred Drug List Status: On the preferred drug list with a physician-edit
Zyvox, an antibacterial medication, is restricted to prescribing by an infectious disease specialist. Claims from providers with this specialty code will process automatically without prior approval.
Loteprednol/Tobramycin combination eye drop (Zylet)
Medication Category: Eyes, Ears and Nose
Preferred Drug List Status: On the preferred drug list without restrictions
Zylet is an antibacterial and anti-inflammatory combination eye drop used for treating patients with inflammatory eye conditions who have or are at risk of developing superficial bacterial eye infections.
Lovastatin (Mevacor)
Medication Category: Cholesterol Lowering Drugs
Preferred Drug List Status: On the preferred drug list without restrictions
Lovastatin was added to provide a generic statin cholesterol medication option. Atorvastatin (Lipitor) and simvastatin (Zocor) remain on the preferred drug list.
Meglitol (Glyset)
Medication Category: Diabetes Products
Preferred Drug List Status: On the preferred drug list without restrictions
This alpha glucosidase inhibitor is usually a 2nd-line oral diabetes medication.
Moxifloxacin eye drops (Vigamox)
Medication Category: Eyes, Ears and Nose
Preferred Drug List Status: On the preferred drug list with a physician-edit
Vigamox, a quinolone antibiotic eye drop, is restricted to prescribing by ophthalmology and optometry. Claims from providers with these specialty codes will process automatically without prior approval. Ofloxacin is the preferred quinolone eye drop on the preferred drug list. Gatifloxacin eye drop (Zymar) is also available with the same physician-edit for ophthalmology and optometry.
Nateglinide (Starlix)
Medication Category: Diabetes Products
Preferred Drug List Status: On the preferred drug list without restrictions
Starlix is usually a 2nd-line oral diabetes medication, most useful for treating elevated blood glucose levels that occur after eating (post-prandial hyperglycemia).
Nitazoxinide (Alinia)
Medication Category: Anti-Infective Medications
Preferred Drug List Status: On the preferred drug list with step therapy
Alinia is restricted to treatment failures on metronidazole (if there is a previous pharmacy claim for metronidazole, Alinia claims will process automatically without prior approval). Alinia is FDA-approved for diarrhea.
Novo Nordisk Insulins (Novolin, Novolog, Novolog Mix)
Medication Category: Diabetes Products
Preferred Drug List Status: On the preferred drug list without restrictions
Novo Nordisk Insulins (Novolin, Novolog and Novolog Mix) will replace Lilly insulins (Humulin NPH, Humulin R, Humulin 70/30, Humalog and Humalog Mix).
Patients using Humulin vials have been grandfathered until July 15. These products are equivalent and can be changed to Novolin vials at pharmacies.
Patients using Humalog, Humalog Mix and Humulin pens have been grandfathered until September 30 to allow for teaching and new prescriptions. Transitions from Lilly insulins to Novo Nordisk insulins will be required (either a transition or a response indicating that Lilly insulin is medically necessary), and will be supported with patient-specific letters mailed to providers and to patients notifying them of changes. The rapid-acting insulin analogs (Novolog and Humalog) are similar but are not considered equivalent by the FDA. The kinetic profiles of Novolog and Humalog are nearly super-imposable. These products have different pregnancy ratings (Humalog is pregnancy class B and Novolog is class C).
Humulin Lente, Ultralente, and 50/50 remain on the preferred drug list. Insulin glargine (Lantus) also remains on the preferred drug list.
Oxybutynin sustained release (Ditropan XL)
Medication Category: Miscellaneous Products
Preferred Drug List Status: On the preferred drug list with step therapy
Ditropan XL is available for overactive bladder without restrictions for patients 65 years of age and over. If less than 65 years of age, Ditropan XL is reserved for patients who have side effects with oxybutynin immediate-release. Tolterodine (Detrol and Detrol LA) both remain on the preferred drug list with the same criteria as Ditropan XL.
Paroxetine mesylate (Pexeva)
Medication Category: Mental Health Drugs
Preferred Drug List Status: On the preferred drug list without restrictions
Pexeva contains the same active ingredient as paroxetine hydrochloride (generic equivalent of Paxil) in a different salt form (mesylate rather than hydrochloride). Because they are different salt forms, they are not considered identical products (not an AB-rated generic by the FDA). Pexeva is a branded product; however, it is currently less costly than generic paroxetine hydrochloride and therefore will be considered a generic medication by HealthPartners. Generic paroxetine hydrochloride remains on the preferred drug list and paroxetine controlled release (Paxil CR) has been deleted.
Propranolol sustained release (Inderal LA)
Medication Category: Migraine Drugs
Preferred Drug List Status: On the preferred drug list with step therapy
Inderal LA is restricted to patients diagnosed with migraine headaches who have tried another migraine medication on the preferred drug list.
Repiglinide (Prandin)
Medication Category: Diabetes Products
Preferred Drug List Status: On the preferred drug list without restrictions
Prandin is usually a 2nd-line oral diabetes medication, most useful for treating elevated blood glucose levels that occur after eating (post-prandial hyperglycemia).
Seasonale (Ethinyl estradiol/Levonorgestrel)
Medication Category: Contraceptives (Oral and Topical)
Preferred Drug List Status: On the preferred drug list without restrictions
Seasonale is an oral contraceptive, approved and packaged for an extended 3-month cycle.
Timolol maleate eye drops (Istalol)
Medication Category: Eyes, Ears and Nose
Preferred Drug List Status: On the preferred drug list without restrictions
Istalol is a beta-blocker eye drop for glaucoma. Istalol is a once-daily form of timolol maleate, most similar to Timoptic XE.
Travaprost eye drops 2.5 ml bottle only (Travatan)
Medication Category: Eyes, Ears and Nose
Preferred Drug List Status: On the preferred drug list without restrictions
Travatan is used for glaucoma. Bimatoprost (Lumigan) 2.5ml bottle only also remains on the preferred drug list. Lumigan and Travatan will meet most clinical needs and are less costly than other options.
Additions to the Preferred Drug List (Line Extensions)
Alendronate/Cholecalciferol combination (Fosamax Plus D)
Ipratropium HFA oral inhaler (Atrovent HFA) The CFC (chlorofluorocarbons) propellant has been replaced with an environmentally-friendly HFA (free of chlorofluorocarbons) aerosol in Atrovent HFA).
Prednisolone sodium phosphate oral solution (Orapred) A generic equivalent for Orapred is now available.
Sulfacetamide/Sulfur combination topical products (Clenia, Rosac and Rosula) Rosanil and a generic for Sulfacet-R lotion are also on the preferred drug list.
Sumatriptan (Imitrex) 25mg tablet All forms and strengths of Imitrex are on the preferred drug list.
Valacyclovir (Valtrex) 500mg All strengths of Valtrex are available on the preferred drug list.
Changes to the Preferred Drug List
Adalimumab (Humira) and Anakinra (Kineret) prior approval criteria have been modified. These drugs are now reserved for patients not responding to etanercept (Enbrel). Patients currently using Humira and Kineret have been grandfathered indefinitely. Transitions from Humira to Enbrel are suggested but not required. These medications are on the HealthPartners specialty drug list and must be obtained from CuraScript when self-administered (this does not apply to in-clinic administration). CuraScript can be reached at 877-696-5247.
Adefovir (Hepsera), for hepatitis B, is now available with a physician-edit. Prescribing is restricted to gastroenterology and infectious disease. Claims from providers with these specialty codes will process automatically without prior approval. These specialist providers are often more familiar with these medications (testing, treatment durations, and safety).
Cetirizine (Zyrtec and Zyrtec D) prior approval criteria have been modified. Zyrtec and Zyrtec D are now reserved for patients with significant allergy symptoms despite loratadine C/loratadine-D OTC AND fexofenadine (Allegra/Allegra-D) Patients currently using Zyrtec and Zyrtec D have been grandfathered. Transitions are suggested but not required. Loratadine/lortatadine-D OTC is preferred, and fexofenadine (Allegra/Allegra D) is available with prior approval for patients with significant allergy symptoms despite use of loratadine OTC products.
Zyrtec chewable tablets and syrup remain available for young children (there are no restrictions for children less than 2 years of age).
Loratadine OTC and Allegra products are safe and effective options for treating allergies and are less costly.
Cinacalcet (Sensipar) prior approval criteria have been modified. Sensipar is now reserved for prescribing by nephrologists and endocrinologists, and for dialysis patients with an excessive amount of parathyroid hormone (hyperparathyroidism) despite standard treatments.
Cyclosporine eye drops (Restasis), for dry eyes, is now available with a physician-edit. Prescribing is reserved for ophthalmologists and rheumatologists. Claims from providers with these specialty codes will process automatically without prior approval. Requests from other providers will be reviewed like a prior approval medication for severe cases unresponsive to other therapies that include Refresh Endura.
Duloxetine (Cymbalta) is now available with step therapy. It is reserved for (1) new start patients with an inadequate response to a preferred drug list generic SSRI medication (fluoxetine, citalopram, paroxetine hcl, paroxetine mesylate/Pexeva) or generic bupropion (Wellbutrin and Wellbutrin SR); and (2) patients previously stable on this medication. If there is a previous pharmacy claim for these antidepressants, Cymbalta prescriptions will process automatically without prior approval.
Cymbalta also has an indication for peripheral neuropathy. This use will be addressed at a future P&T Committee meeting. Current requests for this use or other unique situations and needs will be reviewed as preferred drug list exceptions.
Enfuvirtide (Fuzeon) is now available with a physician-edit. Prescribing is restricted to HIV provider specialists. Claims from providers with this specialty code will process automatically without prior approval. Requests from other providers will be reviewed as a preferred drug list exception. Fuzeon is on the HealthPartners specialty drug list and must be obtained from CuraScript when self-administered (this does not apply to in-clinic administration). CuraScript can be reached at 877-696-5247.
Efalizumab (Raptiva) prior approval criteria have been modified so that phototherapy is no longer required. It is now restricted: (1) for patients who have been diagnosed with severe psoriasis; AND (2) when prescribed by a dermatologist; AND (3) for patients who have tried and failed either UVB phototherapy or systemic therapy (methotrexate or cyclosporine or acitretin/Soriatane). Initial approval is for three months. Continued therapy is authorized for one-year intervals with documentation of improvement.
Raptiva is on the HealthPartners specialty drug list and must be obtained from CuraScript when self-administered (this does not apply to in-clinic administration). CuraScript can be reached at 877-696-5247.
Estradiol twice weekly patch (Estraderm, Vivelle & Vivelle DOT) Step therapy was removed and these estrogen replacement patches are now available on the preferred drug list without restrictions.
Estradiol/Norethindrone combination patch (Combipatch) Step therapy was removed and Combipatch is now available on the preferred drug list without restrictions.
Escitalopram (Lexapro) is now restricted as a step therapy medication. Lexapro is restricted for (1) new start patients who have tried and not responded to citalopram; or (2) patients previously stable on this medication. If there is a previous pharmacy claim for citalopram, Lexapro prescriptions will process automatically without prior approval. Unique patient situations requiring Lexapro as a first-line medication can be reviewed as a preferred drug list exception.
All patients currently using Lexapro have been grandfathered indefinitely. Transitioning patients from Lexapro to citalopram is encouraged if appropriate, but is not required, and will be supported with patient-specific letters to providers.
S-citalopram is very similar to citalopram (there are minimal differences in efficacy and tolerability) and generic citalopram is significantly less costly.
Etanercept (Enbrel) for Dermatology Use Prior approval criteria for dermatology use have been modified for so that phototherapy is no longer required. When prescribed for dermatology use, it is now restricted: (1) for patients who have been diagnosed with severe psoriasis; AND (2) when prescribed by a dermatologist; AND (3) for patients who have tried and failed either UVB phototherapy or systemic therapy (methotrexate or cyclosporine or acitretin/Soriatane).
Initial approval is for three months. Continued therapy is authorized for one-year intervals with documentation of improvement.
Enbrel is on the HealthPartners specialty drug list and must be obtained from CuraScript when self-administered (this does not apply to in-clinic administration). CuraScript can be reached at 877-696-5247.
Interferon beta-1a (Avonex) and interferon beta-1b (Betaseron) are now restricted as step therapy medications. They are restricted for patients with an inadequate response to interferon beta-1a (Rebif) AND glatiramer (Copaxone). All patients currently using Avones and Betaseron have been grandfathered indefinitely. Rebif and Copaxone remain on the preferred drug list without restrictions. Unique patient situations requiring Avonex and Betaseron can be reviewed as preferred drug list exceptions. All of these multiple sclerosis products are on the HealthPartners specialty drug list and must be obtained from CuraScript when self-administered (this does not apply to in-clinic administration). CuraScript can be reached at 877-696-5247.
Leflunomide (Arava) is now available with a physician-edit. Prescribing is restricted to rheumatology. Claims from providers with this specialty code will process automatically without prior approval. Arava has significant toxicities, and will be reserved for providers with the most experience in its use.
Memantine (Namenda) prior approval criteria have been modified to allow its use for patients with mild Alzheimers disease who do not tolerate Aricept.
Pegfilgrastim (Neulasta). Prior approval was removed and Neulasta is now available on the preferred drug list without restrictions. Neulasta is on the HealthPartners specialty drug list and must be obtained from CuraScript when self-administered (this does not apply to in-clinic administration). CuraScript can be reached at 877-696-5247.
Peginterferon (Pegasys) is now restricted as a prior approval medication for patients who have tried and failed Peg-Intron. Current patients have been grandfathered. Transitions to Peg-Intron are suggested but not required. Unique situations and needs for Pegasys can be reviewed as preferred drug list exceptions.
Peg-Intron remains on the preferred drug list with a physician-edit for gastroenterology and infectious disease providers. Claims from providers with these specialty codes will process automatically without prior approval. These specialist providers are more familiar with these medications (testing, treatment durations, and safety) and more often have infrastructure in place for monitoring therapy. Both Peg-Intron and Pegasys are on the HealthPartners specialty drug list and must be obtained from CuraScript when self-administered (this does not apply to in-clinic administration). CuraScript can be reached at 877-696-5247.
Simvastatin-Zocor/Ezetimibe-Zetia combination (Vytorin) Step therapy was removed and Vytorin is now available on the preferred drug list without restrictions. Zetia remains on the preferred drug list with step therapy to a statin.
Teriparatide (Forteo) prior approval criteria have been modified to allow its use for patients with severe osteoporosis (bone mineral density t-score less than minus 3.5). Forteo is on the HealthPartners specialty drug list and must be obtained from CuraScript when self-administered (this does not apply to in-clinic administration). CuraScript can be reached at 877-696-5247.
Venlafaxine (Effexor/Effexor XR) is now restricted as a step therapy medication. Effexor/Effexor XR is restricted for (1) new start patients with an inadequate response to a preferred drug list generic SSRI medication (fluoxetine, citalopram, paroxetine hcl, paroxetine mesylate/Pexeva) or generic bupropion (Wellbutrin and Wellbutrin SR); and (2) patients previously stable on this medication. If there is a previous pharmacy claim for these antidepressants, Effexor/Effexor XR prescriptions will process automatically without prior approval. Unique situations and needs for Effexor/Effexor XR can be requested as preferred drug list exceptions.
All patients currently using Effexor/Effexor XR have been grandfathered indefinitely.
DELETIONS FROM THE PREFERRED DRUG LIST
Dolasetron (Anzemet) has been deleted. Ondansetron (Zofran) remains on the preferred drug list with a quantity limit allowing for a 3 day supply.
Growth hormone (Humatrope) has been deleted. Patients currently receiving Humatrope have been grandfathered until September 30 to allow for transitions to preferred growth hormone products (Norditropin, Nutropin and Nutropin AQ). Growth Hormone is included on the HealthPartners specialty drug list and must be obtained from HealthPartners Riverside Pharmacy when self-administered (this does not apply to in-clinic administration). HealthPartners Riverside Pharmacy can be reached at 612-371-1641.
Latanoprost (Xalatan) has been deleted. Current patients have been grandfathered until September 30 to allow transitions to preferred drug list products bimatoprost/(Lumigan) and travaprost (Travatan). Transitions from Xalatan to preferred drug list products will be required (either a transition or a response indicating that Xalatan is medically necessary) with patient-specific letters mailed to providers.
Lumigan and Travatan will meet most clinical needs and are less costly than other options.
Levocabastine (Livostin) is no longer available on the market and has been deleted. Preferred allergy eye drops are azelastine (Optivar), cromolyn (Crolom), epinastine (Elestat), olopatadine (Patanol) and pemirolast (Alamast).
Lilly Insulins (Humulin NPH, Humulin R, Humulin 70/30, Humalog and Humalog Mix) have been deleted and replaced with Novo Nordisk insulins (Novolin NPH, Novolin R, Novolin 70/30, Novolog and Novolog Mix).
Patients using Humulin vials have been grandfathered until July 15. These products are equivalent and can be changed to Novolin vials at pharmacies.
Patients using Humalog, Humalog Mix and Humulin pens have been grandfathered until September 30 to allow for teaching and new prescriptions. Transitions from Lilly insulins to Novo Nordisk insulins will be required (either a transition or a response indicating that Lilly insulin is medically necessary) and will be supported with patient-specific letters mailed to providers and to patients notifying them of changes. The rapid-acting insulin analogs (Novologand Humalog) are similar but are not considered equivalent by the FDA. The kinetic profiles of Novolog and Humalog are nearly super-imposable. These products do have different pregnancy ratings (Humalog is pregnancy class B and Novolog is class C).
Humulin lente, ultralente and 50/50 remain on the preferred drug list. Insulin glargine (Lantus) also remains on the preferred drug list.
Lodoxamide (Alomide) has been deleted. Patients currently using Alomide have been grandfathered indefinitely. Transitions are encouraged but not required. Preferred allergy eye drops are azelastine (Optivar), cromolyn (Crolom), epinastine (Elestat), olopatadine (Patanol) and pemirolast (Alamast).
Ofloxacin tablets (Floxin) have been deleted. Unique situations requiring ofloxacin tablets can be reviewed as preferred drug list exceptions. Preferred drug list options are ciprofloxacin, moxifloxacin (Avelox) and levofloxacin (Levaquin).
Paroxetine hydrochloride controlled release (Paxil CR) has been deleted. All patients currently using Paxil CR have been grandfathered indefinitely. Paxil CR is also available for patients previously stable on Paxil CR and unique situations and needs for Paxil CR can be requested as a preferred drug list exception.
Transitioning patients from Paxil CR to preferred drug list paroxetine products is encouraged if appropriate, but is not required, and will be supported with patient-specific letters to providers.
Paxil CR is a controlled-release version of paroxetine hydrochloride. All forms of paroxetine are given once-daily and there are little or no differences in efficacy or tolerability. Paxil CR is significantly more costly than other forms of paroxetine. Preferred drug list paroxetine products are generic paroxetine hydrochloride and paroxetine mesylate (Pexeva) which will be processed as a generic option.
Rabeprazole (Aciphex) has been deleted. Unique situations and needs for Aciphex can be requested as preferred drug list exceptions.
All patients currently receiving Aciphex have been grandfathered until September 30. Transitions from Aciphex to preferred drug list products will be required (either a transition or a response indicating that Aciphex is medically necessary) with patient-specific letters mailed to providers.
The preferred proton-pump inhibitor is Prilosec OTC (omeprazole). Lansoprazole (Prevacid Solutabs) and pantoprazole (Protonix) are also available on the preferred drug list with step therapy to Prilosec OTC.
Tamsulosin (Flomax) has been deleted from the preferred drug list and replaced with alfuzosin (Uroxatral).
Unique situations and needs for Flomax can be reviewed as preferred drug list exceptions. Patients currently receiving Flomax have been grandfathered until September 30. Transitions to Uroxatral will be required (either a transition or a response indicating that Flomax is medically necessary) with patient-specific letters mailed to providers.
New Medications Reviewed But Not Added
Darifenacin (Enablex) for overactive bladder.
Hydromorphone extended-release (Palladone). Unique needs can be requested as a preferred drug list exception.
Solifenacin (Vesicare) for overactive bladder.
Trospium (Sanctura) for over active bladder.
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 contact 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.
|
|
|
|
|
|
