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The HealthPartners Pharmacy and Therapeutics Committee updates the preferred drug list every three months. This listing represents changes implemented January 1, 2006.
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.
Additions to the Preferred Drug List
Entecavir (Baraclude®)
Medication Category: Anti-Infectives
Preferred Drug List Status: On the preferred drug list with physician-edit
Baraclude® is reserved for prescribing by Gastroenterology and Infectious Disease. Claims from these providers will process automatically without needing prior approval.
Baraclude® is indicated for chronic hepatitis B.
Exenatide (Byetta®)
Medication Category: Diabetes Products
Preferred Drug List Status: On the preferred drug list with prior approval
Byetta® is restricted for patients who have tried and failed metformin AND a sulfonylurea, or have medical contraindications to their use.
Byetta® is an injectable medication for diabetes. Prescribing information is
available.
Famotidine 20mg & 40mg swallow tablets and suspension only (Pepcid®)
Medication Category: Gastrointestinal Drugs
Preferred Drug List Status: On the preferred drug list without restriction
Famotidine tablet is available as a low-cost generic H2-blocker, like ranitidine and cimetidine.
Lutropin (Luveris®)
Medication Category: Obstetrical and Gynecological Drugs
Preferred Drug List Status: On the preferred drug list per member infertility benefits
Luveris® is an injectable medication for infertility. CuraScript is preferred for this specialty medication but is not required. CuraScript can be reached at 877-696-5247.
Menotropins (Menopur®)
Medication Category: Obstetrical and Gynecological Drugs
Preferred Drug List Status: On the preferred drug list per member infertility benefits
Menopur® is an injectable medication for infertility. CuraScript is preferred for this specialty medication but is not required. CuraScript can be reached at 877-696-5247.
Mometasone (Asmanex®)
Medication Category: Respiratory Drugs
Preferred Drug List Status: On the preferred drug list without restriction
Asmanex® is an oral inhaled steroid for asthma. Effects and costs appear similar to current options. Asmanex® is approved for once-daily dosing. Prescribing information is
available.
Nepafenac (Nevanac®)
Medication Category: Eyes, Ears and Nose
Preferred Drug List Status: On the preferred drug list without restriction
Nevanac® is a new non-steroidal anti-inflammatory eye drop indicated for pain and inflammation associated with cataract surgery.
Pregabalin (Lyrica®)
Medication Category: Anticonvulsants
Preferred Drug List Status: On the preferred drug list with prior approval
Lyrica® is reserved for: (1) Diabetic peripheral neuropathic pain for patients who have tried and failed a tricyclic antidepressant and gabapentin; and (2) Post-herpetic neuralgia for patients who have tried and failed gabapentin. There are no restrictions for Lyrica® when prescribed for seizures.
Lyrica® is similar to gabapentin (Neurontin®). Clinical advantages versus standard therapies have not been shown and Lyrica® is more costly. Prescribing information is
available.
Additions to the Preferred Drug List Line Extensions
Pioglitazone / Metformin combination (Actoplus Met®)
Medication Category: Diabetes Products
Preferred Drug List Status: On the preferred drug list with step therapy
Actoplus Met® is a combination product of pioglitazone (Actos®) and metformin (Glucophage®) used for diabetes. Actoplus Met® is on the preferred drug list as a step therapy medication and reserved for patients with Type II diabetes who have tried metformin or a thiazolidinedione (TZD) such as Actos® or Avandia®.
Changes to the Preferred Drug List (Prior Approvals, Step Therapy)
Duloxetine (Cymbalta®). Prior approval criteria have been added for use in diabetic peripheral neuropathic pain. Cymbalta® will be reserved for members who have tried and failed a tricyclic antidepressant and gabapentin.
Cymbalta® remains on the preferred drug list as a step therapy medication for depression and is reserved for patients with prior use of a generic SSRI antidepressant (fluoxetine, citalopram and paroxetine) or to generic bupropion, and for members previously stable on Cymbalta®. If there is a previous pharmacy claim for these antidepressants, then Cymbalta® prescriptions for depression will process automatically without needing prior approval.
Ropinirole (Requip®). The step therapy criteria are removed from Requip®. It is now on the preferred drug list without restriction. Requip® is used for Parkinson's and was recently approved also for the treatment of restless leg syndrome (RLS).
Deletions from the Preferred Drug List
Pemoline (Cylert®). Pemoline, a second-line medication for attention deficit hyperactivity disorder (ADHD), has been withdrawn from the market.
Medications Reviewed But Not Added
Bromfenac (Xibrom®). Xibrom® is a new non-steroidal anti-inflammatory eye drop indicated for pain and inflammation associated with cataract surgery. The preferred drug list non-steroidal anti-inflammatory eye drop alternatives are: Acular®/Acular LS® ophthalmic, Nevanac® ophthalmic and Voltaren® ophthalmic.
Ibandronate (Boniva®). Boniva® is a new once-monthly bisphosphonate medication for osteoporosis. The preferred drug list bisphosphonate alternative is Fosamax (Alendronate) which is available in a once-weekly and a once-daily dosage form.
Levoalbuterol inhaler (Xopenex HFA®). Xopenex HFA® is a beta-agonist (like albuterol) for asthma. Effects appear similar to albuterol which is available as a generic on the preferred drug list.
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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