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 The HealthPartners Pharmacy and Therapeutics Committee updates the preferred drug list every three months. This listing represents changes implemented April 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
Albuterol HFA (Proventil® HFA, Ventolin® HFA and generic)
Medication Category: Respiratory Drugs
Preferred Drug List Status: On the preferred drug list without restriction
Added due to supply problems with regular albuterol (with CFC aerosol propellants) inhalers. Regular albuterol supply was expected to remain through 2008, but availability is now sporadic. The CFC aerosols will be replaced by environmentally-friendly CFC-free products. Regular albuterol inhalers are less costly and are preferred over albuterol HFA (CFC-free) products.
Deferasirox (Exjade®)
Medication Category: Miscellaneous Products
Preferred Drug List Status: On the preferred drug list with prior approval
Exjade® is restricted for use by hematology-oncology and for FDA-approved indications.
Deferasirox is an oral tablet used for treating chronic iron overload due to blood transfusions.
Metoproterenol (Alupent®) inhaler
Medication Category: Respiratory Drugs
Preferred Drug List Status: On the preferred drug list without restriction
Added due to supply problems with regular albuterol (CFC) inhalers. Regular albuterol inhalers are less costly and are preferred over Alupent®.
Omega-3 polyunsaturated fatty acids (Omacor®)
Medication Category: Cholesterol Lowering Drugs
Preferred Drug List Status: On the preferred drug list with step therapy
Omacor® is on the preferred drug list as a step therapy medication and reserved for patients who have had previous use of either gemfibrozil or fenofibrate, such as Tricor®.
Omega-3 fatty acids are derived from fish oil and are available as dietary supplements. Omacor® is a purified prescription form, used for treating high triglycerides (>= 500 mg/dL). Gemfibrozil also treats high triglycerides and is less costly. Prescribing information for Omacor is available at www.omacorrx.com.
Omeprazole 20mg
Medication Category: Gastrointestinal Drugs
Preferred Drug List Status: On the preferred drug list without restriction
Generic prescription omeprazole is now added to the preferred drug list (Prilosec OTC® has been preferred until now). Costs for generic prescription omeprazole have dropped and are now similar to Prilosec OTC®. Either omeprazole form can be used.
Oseltamivir (Tamiflu®)
Medication Category: Anti-Infectives
Preferred Drug List Status: On the preferred drug list without restriction
Tamiflu® has been added to the preferred drug list for influenza (flu) because of resistance concerns with amantadine and rimantadine. Careful use is needed to preserve the effectiveness of Tamiflu®. Treatment should be reserved for individuals in high risk categories. Using Tamiflu® for prevention may be appropriate for outbreaks in nursing homes and very high-risk individuals exposed to influenza. More information about influenza is available from the Centers for Disease Control (CDC) at www.cdc.gov/flu and from the Minnesota Department of Health at www.health.state.mn.us. Prescribing information for Tamiflu® is available at www.rocheusa.com.
Sorafenib (Nexavar®)
Medication Category: Cancer Drugs
Preferred Drug List Status: On the preferred drug list without restriction
Nexavar® is a new cancer drug for advanced renal cell carcinoma. It is a specialty medication with distribution limited to CuraScript Pharmacy.
Additions to the Preferred Drug List Line Extensions
Folic acid/ Vitamin B6/ Vitamin B12 (Foltx®) is added to the preferred drug list. A generic is available for Foltx®.
Galantamine ER (Razadyne ER) is an extended release form of galantamine now available on the preferred drug list with prior approval.
Changes to the Preferred Drug List
Quantity Limits. These medications will be limited to one tablet daily (starting on May 1st). An additional communication will be sent to patients who will be affected by this limit and to their providers.- Atorvastatin (Lipitor®)
- Simvastatin (Zocor®)
- Irbesartan (Avapro®)
- Irbesartan / HCTZ (Avalide®)Telmisartan (Micardis®)
- Telmisartan / HCTZ (Micardis® HCT)
Oxycodone CR (OxyContin® and generics) will be limited to #180 tablets per prescription (starting on May 1st) to help limit fraud and abuse. An additional communication will be sent to patients who will be affected by this limit and to their providers. Exceptions can be requested for unique patient needs requiring greater quantities.
Levothyroxine. HealthPartners is now encouraging lower-cost forms of levothyroxine (Levothroid and generics). Thyroid testing is recommended following any change in the formulation of levothyroxine. Adults should have labs checked within 6-12 weeks. Pediatric patients should be checked within 2-4 weeks.
Mircette / Kariva generic. Previously only brand-name Mircette® was covered. Generics for Mircette® are now preferred.
Tolterodine (Detrol® and Detrol® LA) and Oxybutynin XL (Ditropan® XL) step therapy criteria were changed. Both medications have an age-edit of 65 (no restrictions for individuals 65 years of age and over). For individuals less than age 65, both are reserved for patients having side effects with oxybutynin regular release or hyoscyamine. These medications are used for treating overactive bladder.
Deletions from the Preferred Drug List
none
Medications Reviewed But Not Added
BiDil® (hydralazine/ isosorbide dinitrate). BiDil® is approved for heart failure in black patients. Hydralazine and isosorbide are available on the preferred drug list.
Doxercalciferol (Hectorol®). Hectorol® is a vitamin D analog for hyperparathyroidism (high levels of parathyroid hormone) in patients with kidney disease. Calcitriol (Rocaltrol and generics) is available on the preferred drug list.
Iloprost (Ventavis®). Ventavis® is an inhalation solution for pulmonary arterial hypertension (high blood pressure in the lungs).
Lanthanum (Fosrenol®). Fosrenol® is a phosphate-binder for patients with end-stage renal disease. Calcium acetate (PhosLo®) and sevelamer (Renagel®) are available on the preferred drug list.
Paricalcitol (Zemplar®). Zemplar® is a vitamin D analog for hyperparathyroidism (high levels of parathyroid hormone) in patients with kidney disease. Calcitriol (Rocaltrol® and generics) is available 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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