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October 2006
The HealthPartners Pharmacy and Therapeutics Committee updates the preferred drug list every three months. This listing represents changes implemented October 1, 2006. 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 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.
ANNOUNCEMENT
Generic Update:
Generic simvastatin (Zocor®) is now available. Patients taking brand-name "statins" may be interested - most patients have a lower co-pay for generic medications.
Recent generics include: sertraline (Zoloft®) and venlafaxine immediate release tablets (Effexor® tablets only - NOT Effexor® XR), both for depression.
Generic clopidogrel (Plavix®), an antiplatelet drug to prevent strokes and heart attacks, became available in August but was removed from the market after a few days. Pharmacies can dispense all generic supply received prior to its removal from the market; however, the generic company may not distribute additional supplies. A final court decision is expected in January 2007 and it is possible a generic for Plavix may be delayed until 2011.
Generics expected soon include: Zofran® for nausea in December 2006 and Ambien® for sleep in April 2007.
ADDITIONS TO THE PREFERRED DRUG LIST
Atripla® (combination Efavirenz- Emtricitabine- Tenofovir)
Medication Category: Anti-Infectives / Antivirals for Medicare Part D
Preferred Drug List Status: On the preferred drug list without restriction
Atripla® is a new combination antiretroviral medication for HIV.
Budesonide oral (Entocort EC®)
Medication Category: Gastrointestinal Drugs / Gastrointestinal Agents for Medicare Part D
Preferred Drug List Status: On the preferred drug list with prior approval
Entocort EC® is restricted for ileocolonic Crohn's, lymphocytic colitis, and microscopic colitis.
Darunavir (Prezista®)
Medication Category: Anti-Infectives / Antivirals for Medicare Part D
Preferred Drug List Status: On the preferred drug list without restriction
Prezista® is a new antiretroviral medication for HIV.
Dasatinib (Sprycel®)
Medication Category: Cancer Drugs
Preferred Drug List Status: On the preferred drug list without restriction
Sprycel&3174; is a new oral treatment for leukemia.
Lubiprostone (Amitiza®)
Medication Category: Gastrointestinal Drugs / Gastrointestinal Agents for Medicare Part D
Preferred Drug List Status: On the preferred drug list with prior approval
Amitiza® is reserved for patients with significant symptoms of constipation despite use of two or more over-the-counter options and one or more prescription products. Initial approvals are for one month, then approved indefinitely for patients with a positive response.
Amitiza® appears effective and appropriate when other options have not worked. Monthly costs are about $150 and are significantly more than prescription (generic for Miralax® and lactulose) and over-the-counter options. Prescribing information is available at www.amitiza.com.
Oseltamivir (Tamiflu®)
Medication Category: Anti-Infectives / Antivirals for Medicare Part D
Preferred Drug List Status: On the preferred drug list without restriction
This antiviral medication is used to treat and prevent the flu. It is recommended by national guidelines due to resistance concerns with rimantadine and amantadine.
Rasagiline (Azilect®)
Medication Category: Parkinson's Drugs / Antiparkinson Agents for Medicare Part D
Preferred Drug List Status: On the preferred drug list with prior approval
Azilect® is restricted for patients with an inadequate response to selegiline (generic available) or with medical contraindications to selegiline.
Azilect® is a monoamine oxidase inhibitor used for Parkinson's disease. Significant advantages over selegiline (another monoamine oxidase inhibitor) are not clear and it is more costly than generic selegiline.
Selegiline patch (Emsam®)
Medication Category: Mental Health Drugs / Antidepressants for Medicare Part D
Preferred Drug List Status: On the preferred drug list with prior approval
Emsam® is restricted for patients: (1) with an inadequate response to several other antidepressants (at least three SSRIs such as citalopram, fluoxetine, Lexapro®, paroxetine or sertraline AND at least one SSNRI such as Cymbalta® or venlafaxine / Effexor® XR AND at least one other antidepressant such as bupropion, mirtazapine, phenelzine, or tranylcypromine); OR (2) previously stable on this medication.
Emsam® is indicated for the treatment of major depressive disorder and is available in a patch form.
Varenicline (Chantix®)
Medication Category: Smoking Cessation Products / Antidotes, Deterrents and Toxicologic Agents for Medicare Part D
Preferred Drug List Status: On the preferred drug list without restriction
Chantix® is a partial nicotine agonist used for smoking cessation.
Coverage is based on the member's smoking cessation benefit (usually covered for up to 180 days each year). Research data shows abstinence rates are slightly better than bupropion (Zyban®). The cost for Chantix® is 1.3 times more than the generic for Zyban®, and 1.8 times more than nicotine patches. Prescribing information is available at www.pfizer.com.
Yaz®
Medication Category: Obstetrical & Gynecological / Hormone Agents, Stimulant-Replacement-Modifying for Medicare Part D
Preferred Drug List Status: On the preferred drug list without restriction
Yaz® is an oral contraceptive similar to Yasmin® which is also on the preferred drug list.
Zanamivir (Relenza®)
Medication Category: Anti-Infectives / Antivirals for Medicare Part D
Preferred Drug List Status: On the preferred drug list with prior approval
This antiviral medication is used to treat and prevent the flu. It is recommended by national guidelines due to resistance concerns with rimantadine and amantadine.
ADDITIONS TO THE PREFERRED DRUG LIST (LINE EXTENSIONS)
Aripiprazole disintegrating tablet (Abilify Discmelt®). Abilify® now available in a disintegrating tablet dosage form (Abilify Discmelt®). This dosage form is added to the preferred drug list with the same prior approval criteria as other antipsychotic agents in the disintegrating tablet dosage form (Risperdal-M® and Zyprexa Zydis®). Abilify Discmelt® is restricted to: (1) new start patients with: (a) difficulty swallowing; or (b) compliance concerns; or (2) patients previously stable on this medication. Abilify®, Risperdal® and Zyprexa® oral swallow tablets are on the preferred drug list with no restrictions.
Epinephrine injection (Twinject®). Twinject® is a two-dose epinephrine injectable product available in an auto-injector device. EpiPen® & EpiPen® Jr. (epinephrine injection) auto-injectors are also available on the preferred drug list.
Fluticasone / Salmeterol (Advair HFA® inhalation aerosol). Advair Diskus® is also on the preferred drug list.
CHANGES TO THE PREFERRED DRUG LIST
Lansoprazole (Prevacid Solutab®). The step-therapy restriction has been removed for children less than or equal to nine years of age to allow easier access for younger children having difficulty swallowing tablets and capsules. For adults and children over age nine, Prevacid SoluTab® remains on the preferred drug list with step-therapy which includes prior use of omeprazole.
Raloxifene (Evista®). Prior approval restrictions have been removed. Evista® is now on the preferred drug list without restriction.
Evista® is FDA-approved for osteoporosis and new data supports a role for preventing breast cancer in high-risk women. Comparisons to tamoxifen are still unsettled, with differences in effects and side effects.
Tegaserod (Zelnorm®). The prior approval has been changed to: reserved for patients with significant symptoms of constipation despite use of two or more over-the-counter options and one or more prescription products. Initial approvals are for one month, then approved indefinitely for patients with a positive response.
MEDICATION REVIEWED BUT NOT ADDED
Insulin, inhaled (Exubera®). Exubera® is a new inhaled form of insulin. Effectiveness is similar to insulin in a subcutaneous injectable form. Exubera® has a unique side effect affecting lung function which requires monitoring. Significant advantages are not clear. Exubera® may have a role for patients with needle-phobias, but most patients learn and overcome their concerns with teaching and some experience.
Methylphenidate patch (Daytrana®). Daytrana® contains methylphenidate in a patch form for treating attention deficit hyperactivity disorder (ADHD). Significant advantages are not clear.
Dexmethylphenidate XR (Focalin XR®). Focalin® XR contains the d-isomer of methylphenidate in a long acting form for treating ADHD. Significant advantages are not clear.
Seasonique® (levonorgestrel/ ethinyl estradiol). This extended-cycle oral contraceptive is similar to Seasonale® for which a generic is now available.
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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