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- Definitions
- Additions to the Preferred Drug List
- Changes to Preferred Drug List
- Medications Reviewed but Not Added
- Deletions from the Preferred Drug List
- Legal Disclaimer
July 2007 Preferred Drug List Updates
The HealthPartners Pharmacy and Therapeutics Committee updates the preferred drug list every three months. This listing represents additions and changes implemented July 1, 2007 unless otherwise stated. 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.
GENERIC UPDATE
Most members have a lower co-pay for generic medications. Members who choose to continue using brand-name medications when a generic is available may pay a higher co-pay. Recent generics for preferred drug list products include amlodipine (Norvasc®) and zolpidem (Ambien®).
Brands for the new generics listed above will be removed from the HealthPartners Medicare Formulary effective September 1, 2007. Members with Part D coverage will pay a higher amount for the brand.
ADDITIONS TO THE PREFERRED DRUG LIST
Aliskiren (Tekturna®)
Medication Category: Cardiovascular Drugs / Cardiovascular Agents for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list with prior approval
Tekturna® will be available for patients with an inadequate response or medical contraindications to an ACE inhibitor such as lisinopril AND an ARB medication such as Avapro® / Avalide® or Micardis® / Micardis HCT®.
Tekturna® is a renin-inhibitor, a new class of antihypertensive medications. Significant benefits over current products are not clear. Prescribing information is available at: http://www.pharma.us.novartis.com/product/pi/pdf/tekturna.pdf .
Budesonide oral inhaler (Pulmicort Flexhaler®).
Medication Category: Respiratory Drugs / Respiratory Tract Agents for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list without restriction
This inhaled steroid product for asthma has been re-formulated. The previous form (the Pulmicort Turbuhaler®) is being phased out. These two forms are not rated as equivalent by the FDA, and new prescriptions may be required. Prescribing information is available at: http://www.astrazeneca-us.com/pi/pulmicortfh.pdf.
Desogestrel / Ethinyl Estradiol (Cyclessa®)
Medication Category: Contraceptives (Oral & topical) / Hormonal Agents, Stimulant / Replacement / Modifying (Sex Hormones) for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list without restriction
This oral contraceptive is available generically with costs similar to other generic oral contraceptives.
Fenofibrate generics
Medication Category: Cholesterol Lowering Drugs / Cardiovascular Agents for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list with step therapy
Generic fenofibrate, a medication used for high cholesterol, is now on the preferred drug list with step therapy and is reserved for patients (i) who have previously tried gemfibrozil; or (ii) who are currently receiving a statin, such as lovastatin, simvastatin (Zocor®), atorvastatin (Lipitor®). Fenofibrate generics are available in 200mg, 134mg, 67mg capsules and 160mg or 54mg tablets.
Tricor®, also a fenofibrate product available as 145mg and 48mg tablets, will remain on the preferred drug list with the same step therapy criteria.
Lapatinib (Tykerb®)
Medication Category: Cancer Drugs / Antineoplastics (Cancer Drugs) for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list without restriction
Tykerb® is a new oncology medication and is FDA-approved for certain types of breast cancer.
Use of CuraScript (our specialty pharmacy provider) for filling prescriptions for Tykerb® is encouraged.
MoviPrep®
Medication Category: Gastrointestinal Drugs / Gastrointestinal Agents for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list without restriction
MoviPrep® is a bowel evacuation preparation similar to GoLytely® and generic CoLyte®.
Nifedipine immediate release
Medication Category: Obstetrical & Gynecological Drugs / Not Added to HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list with an age and gender edit
Nifedipine immediate release is added to the preferred drug list for women 45 years of age or less for the inhibition of pre-term labor. Nifedipine immediate release should not be used by patients with heart disease.
Nifedipine immediate release will not be added to the HealthPartners Medicare Formulary.
Olopatadine ophthalmic (Pataday®). Pataday® is added to the preferred drug list as a line extension to Patanol® which remains on the preferred drug list. Pataday® is a new once-daily form of Patanol® (given twice-daily) and is used for allergic conjunctivitis. Costs are similar.
Sitagliptin / Metformin combination (Janumet®)
Medication Category: Diabetes Products / Blood Glucose Regulators HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list with step therapy
Janumet®, a medication used for diabetes, is a combination of sitagliptin (Januvia®) and metformin (Glucophage®). Step therapy criteria are: Reserved for patients who have had an inadequate response to metformin OR Januvia® alone. Costs for Januvia® and Janumet® are similar.
CHANGES TO THE PREFERRED DRUG LIST
Adalimumab (Humira®). Prior approval criteria have been added to Humira® to address a new indication for Crohn's Disease. Humira® prior approval criteria are now as follows:
1. For Rheumatoid Arthritis and related disorders: Humira® is reserved for prescribing by rheumatologists for patients with an inadequate response to Enbrel®. Doses are limited to 40mg every other week. This specialty drug must be obtained through from CuraScript Pharmacy.
2. For Crohn's Disease: Humira® is reserved for prescribing by gastroenterology for patients with moderately to severely active Crohn's disease and for patients who have had an inadequate response to conventional therapy. Conventional therapy includes 5-ASA products, steroids, and immunomodulators (such as azathioprine, 6 mercaptopurine, cyclosporine, or methotrexate). This specialty drug must be obtained from CuraScript Pharmacy.
Duloxetine (Cymbalta®). Step therapy criteria have been changed to address a new indication for generalized anxiety disorder.
1. For depression and anxiety:
a. Cymbalta® is reserved as a step therapy medication to one of the following generic medications on the preferred drug list (i) a generic SSRI (such as citalopram, fluoxetine, paroxetine), or (ii) generic bupropion; or
b. Cymbalta® is available with prior approval for patients previously stable on this medication for depression and anxiety.
2. For diabetic peripheral neuropathic pain: Cymbalta® requires prior approval for patients who have tried and failed gabapentin and a tricyclic antidepressant.
For Medicare Part D, Cymbalta® is covered as follows:
For depression and anxiety:
a. Reserved for: (i) new start patients with an inadequate response to a preferred drug list generic SSRI medication or generic bupropion; or
b. Patients previously stable on this medication for depression and anxiety may continue therapy with Cymbalta®. In order for patients previously stable on Cymbalta® to continue therapy, providers must call for a prior approval to be entered.
Omega-3 polyunsaturated fatty acids. The brand name for this medication is changing, from Omacor® to Lovaza®, due to name confusion with another medication (Amicar®). Lovaza® will remain on the preferred drug list with the same step therapy criteria (reserved for patients who have had previous use of gemfibrozil or fenofibrate). Omacor®/Lovaza® is used for treating high triglycerides (>= 500 mg/dL).
Ondansetron (Zofran®). Ondansetron remains on the preferred drug list with a quantity limit allowing for a 3-days supply.
Prior approval criteria is being added to ondansetron to clarify that greater quantities are available for the following: (i) oncology uses that may require greater quantities; or (ii) hyperemesis gravidarum (severe nausea during pregnancy) when greater quantities are needed for patients with inadequate relief from other nausea medications such as metoclopramide, promethazine, prochlorperazine, and trimethobenzamide, or (iii) severe nausea for patients who have been hospitalized, or have received IV fluids. Smaller 1-2 week supplies are encouraged.
Sitagliptin (Januvia®). Januvia®, a medication for diabetes, will change to a status of on the preferred list with step therapy (previously on the preferred drug list with prior approval). Step therapy criteria are: reserved for patients who have previously tried metformin, a sulfonylurea or insulin. This change will take effect on July 1, 2007 for commercial members.
For Medicare Part D: Januvia® will change from prior approval to step therapy for Medicare Part D, effective September 1, 2007 pending approval from CMS for this change. Please refer to the 2007 HealthPartners Medicare Formulary on the website to determine the current HealthPartners Medicare Formulary status of Januvia®.
Zolpidem controlled release (Ambien CR®). Step therapy criteria will be added to Ambien CR®. Criteria are: reserved for patients who have tried zolpidem (generic for Ambien® regular release). This change will take effect on August 1, 2007 for commercial members.
Patients currently using Ambien CR® will be grandfathered which will allow them to continue using Ambien CR®. Patient letters will be sent noting lower costs for generic Ambien®.
For Medicare Part D: Step therapy will be added to Ambien CR® effective September 1, 2007 pending approval from CMS for this change. Please refer to the 2007 HealthPartners Medicare Formulary on the website to determine the current HealthPartners Medicare Formulary status of Ambien CR®.
MEDICATIONS REVIEWED BUT NOT ADDED
Carvedilol controlled release (Coreg CR®). Coreg CR® is a once-daily form of carvedilol, a drug most often used for treating heart failure. Coreg CR® is not more effective and does not have fewer side effects than regular release Coreg® (twice-daily form) which is expected generically later this year. Coreg CR® may be requested as a preferred drug list exception for unique situations.
Estradiol / Drospirenone (Angeliq®). Angeliq® is a new combination hormone replacement product. Significant advantages are not clear. Angeliq® may be requested as a preferred drug list exception for unique situations.
Mesalamine MMX (Lialda®). Lialda® is a once-daily form of mesalamine for ulcerative colitis. There is little or no data suggesting better effectiveness or fewer side effects, and Lialda® is more costly. Lialda® can be requested as a preferred drug list exception for unique situations such as significant compliance problems.
DELETIONS TO THE PREFERRED DRUG LIST
Quinine sulfate. Quinine is not recommended (by the FDA) for treating leg cramps because of limited effectiveness data and some safety concerns. This deletion will be take effect on August 1, 2007. Patients currently using quinine will be grandfathered until October 1st, and notification letters will be sent to providers and patients.
For Medicare Part D: Quinine was removed from the HealthPartners Medicare Formulary on February 1, 2007 because it is no longer a covered Part D medication.
Tegaserod (Zelnorm®). Zelnorm® was withdrawn from the market on March 30, 2007.
Trimethobenzamide suppositories. Trimethobenazmide suppositories are being withdrawn from the market because there is no data demonstrating effectiveness (per the FDA). This deletion will take effect on August 1, 2007.
For Medicare Part D: No change because trimethobenzamide suppositories have never been included on the Medicare HealthPartners.
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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