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October 2007 Preferred Drug List Updates
- Definitions
- Additions to the Preferred Drug List
- Changes to the Preferred Drug List
- Medications Reviewed but Not Added
- Deletions from the Preferred Drug List
- Legal Disclaimer
October 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 October 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 who choose to continue using brand-name medications when a generic is available may pay a higher amount for the brand.
Recent generics for products on the preferred drug list (formulary) include:- Amlodipine/ Benazepril (Lotrel®), for hypertension. Generics are available for 2.5mg-10mg, 5 mg -10 mg, 5 mg -20 mg, and 10 mg -20 mg strengths. Generics are not yet available for 5 mg -40 mg and 10 mg -40 mg.
- Carvedilol (Coreg®), for congestive heart failure.
- Metoprolol succinate (Toprol® XL), for congestive heart failure. All strengths are now available generically.
- Terbinafine oral (Lamisil®), for fungal nail infections.
ADDITIONS TO THE PREFERRED DRUG LIST
Ambrisentan (Letairis®)
Medication Category: Respiratory Drugs & Cardiovascular Drugs / Respiratory Tract Agents & Cardiovascular Agents for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list with prior approval
Letairis® is restricted for its FDA-approved indication of pulmonary arterial hypertension (high blood pressure in the lungs.
Letairis® is considered a specialty drug and must be obtained from CuraScript. Members with Part D coverage are encouraged to obtain Letairis® from CuraScript.
Ethinyl Estradiol / Levonorgestrel (Lybrel®)
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
Lybrel® is an oral contraceptive for continuous use, without any hormone-free periods. Lybrel® does not offer clinical advantages over current products, but will be easier to use for patients needing continuous suppression. Costs are more than generic options, and most patients will pay a higher brand co-pay for Lybrel®.
Lisdexamfetamine (Vyvanse®)
Medication Category: Central Nervous System Drugs / Central Nervous System Agents for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list without restriction
Vyvanse® is used for treating attention deficit hyperactivity disorder (ADHD). Limited data suggests similar effectiveness and safety compared with other stimulant ADHD medications, and costs are also similar. Prescribing information is available at www.vyvanse.com/pdf/prescribing_information.pdf.
Rotigotine patch (Neupro®)
Medication Category: Parkinson's Drugs / Antiparkinson Agents for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list with prior approval and with a physician-edit.
Neupro®, a new once-daily patch, is reserved for patients with Parkinson's disease. No prior approval is needed when prescribed by a neurologist.
CHANGES TO THE PREFERRED DRUG LIST
None.
MEDICATIONS REVIEWED BUT NOT ADDED
Budesonide/ Formoterol (Symbicort®). Significant advantages of this oral inhaled combination steroid and bronchodilator product over current asthma products are not clear.
Levocetirizine (Xyzal®). Significant advantages of this antihistamine for allergies over current products are not clear. Alternatives include loratadine which is available over-the-counter, fexofenadine (generic Allegra®), and cetirizine (Zyrtec®). Zyrtec® is expected to move over-the-counter in late December of this year.
Fluticasone furoate nasal spray (Veramyst®). Significant advantages of this nasal steroid for allergies over current products are not clear. Generic fluticasone propionate nasal spray (Flonase®) is available on the preferred drug list.
Formoterol (Perforomist®). Significant advantages of this nebulization solution for chronic obstructive pulmonary disease (COPD) are not clear.
Arformoterol (Brovana®). Significant advantages of this nebulization solution for chronic obstructive pulmonary disease (COPD) are not clear.
Selegiline disintegrating tablet (Zelapar®). Significant advantages of this Parkinson's disease drug are not clear.
Retapamulin ointment (Altabax®). Significant advantages of this antibiotic ointment over current preferred drug products like mupirocin (Bactroban® generic) ointment are not clear.
DELETIONS FROM THE PREFERRED DRUG LIST
Omalizumab (Xolair®). Recent FDA warnings state that Xolair® should only be administered to patients in a healthcare setting under direct medical supervision. Patients requiring home administration can be reviewed as exceptions. Letters will be sent to both providers and patients affected by this change.
For Medicare Part D, Xolair® will be deleted from the preferred drug list in 2008 pending approval from CMS. Please refer to the HealthPartners Medicare Formulary on the website to determine the current HealthPartners Medicare Formulary status in 2008.
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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