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- 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
The HealthPartners Pharmacy and Therapeutics Committee updates the preferred drug list every three months. This listing represents additions and changes implemented April 1, 2008 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
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 (formulary) products include:- pantoprazole (Protonix). Long-term supplies of this proton-pump inhibitor for GI ulcers and heart burn are uncertain due to on-going legal battles, but generics are currently available.
- ramipril capsules (Altace). Generic supplies of this ACE-inhibitor for hypertension are limited, but are expected to improve.
- alendronate tablets (Fosamax). Alendronate is a standard treatment for osteoporosis, used to prevent bone fractures.
ADDITIONS TO THE PREFERRED DRUG LIST
Aliskiren / Hydrochlorothiazide (Tekturna HCT)
Medication Category: Cardiovascular Drugs / Cardiovascular Agents for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list with prior approval
Tekturna HCT has been added as a line-extension to the preferred drug list (formulary) with the same prior approval criteria as Tekturna. Tekturna HCT is reserved for patients with an inadequate response or medical contraindications to an ACE-inhibitor (such as lisinopril, enalapril, captopril, benazepril) and an ARB medication (such as Avalide/Avapro or Micardis/Micardis HCT).
Etravine (Intelence)
Medication Category: Anti-Infectives / Antivirals for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list without restriction
Intelence is a new HIV medication used for patients with resistance to current treatments.
Lansoprazole capsules (Prevacid capsules)
Medication Category: Gastrointestinal Drugs / Gastrointestinal Agents for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list with step therapy
Prevacid capsules have been added as a line extension on the preferred drug list (formulary) with the same criteria as the Prevacid SoluTab. Prevacid is reserved for patients who have not responded to treatment with omeprazole.
Prevacid is a proton-pump inhibitor used for gastrointestinal ulcers and heartburn.
Nilotinib (Tasigna)
Medication Category: Cancer Drugs / Antineoplastics (Cancer Drugs) for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list without restriction
Tasigna is an oncology medication used for chronic myeloid leukemia (CML) for patients who are resistant to or who can no longer tolerate other medication options.
Sapropterin (Kuvan)
Medication Category: Miscellaneous Products / Therapeutic Nutrients/Minerals/Electrolytes for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list with prior approval
Kuvan is restricted for: (1) prescribing by specialists in the management of phenylketonuria (PKU), and (2) for patients with PKU and who have elevated phenylalanine levels despite a phenylalanine-restricted diet.
Initial requests will be approved for three months, then indefinitely for patients with a positive response.
Kuvan is a specialty medication and must be obtained from CuraScript. For Medicare Part D, CuraScript is preferred but not required.
Ursodiol (URSO Forte)
Medication Category: Gastrointestinal Drugs / Gastrointestinal Agents for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list without restriction
URSO Forte 500mg tablet is used for primary biliary cirrhosis. Although ursodiol capsule is available generically, some patients need this higher strength product.
CHANGES TO THE PREFERRED DRUG LIST
Lubiprostone (Amitiza)
Prior approval criteria for Amitiza has been changed to require prior use of only 2 other options. The new criteria is: reserved for patients with significant symptoms of constipation despite Miralax OTC and one other option. Initial approvals are for one month, then approved indefinitely for patients with a positive response.
MEDICATIONS REVIEWED BUT NOT ADDED
Nebivolol (Bystolic)
Significant advantages of this new beta-blocker for high blood pressure (hypertension) are not clear.
DELETIONS TO THE PREFERRED DRUG LIST
Rosiglitazone & Rosiglitazone combinations (Avandia, Avandamet, Avandaryl)
Due to safety concerns, products containing Avandia will be deleted from the preferred drug list.
From the Avandia Black Box Warning: A meta-analysis showed an increased risk of myocardial ischemic events such as angina or myocardial infarction. Other studies have not confirmed or excluded this risk. In their entirety, available data on the risk of myocardial ischemia are inconclusive.
HealthPartners has reviewed this class of medications and determined that a similar medication is available that has not been associated with this increased risk.
Avandia products will be deleted July 1, 2008. Patients currently using Avandia will be grandfathered through December 31, 2008, and will be asked to change to alternative medications (such as Actos). Exceptions can be requested for patients needing to stay on Avandia. Additional communications will be sent to affected providers and patients.
Pioglitazone (Actos) will remain on the preferred drug list with step-therapy. Step therapy criteria will remain the same which is reserved for patients with Type II diabetes who have previously tried metformin, or a sulfonylurea, or insulin.
Avandia products will be removed from the Commercial Preferred Drug List only on July 1, 2008. For Medicare Part D: Avandia, Avandamet and Avandaryl remain on the HealthPartners Medicare Formulary with step therapy.
Cetirizine (Zyrtec & Zyrtec-D)
Because all forms of Zyrtec and Zyrtec-D are now available as over-the-counter (OTC) products, they will be removed from the preferred drug list on April 1, 2008. For Medicare Part D: tablet forms will be deleted April 1, and Zyrtec syrup will be deleted pending approval from CMS. Please refer to the HealthPartners Medicare Formulary on the website to determine the current HealthPartners Medicare Formulary status for the syrup.
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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