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- Definitions
- Preferred Drug List Replacements
- Additions to the Preferred Drug List
- Deletions from the Preferred Drug List
- Medical Policy Changes
- Medications Reviewed but Not Added
- Legal Disclaimer
April 2009 Preferred Drug List (Formulary) Updates
The HealthPartners Pharmacy and Therapeutics Committee updates the preferred drug list every three months. This listing represents additions and changes implemented April 1, 2009 unless otherwise stated. All drug additions and changes are the same for the HealthPartners Medicare Drug Formulary unless otherwise stated in this Update.
This summary was written for health care providers and has been slightly modified for the general public.
Learn more about our HealthPartners preferred drug list, also available within the ePocrates database at no charge to users. The electronic ePocrates 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.
Visit www.healthpartners.com/medicare for additional information.
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.
Quantity Limit: This term means that a limit has been set on the amount of medication you will receive each time you fill a prescription for that medication.
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 amount. These brand medications will be deleted from the Medicare Formulary in 2009 pending CMS approval. Refer to the 2009 HealthPartners Medicare Formulary on our website to determine the current formulary status for these brands. Recent generics for preferred (formulary) products include:
Generic Update: Recently-available generics are listed below. Most members have a lower co-pay for generic medications.
- divalproex extended release (Depakote ER)
- divalproex sprinkle (Depakote Sprinkles)
- stavudine (Zerit)
Changes include:
- Effexor XR (venlafaxine extended release) will be deleted and replaced with a new Venlafaxine ER on June 1, 2009. See below for more information.
- Pantoprazole (Protonix) will be deleted on June 1, 2009. See below for more information.
- Allegra-D 12 hour and 24 hour will be deleted on July 1, 2009. See below for more information.
PREFERRED DRUG LIST (FORMULARY) REPLACEMENTS
ADD Venlafaxine ER & DELETE Effexor XR (venlafaxine extended release)
Medication Category: Mental Health Drugs - HealthPartners Preferred Drug List (Formulary)
Pychotherapeutic Agents - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list with step therapy
Effective Dates:
- HealthPartners Preferred Drug List (Formulary): ADD Venlafaxine ER June 1, 2009 and DELETE Effexor XR June 1, 2009.
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2009 Medicare Drug Formulary: ADD Venlafaxine ER July 1, 2009. DELETE Effexor XR pending CMS approval. Additional notice will be provided regarding the deletion of Effexor XR.
Members currently using Effexor XR will be grandfathered (no changes required), but will be encouraged to use Venlafaxine ER.
Venlafaxine is commonly used for depression. Venlafaxine ER is considered bioequivalent (by the FDA) when given with food, but changes will need a new prescription because the Venlafaxine ER and Effexor XR are available in different dosage forms (tablet instead of capsule). Effexor XR is a once-daily capsule form and Venlafaxine ER is a once-daily tablet form.
Venlafaxine ER is less costly than Effexor XR. Though Venlafaxine ER is also rated as a brand medication, HealthPartners will cover it under a member's generic benefit level.
Additional "Questions and Answers" are available at
www.healthpartners.com/files/46423.pdf .
ADDITIONS TO THE PREFERRED DRUG LIST (FORMULARY)
Dapsone gel (Aczone)
Medication Category: Dermatologic (Skin) Medications - HealthPartners Preferred Drug List (Formulary)
Skin and Mucous Membrane Agents, Miscellaneous - 2009 Medicare Drug Formulary
Effective Date: Effective Date: April 1, 2009
This medication will be displayed on 2009 Medicare Drug Formulary on June 1, 2009, but formulary coverage is effective April 1, 2009.
Preferred Drug List Status: On the preferred drug list with prior approval
This acne medication has been added with prior approval for patients with an inadequate response to tretinoin/Retin-A Micro or Differin.
Eltrombopag (Promacta)
Medication Category: Blood Modifiers - HealthPartners Preferred Drug List (Formulary)
Miscellaneous Therapeutic Agents - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list with prior approval
Effective Date: April 1, 2009
This medication will be displayed on 2009 Medicare Drug Formulary on May 1, 2009, but formulary coverage is effective April 1, 2009.
Promacta is added to the preferred drug list with prior approval and will be reserved for: (i) prescribing by hematology, and (ii) for FDA-approved uses, if medically necessary. Initial approvals are for two months, then once per year for patients with a positive response.
Promacta is FDA-approved for chronic idiopathic thrombocytopenia, a bleeding condition in which the blood doesnt clot as it should due to a low number of platelets. Promacta is considered a specialty medication by HealthPartners. SpecialtyScripts is the preferred specialty pharmacy vendor.
Rufinamide (Banzel)
Medication Category: Anticonvulsants - HealthPartners Preferred Drug List (Formulary)
Anticonvulsants - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list with prior approval
Effective Date: April 1, 2009
This medication will be displayed on 2009 Medicare Drug Formulary on May 1, 2009, but formulary coverage is effective April 1, 2009.
Banzel is added to the preferred drug list with prior approval and will be reserved for: (i) prescribing by neurology, and (ii) for FDA-approved uses, if medically necessary. Initial approvals are for three months, then once per year for patients with a positive response.
Banzel is FDA-approved for adjunctive treatment of seizures associated with Lennox-Gastaut syndrome, a form of epilepsy. Banzel is considered a specialty medication by HealthPartners. SpecialtyScripts is the preferred specialty pharmacy vendor.
Sacrosidase (Sucraid)
Medication Category: Miscellaneous Therapeutic Agents - HealthPartners Preferred Drug List (Formulary)
Enzymes - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list with prior approval
Effective Date: April 1, 2009 for HealthPartners Preferred Drug List (Formulary).
Sucraid is already on the 2009 Medicare Drug Formulary with prior approval.
Sucraid is added to the preferred drug list with prior approval and will be reserved for: (i) prescribing by providers specializing in genetics and metabolism, and (ii) for FDA-approved uses, if medically necessary. Initial approvals are for two months, then once per year for patients with a positive response.
There are currently no prescriber restrictions or coverage duration restrictions applied to Sucraid for the 2009 Medicare Drug Formulary.
Sucraid is FDA-approved for deficiency in the enzyme, sucrase. Sucraid is considered a specialty medication by HealthPartners. SpecialtyScripts is the preferred specialty pharmacy vendor.
Tetrabenazine (Xenazine)
Medication Category: Central Nervous System Drugs - HealthPartners Preferred Drug List (Formulary)
Central Nervous System Agents, Miscellaneous - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list with prior approval
Effective Date: April 1, 2009
This medication will be displayed on 2009 Medicare Drug Formulary on May 1, 2009, but formulary coverage is effective April 1, 2009.
Xenazine is added to the preferred drug list with prior approval and will be reserved for: (i) prescribing by neurology, and (ii) for FDA-approved uses, if medically necessary. Initial approvals are for three months, then once per year for patients with a positive response.
Xenazine is FDA-approved for the treatment of chorea (abnormal involuntary movement disorder) associated with Huntingtons disease, a hereditary degenerative disorder of the central nervous system. Xenazine is considered a specialty medication by HealthPartners. Xenazine has limited distribution and is available at only a few specialty pharmacies nationwide, including Caremark Rx Specialty Pharmacy.
DELETIONS FROM THE PREFERRED DRUG LIST
Fexofenadine-Pseudoephedrine (Allegra-D 12 hour and Allegra-D 24 hour)
Effective Date of Change:
- HealthPartners Preferred Drug List (Formulary): Allegra-D will be deleted on July 1, 2009.
- 2009 Medicare Drug Formulary: Allegra-D will be deleted pending CMS approval. Additional notice will be provided regarding this deletion.
Allegra-D is a costly combination product for allergies. Lower-cost options include over-the-counter products (not covered as a prescription benefit) such as loratadine, cetirizine, pseudoephedrine, loratadine-D, and cetirizine-D. Fexofenadine (generic Allegra) remains on the preferred drug list.
Members currently using Allegra-D will be asked to use preferred options. Members continuing to use Allegra-D may pay a higher co-pay.
Additional "Questions and Answers" are available at www.healthpartners.com/files/46422.pdf
Pantoprazole (Protonix)
Effective Date of Change:
- HealthPartners Preferred Drug List (Formulary): Pantoprazole/Protonix will be deleted on June 1, 2009. Members currently using pantoprazole are grandfathered through June 30, 2009.
- 2009 Medicare Drug Formulary: Pantoprazole & Protonix will be deleted pending CMS approval. Additional notice will be provided regarding this deletion.
Pantoprazole is a costly generic proton pump inhibitor (PPI). Preferred drug list options include omeprazole and Prevacid (lansoprazole). PPI medications have very similar effects.
Members currently using pantoprazole will be asked to use preferred drug list options (omeprazole or Prevacid). Members continuing to use pantoprazole may pay a higher co-pay.
Additional "Questions and Answers" are available at www.healthpartners.com/files/46424.pdf.
MEDICAL POLICY CHANGES
C1 inhibitor (Cinryze). A medical policy and coverage guidelines will be added, effective June 1, 2009. Prophylaxis with Cinryze will be reserved for: (i) prescribing by specialists, and (ii) FDA-approved uses, if medically necessary, and (iii) patients with significant symptoms inadequately controlled with androgen therapy. Initial approvals are for three months, then once per year for patients with a positive response.
Cinryze is an intravenous infusion, given every 3-4 days, for hereditary angioedema (swelling that occurs in the tissue just below the surface of the skin).
Rilonacept (Arcalyst). A medical policy and coverage guidelines will be added, effective June 1, 2009. Rilonacept will be reserved for: (i) prescribing by specialists, and (ii) FDA-approved uses, if medically necessary. Initial approvals are for two months, then once per year for patients with a positive response.
Rilonacept is FDA-approved for the treatment of Cryopyrin-Associated Periodic Syndromes, a hereditary inflammatory condition.
Plerixafor (Mozobil). A medical policy and coverage guidelines will be added, effective June 1, 2009. Mozobil will be reserved for: (i) prescribing by specialists, and (ii) FDA-approved uses, if medically necessary. Approvals are for the duration of the mobilization attempt.
Mozobil is FDA-approved to begin movement of hematopoietic stem cells prior to bone marrow transplantation.
MEDICATIONS REVIEWED BUT NOT ADDED
Bimatoprost (Latisse)
Latisse is FDA-approved to increase the growth of eyelashes. Latisse is considered a cosmetic medication by HealthPartners and is not covered.
Epiduo gel (benzoyl peroxide/ Differin)
Epiduo is a combination medication for acne. Significant advantages over the ingredients given separately have not been shown. Differin and benzoyl peroxide are available on formulary as separate agents. Benzoyl peroxide is also available over-the-counter without a prescription.
Fenofibrate ER (Trilipix)
Trilipix is FDA-approved for treatment of cholesterol, and also for use in combination with a statin (such as lovastatin, pravastatin, simvastatin or Lipitor). Fenofibrate is on the preferred drug list with step therapy both generically and the Tricor brand.
Tetrix cream
This barrier protection cream is FDA-approved for dermatitis, and also used for eczema. Many moisturizing creams and barrier products are available as over-the-counter products.
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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