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- Definitions
- Generic Update
- Additions to the Preferred Drug List (Formulary)
- Deletions from the Preferred Drug List
- Medications reviewed but not added
- Legal disclaimer
The HealthPartners Pharmacy and Therapeutics Committee updates the preferred drug list every three months. This listing represents additions and changes implemented October 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.
Our HealthPartners preferred drug list information is available at www.healthpartners.com/formulary, and also 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.
The 2009 Medicare Drug Formulary is available at http://www.healthpartners.com/medicare-formulary/search.do and the 2010 Medicare Drug Formulary is available at http://www.healthpartners.com/medicare-formulary/medicare.do. Visit medicare.healthpartners.com/ 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.
- Nateglinide (Starlix), a medication used to reduce high blood sugar for patients with type 2 diabetes.
- Tacrolimus (Prograf), an immunosuppressant used for patients who have had an organ transplant.
More generic options are listed here .
Additions to the Preferred Drug List (Formulary)
Dronedarone (Multaq)
Medication Category: Heart Health - HealthPartners Preferred Drug List (Formulary)
Cardiac Drugs - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list with prior approval
Multaq is added to the preferred drug list with prior approval and will be reserved for prescribing by Cardiology for patients who have tried and failed or who have medical contraindications to first-line medications such as amiodarone, flecainide, sotalol, or propafenone.
Multaq is used to help maintain normal heart rhythms in patients with a history of atrial fibrillation or atrial flutter.
Effective Date: HealthPartners Preferred Drug List October 1, 2009
2009 Medicare Drug Formulary October 1, 2009
Lamotrigine ODT (Lamictal ODT)
Medication Category: Bipolar Disorder & Seizures/Epilepsy - HealthPartners Preferred Drug List (Formulary)
Anticonvulsants - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list with prior approval
Lamictal ODT is added to the preferred drug list with prior approval. Lamictal ODT will be reserved for patients with difficulty swallowing or has compliance concerns with lamotrigine immediate release tablets.
Lamotrigine is used for bipolar disease and seizures. Lamotrigine immediate release tablets are available generically and are preferred.
Effective Date: HealthPartners Preferred Drug List October 1, 2009
2009 Medicare Drug Formulary October 1, 2009
Miglustat (Zavesca)
Medication Category: Other - HealthPartners Preferred Drug List (Formulary)
Miscellaneous Therapeutic Agents - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list
Zavesca is an oral capsule used to treat patients with Gaucher's Disease.
Effective Date: HealthPartners Preferred Drug List October 1, 2009
2009 Medicare Drug Formulary This medication is already on the 2009 Medicare Drug Formulary with prior approval. Effective October 1, 2009, the prior approval will be removed.
Milnacipran (Savella)
Medication Category: Pain - HealthPartners Preferred Drug List (Formulary)
Psychotherapeutic Agents - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list with step therapy
Savella is added to the preferred drug list with step therapy and is reserved for patients who have tried and failed gabapentin in the previous 12 months. An accurate diagnosis of fibromyalgia using the American College of Rheumatology (ACR) or similar criteria is encouraged. Physical therapy consults and psychosocial evaluation are also encouraged before using Savella.
Effective Date: HealthPartners Preferred Drug List October 1, 2009
2009 Medicare Drug Formulary October 1, 2009
Octreotide immediate-release subcutaneous injection (Sandostatin)
Medication Category: Stomach/Gastrointestinal & Other - HealthPartners Preferred Drug List (Formulary)
Gastrointestinal Drugs, Miscellaneous & Miscellaneous Therapeutic Agents - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list
Sandostatin is used for acromegaly (too much growth hormone made by the pituitary gland) and gastrointestinal tumors.
Effective Date: HealthPartners Preferred Drug List October 1, 2009
2009 Medicare Drug Formulary This medication is already on the 2009 Medicare Drug Formulary with prior approval.
Effective October 1, 2009, the prior approval will be removed.
Prasugrel (Effient)
Medication Category: Heart Health & Platelet Inhibitor - HealthPartners Preferred Drug List (Formulary)
Antithrombotic Agents - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list with prior approval
Effient is added to the preferred drug list with prior approval and is reserved for prescribing by Cardiology for FDA-approved uses. Approvals will be for 15 months.
Effient is used to reduce the rate of thrombotic heart events in patients with acute coronary syndrome who are managed with percutaneous coronary intervention (PCI) such as insertion of a stent.
Effective Date: HealthPartners Preferred Drug List October 1, 2009
2009 Medicare Drug Formulary October 1, 2009
Tobramycin inhaled (TOBI)
Medication Category: Antibiotics - HealthPartners Preferred Drug List (Formulary)
Antibacterials - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list
TOBI is an inhaled antibiotic used in patients with cystic fibrosis.
Effective Date: HealthPartners Preferred Drug List - October 1, 2009
2009 Medicare Drug Formulary No change, TOBI is already on the 2009 Medicare Drug Formulary
Tretinoin oral (Vesanoid)
Medication Category: Cancer - HealthPartners Preferred Drug List (Formulary)
Antineoplastic Agents - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list
Vesanoid is an oral capsule used for certain types of acute promyelocytic leukemia.
Effective Date: HealthPartners Preferred Drug List October 1, 2009
2009 Medicare Drug Formulary No change, Vesanoid is already on the 2009 Medicare Drug Formulary
Deletions from the Preferred Drug List
Propoxyphene, Propoxyphene with Acetaminophen (Darvon, Darvon-N, Darvocet-N)
Propoxyphene is a pain medication with safety concerns by the FDA (www.fda.gov/Drugs/DrugSafety). Formulary options include:
non-steroidal anti-inflammatories (NSAIDs) such as ibuprofen, naproxen, diclofenac, ketorolac, etc., acetaminophen with codeine (Tylenol #3), hydrocodone with acetaminophen (Vicodin), oxycodone with acetaminophen (Percocet)
Effective Date: HealthPartners Preferred Drug List January 1, 2010. Additional notices will be sent to affected providers and members.
2009 Medicare Drug Formulary No change in 2009.
Acetic acid/ Hydrocortisone otic (Vosol HC)
Vosol HC is an ear drop used for otitis externa (an inflammation of the outer ear). Costs have increased significantly to approximately $100 per prescription. Alternatives include:
- generic ofloxacin (Floxin) ear drops
- generic Cortisporin otic (neomycin/ polymyxin/ hydrocortisone)
- generic Tobradex eye drops (tobramycin/ dexamethasone)
- Ciprodex otic and Cipro HC otic brand products
Effective Date: HealthPartners Preferred Drug List December 1, 2009. Additional notices will be sent to affected providers and members.
2009 Medicare Drug Formulary No change in 2009.
Medications reviewed but not added
Armodafinil (Nuvigil)
Besifloxacin (Besivance)
Certolizumab (Cimzia)
Coartem (artemether/ lumefantrine)
Amlodipine / Hydrochlorothiazide / Valsartan (Exforge HCT)
Golimumab (Simponi)
Lamotrigine XR (Lamictal XR)
Oxybutynin gel (Gelnique)
Tapentadol (Nucynta)
Tolvaptan (Samsca)
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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