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- Definitions
- Generic Update
- Additions to the Preferred Drug List
- Preferred Drug List Changes
- Deletions from the Preferred Drug List
- Medications Reviewed but Not Added
- Legal Disclaimer
January 2010 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 January 1, 2010 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 2010 Medicare Drug Formulary is available at 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.
Generic Update: Recently available generics include:
- Lansoprazole (Prevacid) capsules, for stomach ulcers and gastroesophageal reflux disease (GERD). NOTE: Lansoprazole 15mg is also available over-the-counter.
- Valacyclovir (Valtrex), an antiviral medication.
- Azelastine eye drops (Optivar), for allergic conjunctivitis.
- Brimonidine eye drops 0.15% (Alphagan-P 0.15%), for glaucoma.
More generic options are listed at www.healthpartners.com/files/17758.pdf .
ADDITIONS TO THE PREFERRED DRUG LIST (FORMULARY)
Nystatin topical powder
Medication Category: Skin Conditions - HealthPartners Preferred Drug List (Formulary)
Anti-Infectives (Skin and Mucous Membrane) - 2010 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list with no restrictions
Nystatin topical powder is a low-cost generic topical antifungal medication.
Effective Date: HealthPartners Preferred Drug List January 1, 2010
2010 Medicare Drug Formulary No change, this medication was already on the 2009 Medicare Drug Formulary.
Vigabatrin (Sabril)
Medication Category: Seizures/Epilepsy - HealthPartners Preferred Drug List (Formulary)
Anticonvulsants - 2009 Medicare Drug Formulary
Preferred Drug List Status: On the preferred drug list with prior approval
HealthPartners Preferred Drug List: Sabril will be reserved for prescribing by Neurology for FDA-approved indications and for patients who have tried and failed other therapies.
2010 Medicare Drug Formulary - Sabril will be reserved for FDA-approved indications, not otherwise excluded from Part D, if medically necessary, and for new start patients with documented failure on two other formulary seizure medications such as carbamazepine, divalproex, levetiracetam, gabapentin, topiramate and others.
Sabril is a new anticonvulsant for refractory seizures and for infantile spasms.
Effective Date: HealthPartners Preferred Drug List January 1, 2010
2010 Medicare Drug Formulary January 1, 2010
PREFERRED DRUG LIST CHANGES
Acthar HP injection (corticotropin). Prior approval criteria have been modified, adding a requirement for trying steroids first. Steroids are effective and are much less costly.
When prescribed for infantile spasms, Acthar HP is reserved for prescribing by pediatric neurologists, and for patients with an inadequate response to steroids.
Effective Date: HealthPartners Preferred Drug List January 1, 2010
2010 Medicare Drug Formulary Acthar HP is not included on the 2010 Medicare Drug Formulary.
Zymar (gatifloxacin), Vigamox (moxifloxacin), Iquix (levofloxacin), AzaSite (azithromycin) eye drops.
HealthPartners Preferred Drug List: The physician edit for these anti-infective eye drops has been changed and now includes both ophthalmolgists AND optometrists. Prescriptions from ophthalmologists and optometrists will process automatically. Prescription claims from other providers will require prior approval and will be reviewed for medical necessity.
2010 Medicare Drug Formulary: There will be no physician edit for these medications.
Effective Date: HealthPartners Preferred Drug List January 1, 2010
2010 Medicare Drug Formulary January 1, 2010
Tamiflu (oseltamivir) and Relenza (zanamivir).
HealthPartners Preferred Drug List: Quantity limits were added in late October 2009 for these antiviral medication for influenza, following dosing recommendations from the CDC. Any unique needs will be managed as formulary exceptions.
Tamiflu 75mg, up to 10 capsules
Tamiflu 45mg, up to 10 capsules
Tamiflu 30mg, up to 20 capsules |
Tamiflu suspension, up to 75 milliliters
Relenza, up to 20 inhalations
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2010 Medicare Drug Formulary: The addition of a quantity limit for these medications is pending.
DELETIONS FROM THE PREFERRED DRUG LIST
Chlorpheniramine SR. Chlorpheniramine SR is being withdrawn from the market and no longer available on the HealthPartners Preferred Drug List or the 2010 Medicare Drug Formulary as of January 1, 2010.
Triamcinolone inhaler (Azmacort). Azmacort is being withdrawn from the market and no longer available on the HealthPartners Preferred Drug List or the 2010 Medicare Drug Formulary as of January 1, 2010.
MEDICATIONS REVIEWED BUT NOT ADDED
Asenapine (Saphris).
HealthPartners Preferred Drug List: Saphris was not added to the formulary.
2010 Medicare Drug Formulary: Saphris is on the formulary and will be reserved for FDA-approved indications, not otherwise excluded from Part D, if medically necessary, and for new start patients with documented failure on several other atypical antipsychotic medications such as Abilify, Geodon, Risperidone (Risperdal), Seroquel or Zyprexa.
The following medications have no significant advantages over current formulary options. Unique needs will be reviewed as formulary exceptions.
Acuvail 0.45% eye drops (ketorolac)
Bepreve (bepotastine eye drops)
Embeda (morphine/ naltrexone)
Extavia (interferon beta-1b)
Onglyza (saxagliptin)
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Onsolis (fentanyl buccal film)
Plan B One Step (levonorgestrel)
Ryzolt (tramadol multiphasic ER tablet)
Twynsta (telmisartan/ amlodipine)
Valturna (valsartan/ aliskiren)
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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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