February 2010 Pharmacy Passages

February 2010

Innoviant's Business Committee meets monthly to evaluate product status (tier placements) and new prescription products approved by the Food and Drug Administration (FDA). Decisions made by the Innoviant Business Committee are based on information and recommendations provided by Prescription Solutions' National Pharmacy & Therapeutics Committee (NPTC). The NPTC is comprised of independent physician providers, affiliated plan physicians and pharmacists.

Change Summary Table

The following table provides an at-a-glance summary of the decisions made at the January committee meetings. Details about the products and decisions are further outlined in the "review details" section of this newsletter. All changes are effective April 1, 2010 unless otherwise noted.

TABLE KEY	Tier 3	DACON*
Δ Change + Addition - Deletion	Δ Prevpac	Adderall / Adderall XR amphetamine ER capsule amphetamine tablet amphetamine-dextroamphetamine ER capsule amphetamine-dextroamphetamine tablet Desoxyn Dexedrine dexmethylphenidate tablet dextroamphetamine sulfate ER dextroamphetamine tablet Dextrostat Focalin / Focalin XR Liquadd Metadate / Metadate CD / Metadate ER Methylin / Methylin chew / Methylin ER / Methylin sol methylphenidate ER tablet methylphenidate tablet Procentra Ritalin / Ritalin LA / Ritalin SR Strattera

KEY TO TIERS
TIER 1 = All Generics (One-tier standard plans cover ALL medications at the tier 1 copayment.) TIER 2= Preferred Brands (Multi-tiered standard plans cover tier 2 and tier 3 brand medications at the tier 2 copayment.) TIER 3 = Nonpreferred Brands (Closed plans do not cover tier 3 medications.) * As a result of the November committee meetings, listed items will be added to the DACON program or have revisions to the current limit already in place

Review Details The P&T committee performs evidence-based clinical reviews of new drugs, line extensions, drug classes, preferred products list (PPL) placements, generic alternatives and clinical programs. Tier placement and utilization management edits promote safe, cost-effective use of the product. Details relating to decisions outlined above are provided below.

	► PPL UPDATES Medications added to or removed from the PPL in order to provide the most cost-effective therapy in the category.	Standard Plan Tier 1 = all generics Tier 2 = all brands (OR Tier 1 = all medications)	Select Plan Tier 1 = all generics Tier 2 = preferred brands Tier 3 = nonpref. brands	Closed Plan Tier 1 = all generics Tier 2 = preferred brands
	Prevpac
	A therapy pack with three components (lansoprazole, amoxicillin, clarithromycin) used to treat patients with H. pylori infection and duodenal ulcer disease to eradicate infection with H. pylori and reduce the risk for duodenal ulcer recurrence. Removed from preferred status, Quantity Limit applies	Brand copay. Coverage is determined by the plan sponsor's chosen benefit design.	Third tier, nonpreferred brand copay. Coverage is determined by the plan sponsor's chosen benefit design.	Not covered.

	► CLINICAL PROGRAMS Review of medications for inclusion in DACON, prior authorization, quantity limits, specialty pharmacy, step therapy or other clinical programs.	Standard Plan Tier 1 = all generics Tier 2 = all brands (OR Tier 1 = all medications)	Select Plan Tier 1 = all generics Tier 2 = preferred brands Tier 3 = nonpref. brands	Closed Plan Tier 1 = all generics Tier 2 = preferred brands
	Review of Attention Deficit Hyperactivity Disorder ADHD medications in daily dose (DACON). . SPECIAL NOTE: As reported in the December 1 issue of Pharmacy Passages, a November class review for ADHD medications resulted in a decision to place a safety edit on all products in the therapeutic category. Edits are daily dose (DACON) edits based on maximum FDA approved doses. Edits are currently in place for Concerta, Daytrana, Intuniv, and Strattera.
	DACON for ADHD: amphetamine tablet, amphetamine-dextroamphetamine tablet, dexmethylphenidate tablet, dextroamphetamine tablet, dextroamphetamine sulfate ER capsule, Liquadd, Methylin tablet, Methylin ER, methylphenidate tab, methylphenidate ER tab
	Listed items will be added to the DACON program or have revisions to the current limit already in place, effective April 1, 2010.	Generic copay. Coverage is determined by the plan sponsor's chosen benefit design.	Generic copay. Coverage is determined by the plan sponsor's chosen benefit design.	Generic copay. Coverage is determined by the plan sponsor's chosen benefit design.
	DACON for ADHD: Amphetamine ER capsule, Amphetamine-Dextroamphetamine ER capsule, Desoxyn, Metadate CD, Ritalin LA
	Listed items will be added to the DACON program or have revisions to the current limit already in place, effective April 1, 2010.	Brand copay. Coverage is determined by the plan sponsor's chosen benefit design.	Second tier, preferred brand copay. Coverage is determined by the plan sponsor's chosen benefit design.	Second tier, preferred brand copay. Coverage is determined by the plan sponsor's chosen benefit design.
	DACON for ADHD: Adderall, Adderall XR, Dexedrine, Dextrostat, Focalin, Focalin XR, Methylin Chew, Methylin Sol, Procentra, Ritalin, Ritalin SR, Strattera
	Listed items will be added to the DACON program or have revisions to the current limit already in place, effective April 1, 2010.	Brand copay. Coverage is determined by the plan sponsor's chosen benefit design.	Third tier, non-preferred brand copay. Coverage is determined by the plan sponsor's chosen benefit design.	Not covered.