February 2010 Pharmacy Passages

Pharmacy Passages: Your Source for Information About Changes to the Innoviant Preferred Products List

March 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). The committee makes decisions based on information and recommendations from Prescription Solutions^® National Pharmacy & Therapeutics (NP&T) Committee, which is comprised of independent physician providers, affiliated plan physicians and pharmacists.

Change Summary Table

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


Table Key	Δ Change	• No Change	+ Addition	- Deletion


Tier 2	DACON	Prior Authorization (PA)
Δ Avandamet (eff. 2-14-10)	+ Fanapt	+ Afinitor
Δ Avandaryl (eff. 2-14-10)	+ Gleevec	+ Euflexxa*
Δ Avandia (eff. 2-14-10)	+ Iressa	+ Fanapt
+ Welchol (for Oral Suspension)	+ Nexavar	+ Gleevec
	+ Sprycel	+ Hyalgan*
Tier 3	+ Sutent	+ Iressa
Δ Afinitor	+ Tarceva	+ Kalbitor*
Δ Colcrys	+ Tasigna	+ Nexavar
+ Fanapt	+ Torisel	+ Orthovisc*
Δ Hyalgan*	+ Tykerb	- Seroquel (eff. 4-1-10)
Δ Iressa	+ Votrient	+ Sprycel
+ Kalbitor*	+ Welchol (for Oral Suspension)	+ Supartz*
Δ Mirapex	+ Zolinza	+ Sutent
+ Oforta (eff. 3-1-10)		+ Synvisc*
Δ Optivar	Quantity Limits (QL)	+ Synvisc One*
Δ Prandin	+ Epiduo	+ Tarceva
Δ Pulmicort Respules	+ Gleevec	+ Tasigna
Δ Sprycel	+ Iressa	+ Torisel
+ Sumavel DosePro (eff. 3-1-10)	+ Nexavar	+ Treanda*
Δ Supartz*	+ Sprycel	+ Tykerb
Δ Sutent	+ Sumavel DosePro (eff. 3-1-10)	+ Votrient
Δ Tarceva	+ Sutent	+ Zolinza
Δ Tasigna	+ Tarceva
Δ Torisel	+ Tasigna	Rx InStep
+ Treanda*	+ Torisel	Δ Aciphex
Δ Trileptal	+ Tykerb	+ Byetta
Δ Valtrex	+ Votrient	Δ Prevacid
Δ Wellbutrin SR 200 mg	+ Zolinza	Δ Prevacid Solu-Tab
Δ Zolinza		Δ Prilosec
	*Specialty Pharmacy (SPP)**	Δ Protonix
RxOTC	• Euflexxa	Δ Zegerid
+ omeprazole delayed release tablets	• Hyalgan
+ omeprazole delayed release tablets	+ Kalbitor
	• Orthovisc
Contingent Therapy (CT)	• Supartz
- Byetta	• Synvisc
- Sprycel	• Synvisc One
	+ Treanda

Review Details

The NP&T Committee performs evidence-based clinical reviews of new products, line extensions, therapy classes, formulary placements, generic alternatives and clinical programs. Tier placement and utilization management edits promote safe, cost-effective use of products. Detailed information about the "Change Summary Table" is provided below.


	Table Key



	*Plan Design* Open = all generics at tier-1 and all brands at tier-2 (or all medications at tier-1) Select = generics at tier-1, preferred brands at tier-2 and nonpreferred brands at tier-3 Closed = generics at tier-1 and preferred brands at tier-2 (nonpreferred products are not covered or may require authorization for coverage)

	*PPL Status:* G = Generic PB= Preferred brand N = Nonpreferred brand		*Copay Tier:* 1 = Generic 2 = Brand/Preferred brand 3 = Nonpreferred brand 0 = Not covered/other


†Your plan's actual copays may differ from those indicated depending on your selected plan design; your selected plan design determines coverage and pharmacy provider(s).		Copay Tier^†



	Status	Open	Select	Closed


	New Specialty Medications Please note: If your plan includes the specialty pharamcy program (SPP), your members may get specialty products from Prescription Solutions^® Specialty Pharmacy for your plan's applicable copay. If your plan does not include the SPP, your members may get self-injectable specialty medications from retail pharmacies or specialty products may be covered under the medical plan.



Kalbitor (ecallantide) Used to treat sudden attacks of hereditary angioedema (HAE). Specialty Pharmacy Program (SPP) only Prior Authorization applies	N	2	3	0



*Treanda (bendamustine hcl)* for injection** Used to treat beta cell non-Hodgkin's lymphoma and chronic lymphocytic leukemia (CLL). Specialty Pharmacy Program (SPP) only Prior Authorization applies	N	2	3	0


†Your plan's actual copays may differ from those indicated depending on your selected plan design; your selected plan design determines coverage and pharmacy provider(s).		Copay Tier^†



	Status	Open	Select	Closed


	New Medications (non specialty)



Fanapt (iloperidone) An atypical antipsychotic agent used to treat schizophrenia in adults. Prior Authorization applies DACON edit applies	N	2	3	0



Oforta (fludarabine phosphate tablet) Oral chemotherapy agent used to treat beta cell chronic lymphocytic leukemia (CLL). Effective March 1, 2010	N	2	3	0



Sumavel™ DosePro™ (sumatriptan succinate) for subcutaneous injection A "triptan" agent used for the acute treatment of migraine attacks or cluster headache episodes. Quantity Limit applies Effective March 1, 2010	N	2	3	0



*Welchol (colesevelam HCl)* for oral suspension** Used to reduce LDL cholesterol in patients with primary hyperlipidemia and as an adjunct to diet and exercise to improve glycemic control in adult patients with type 2 diabetes mellitus. Line Extension of Welchol tablets DACON edit applies	PB	2	2	2


†Your plan's actual copays may differ from those indicated depending on your selected plan design; your selected plan design determines coverage and pharmacy provider(s).		Copay Tier^†



	Status	Open	Select	Closed


	Therapy Class Review: Intra-Articular Viscosupplements (used in the treatment of osteoarthritis)



Euflexxa, Orthovisc, Synvisc, Synvisc-One These products will be added to, or remain at, preferred status. Prior Authorization (PA) added, effective May 1, 2010. Current members utilizing these products will be grandfathered for continued use without PA. Specialty Pharmacy Program (SPP) only Prior Authorization applies	PB	2	2	2



Hyalgan, Supartz These products will remain at, or be moved to, nonpreferred status. Current members utilizing products moving to nonpreferred status will receive tier change notification letter. Prior Authorization(PA) added. Current members utilizing these products will be grandfathered for continued use without PA. Specialty Pharmacy Program (SPP) only Prior Authorization applies	N	2	3	0


†Your plan's actual copays may differ from those indicated depending on your selected plan design; your selected plan design determines coverage and pharmacy provider(s).		Copay Tier^†



	Status	Open	Select	Closed


	Therapy Class Review: Antineoplastics-Molecular Target Inhibitors (used in the treatment of cancer)



Gleevec, Nexavar, Tykerb These products will be added to, or remain at, preferred status. Prior Authorization (PA) added. Current members utilizing these products will be grandfathered for continued use without PA. DACON edit added to limit to maximum approved dosing schedule Quantity Limit added to a maximum of one month supply per dispensing. Notification letters will be mailed to members currently exceeding the new dispensing limits. Specialty Pharmacy Program (SPP) applies to Nexavar Prior Authorization DACON edit Quantity Limit	PB	2	2	2



Afinitor, Iressa, Sprycel, Sutent, Tarceva, Tasigna, Torisel, Votrient, Zolinza These products will remain at, or be moved to nonpreferred status. Select Plan members currently utilizing products moving to nonpreferred status will receive tier change notification letter. Closed Plan members currently utilizing products moving to nonpreferred status will be grandfathered for continued use. Prior Authorization (PA) added. Current members utilizing these products will be grandfathered for continued use without PA. DACON edit added to limit to maximum approved dosing schedule Quantity Limit added to a maximum of one month supply per dispensing. Notification letters will be mailed to members currently exceeding the new dispensing limits. Specialty Pharmacy Program (SPP) applies to Torisel Prior Authorization DACON edit Quantity Limit	N	2	3	0


†Your plan's actual copays may differ from those indicated depending on your selected plan design; your selected plan design determines coverage and pharmacy provider(s).		Copay Tier^†



	Status	Open	Select	Closed


	Preferred Products List (PPL) Updates



Avandamet (rosiglitazone maleate and metformin hcl) Used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus when dual therapy with a TZD and metformin is appropriate. Moved to preferred status, effective February 14, 2010. DACON edit applies	PB	2	2	2



Avandaryl (rosiglitazone maleate and glimepiride) Used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus when dual therapy with a TZD and a sulfonylurea is appropriate. Moved to preferred status, effective February 14, 2010. DACON edit applies	PB	2	2	2



Avandia (rosiglitazone maleate) Used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Moved to preferred status, effective February 14, 2010. DACON edit applies	PB	2	2	2



Colcrys (colchicine) Used in the treatment of Familial Mediterranean Fever (FMF) and gout. Removed from preferred status. DACON edit applies	N	2	3	0



*Mirapex (pramipexole dihydrochloride)* tablets** Used to treat the signs and symptoms of Parkinson's disease. Removed from preferred status due to availability of generic equivalent product.	N	2	3	0



*Optivar (azelastine hcl)* ophthalmic solution** Used to treat itching of eyes associated with allergic conjunctivitis. Removed from preferred status due to availability of generic equivalent product. Quantity limit	N	2	3	0



*Prandin (repaglinide)* tablets** Used as an adjunct to diet and exercise to improve glycemic control in patients with type 2 diabetes mellitus. Removed from preferred status. DACON edit applies	N	2	3	0



Pulmicort Respules (budesonide inhalation suspension) An inhaled corticosteroid used as maintenance treatment of asthma and as prophylactic therapy in children 12 months to 8 years of age. Removed from preferred status due to availability of generic equivalent product.	N	2	3	0



Trileptal (oxcarbazepine) suspension An anticonvulsant used as monotherapy or adjunctive therapy in the treatment of partial seizures in adults and children with epilepsy. Removed from preferred status due to availability of generic equivalent product.	N	2	3	0



*Valtrex (valacyclovir hcl)* tablets** An antiviral used in the treatment of shingles (herpes zoster) and for the treatment or suppression of genital herpes. Removed from preferred status due to availability of generic equivalent product.	N	2	3	0



*Wellbutrin SR 200 mg (buproprion SR)* tablet** Used in the treatment of major depressive disorder (MDD). Removed from preferred status due to availability of generic equivalent product.	N	2	3	0


†Your plan's actual copays may differ from those indicated depending on your selected plan design; your selected plan design determines coverage and pharmacy provider(s).		Copay Tier^†



	Status	Open	Select	Closed


	Utilization Management Program^‡: Contingent Therapy



Byetta (exenatide) Injection Used as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. Removed from Contingent Therapy program Added to Rx InStep Program	PB	2	2	2



Sprycel (dasatinib) tablets An oral medication used in the treatment of chronic myeloid leukemia and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). Not considered first-line treatment for either condition. Removed from Contingent Therapy program Added to Prior Authorization program	N	2	3	0


†Your plan's actual copays may differ from those indicated depending on your selected plan design; your selected plan design determines coverage and pharmacy provider(s).		Copay Tier^†



	Status	Open	Select	Closed


	Utilization Management Program^‡: Prior Authorization



*Seroquel (quetiapine)* 25 mg tablet** An atypical antipsychotic used in the treatment of schizophrenia. Removed from Prior Authorization Program, effective April 1, 2010.	PB	2	2	2


†Your plan's actual copays may differ from those indicated depending on your selected plan design; your selected plan design determines coverage and pharmacy provider(s).		Copay Tier^†



	Status	Open	Select	Closed


	Utilization Management Program^‡: Rx InStep - Proton Pump Inhibitors



Aciphex, Prevacid, Prevacid SoluTab, Prilosec, Protonix, Zegerid Used to supress gastric acid secretion in the treatment of ulcers and gastroesophageal reflux disease (GERD). Electronic step edit is being updated to require trial and failure of only two generic or preferred brand agents prior to use of nonpreferred agent. DACON edit applies	N	2	3	0


†Your plan's actual copays may differ from those indicated depending on your selected plan design; your selected plan design determines coverage and pharmacy provider(s).		Copay Tier^†



	Status	Open	Select	Closed


	Utilization Management Program^‡: Quantity LImits



Epiduo (adapalene-benzoyl peroxide gel) Used in the topical treatment of acne. Added to quantity limit program. Members exceeding new limit will be notified by letter. Quantity Limit	PB	2	2	2


	Rx OTC Program for Proton Pump Inhibitors



	Prilosec OTC, omeprazole delayed release tablets Non-branded and store brand omeprazole delayed release tablets will join Prilosec OTC as covered products in the Rx OTC Program, effective April 1, 2010. If Rx OTC is part of your plan design, a written prescription is required for covered over-the-counter (OTC) products.