April 2010 Pharmacy Passages

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

April 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 March committee meetings. Details about products and decisions are further outlined in the "review details" section of this newsletter. All changes are effective June 1, 2010 unless otherwise noted.


Table Key	Δ Change	• No Change	+ Addition	- Deletion


Tier 3 (Nonpreferred)	Tier 2 (Preferred)	Prior Authorization (PA)
+ Actemra*	Δ Avodart (eff. 4-1-10)	+ Actemra
Δ Alamast	Δ Lovaza (eff. 4-1-10)	+ Ampyra (eff. 3-8-10)
Δ Alocril	Δ Maxalt	+ Avastin*
Δ Alomide	Δ Maxalt MLT	+ Erbitux*
+ Ampyra (eff. 3-8-10)	Δ Valturna (eff. 4-1-10)	+ Folotyn* (eff. 5-1-10)
Δ Anzemet		+ Herceptin*
Δ Avastin*	Tier 1	+ Intron-A *
Δ Crolom	Δ Metadate ER tab 10 mg (eff. 4-1-10)	+ Novantrone*
Δ Elestat	Δ Metadate ER tab 10 mg (eff. 4-1-10)	+ Proleukin*
Δ Emadine		+ Revlimid
Δ Erbitux*	DACON	+ Rituxan*
Δ Herceptin*	+ Ampyra (eff. 3-8-10)	+ Thalomid
Δ Intron-A*	Δ Colcrys	+ Vectibix*
+ Intuniv 2, 3, 4 mg	+ Intuniv 2, 3, 4 mg
Δ Noritate	- Renvela (eff. 4-1-10)	Rx InStep
Δ Patanase	- Renvela Pak (eff. 4-1-10)	+ Victoza
Δ Proleukin*	+ Revlimid
Δ Reglan	+ Soriatane	Gender Edit
Δ Relpax	+ Thalomid	+ Vagifem
Δ Remeron SolTab
Δ Revlimid	*Specialty Pharmacy (SPP)	Quantity Limit (QL)
Δ Rituxan*	+ Actemra	Δ Anzemet
Δ Thalomid	+ fluconazole 100 mg/NaCl (eff. 4-1-10)	+ metoclopramide
Δ Vectibix*	+ fluconazole 100 mg/NaCl (eff. 4-1-10)	+ Reglan
+ Victoza	+ vancomycin 750 mg, 1, 5, 10 gm (eff. 4-1-10)	+ Retin-A Micro
	+ vancomycin 750 mg, 1, 5, 10 gm (eff. 4-1-10)	+ Victoza

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



	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. Specialty Program medications are limited to a 30 day supply.



Actemra (tocilizumab) Used to treat adults with moderately to severely active rheumatoid arthritis (RA) after at least one other medicine called a tumor necrosis factor (TNF) antagonist has been used and did not work well. Specialty Pharmacy Program (SPP) only Prior Authorization	N	2	3	0



	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. Specialty Program medications are limited to a 30 day supply.


	New Medications (non specialty)



Ampyra (dalfampridine) extended release tablets Used as a treatment to improve walking in patients with multiple sclerosis (MS). Prior Authorization DACON edit Effective March 8, 2010	N	2	3	0



Intuniv (guanfacine hcl SR 24HR tablet) 2 mg, 3 mg, 4 mg Used for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents aged 6 to 17 years old. Line extension (new strengths) DACON edit applies to all strengths	N	2	3	0



Soriatane (acitretin) 17.5 mg, 22.5 mg capsules Used for the treatment of severe psoriasis in adults. Line extension (new strengths) DACON edit applies to all strengths	PB	2	2	2



*Vagifem (estradiol vaginal tablet)* 10 mcg** Used in the treatment of atrophic vaginitis resulting from the estogen deficiency of menopause. Line extension (new strength) Gender Edit edit applies for all strengths (for use in females only)	PB	2	2	2



Victoza (liraglutide injection) A self-injectable prescription medicine that improves blood sugar (glucose) in adults with type 2 diabetes when used with a diet and exercise program. Rx InStep Program Quantity Limit	N	2	3	0



	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. Specialty Program medications are limited to a 30 day supply.


	Therapy Class Review: Abortive Antimigraine Agents ("Triptans")



sumatriptan (spray, tablets, injection) Used in the treatment of acute migraine. Generic products Quantity Limit	G	1	1	1



Maxalt, Maxalt-MLT, Zomig, Zomig ZMT Used in the treatment of acute migraine. Zomig, Zomig ZMT remain at preferred status Maxalt, Maxalt MLT added to preferred status Quantity Limit	PB	2	2	2



Amerge, Axert, Frova, Imitrex, Relpax Used in the treatment of acute migraine. Amerge, Axert, Frova, and Imitrex remain at nonpreferred status Relpax moved to nonpreferred status; current members utilizing products moving to nonpreferred status will receive tier change notification letter Quantity Limit	N	2	3	0



	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. Specialty Program medications are limited to a 30 day supply.


	Therapy Class Review: Nasal Antihistamines



Astepro 0.15%, Astepro 137 mcg Used to relieve the nasal symptoms of allergies. These products will remain at preferred status Quantity Limit applies	PB	2	2	2



Patanase Used to treat the nasal symptoms of allergies. Removed from preferred status; current members utilizing products moving to nonpreferred status will receive tier change notification letter Quantity Limit applies	N	2	3	0



	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. Specialty Program medications are limited to a 30 day supply.


	Therapy Class Review: Ophthalmic Anti-allergy Agents



azelastine hcl, cromolyn sodium Used to relieve the ocular symptoms of allergies. Generic products Quantity Limit (azelastine)	G	1	1	1



Pataday, Patanol Used to relieve the ocular symptoms of allergies. These products will remain at preferred status Quantity Limit	PB	2	2	2



Alamast, Alocril, Alomide, Bepreve, Crolom, Elestat, Emadine, Optivar Used to relieve the ocular symptoms of allergies. These products will remain at, or be moved to nonpreferred status; members currently utilizing products moving to nonpreferred status will receive tier change notification letter Quantity Limit	N	2	3	0



	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. Specialty Program medications are limited to a 30 day supply.


	Preferred Products List (PPL) Updates



Anzemet Used for the prevention of post-operative or chemotherapy related nausea and vomiting. Removed from preferred status; current members utilizing products moving to nonpreferred status will receive tier change notification letter Quantity Limit revised to allow 6 tablets per Rx for 50 mg and 3 tablets per Rx for 100 mg (currently 1 tablet / month for both)	N	2	3	0



Avodart (dutasteride) Used for the treatment of symptomatic benign prostatic hyperplasia (BPH) in men with an enlarged prostate. Added to preferred status (effective April 1, 2010) DACON edit	PB	2	2	2



Lovaza (omega-3-acid ethyl esters) Used to reduce triglyceride (TG) levels in adult patients with severe (≥500 mg/dL) hypertriglyceridemia. Moved to preferred status (effective April 1, 2010)	PB	2	2	2



*Metadate ER (methylphenidate ER tab)* 10 mg** Used to treat attention deficit and hyperactivity disorder (ADHD). Moved to generic status (effective April 1, 2010) DACON edit applies	G	1	1	1



Noritate (metronidazole) Cream 1% Used for the topical treatment of rosacea. Removed from preferred status; current members utilizing product will receive tier change notification letter	N	2	3	0



Reglan (metoclopramide) tablets and oral solution Used used in the treatment of gastrointestinal disorders such as nausea, vomiting, and diabetic gastroparesis. Long term use has been associated with an adverse effect known as tardive dyskinesia. Removed from preferred status due to availability of FDA approved generic equivalent products; current members utilizing products moving to nonpreferred status will receive tier change notification letter Added to Quantity Limits program: limited to 12 weeks of therapy per 180 days	N	2	3	0



Remeron SolTab (mirtazapine) Orally Disintegrating Tablets Used in the treatment of major depressive disorder (MDD). Removed from preferred status due to availability of FDA approved generic equivalent; current members utilizing products moving to nonpreferred status will receive tier change notification letter	N	2	3	0



Revlimid (lenalidomide) capsules Used in the treatment of multiple myeloma and for patients with myelodysplastic syndromes (MDS). Removed from preferred status; select plan members using product will receive a tier change notification letter; closed plan members using product will be grandfathered for continued use Quantity Limits Prior Authorization added (current utilizers grandfathered for continued use) DACON edit added	N	2	3	0



*Thalomid (thalidomide)* capsules** Used in the treatment of multiple myeloma and for erythema nodosum leprosum (ENL). Removed from preferred status;select plan members using product will receive a tier change notification letter; closed plan members using product will be grandfathered for continued use Quantity Limits Prior Authorization added (current utilizers grandfathered for continued use) DACON edit added	N	2	3	0



Valturna (aliskiren and valsartan) tablets A combination of a renin inhibitor and angiotensin receptor blocker (ARB) used for the treatment of hypertension. Added to preferred status (effective April 1, 2010) DACON edit	PB	2	2	2



	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. Specialty Program medications are limited to a 30 day supply.


	Utilization Management Program: DACON



Colcrys (colchicine) Used in the treatment of Familial Mediterranean Fever (FMF) and for the prophylaxis and treatment of gout flares. Members exceeding new limit will receive notification by letter DACON edit (Maximum daily dose is reduced from 4 tablets daily to 2 tablets daily. Authorization review available for members who have medical necessity for higher doses.)	N	2	3	0



Renvela, Renvela Pak (sevelamer carbonate) Used for the control of serum phosphorus in patients with chronic kidney disease (CKD) on dialysis. Removed from DACON program (effective April 1, 2010)	PB	2	2	2



	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. Specialty Program medications are limited to a 30 day supply.


	Utilization Management Program: Prior Authorization



Folotyn (pralatrexate injection) Used in the treatment of peripheral T-cell lymphoma. Specialty Pharmacy Program Added to Prior Authorization Program (effective May 1, 2010)	N	2	3	0



Novantrone (mitoxantrone) for injection Used in the treatment of multiple sclerosis, prostate cancer, and acute nonlymphocytic leukemia (ANLL) in adults. Specialty Pharmacy Program Added to Prior Authorization Program	N	2	3	0



	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. Specialty Program medications are limited to a 30 day supply.


	Utilization Management Program: Quantity LImits



metoclopramide oral solution, metoclopramide tablets, Generic products used in the treatment of gastrointestinal disorders such as nausea, vomiting, and diabetic gastroparesis. Long term use has been associated with an adverse effect known as tardive dyskinesia. Added to Quantity Limits program: limited to 12 weeks of therapy per 180 days	G	1	1	1



Retin-A Micro (tretinoin) Gel and Pump Used in the topical treatment of acne. Added to Quantity Limit program; members exceeding new limit will receive notification by letter	PB	2	2	2



	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. Specialty Program medications are limited to a 30 day supply.


	Clinical Program: Specialty Pharmacy



*Avastin (bevacizumab)* solution for IV infusion** Used in the treatment of breast cancer, colorectal cancer, glioblastoma, lung cancer, and renal cancer. Removed from preferred status; select plan members using product will receive a tier change notification letter; closed plan members using product will be grandfathered for continued use Specialty Pharmacy Program Prior Authorization added (current utilizers grandfathered for continued use)	N	2	3	0



Erbitux (cetuximab) solution for intravenous infusion Used in the treatment of head and neck cancer and colorectal cancer. Removed from preferred status; select plan members using product will receive a tier change notification letter; closed plan members using product will be grandfathered for continued use Specialty Pharmacy Program Prior Authorization added (current utilizers grandfathered for continued use)	N	2	3	0



fluconazole 100mg in NaCl 0.9% Used in the treatment of fungal infections. Added to Specialty Pharmacy Program (effective April1, 2010)	N	2	3	0



*Herceptin (trastuzumab)* IV infusion** Used for the treatment of HER2+ breast cancer. Removed from preferred status; select plan members using product will receive a tier change notification letter; closed plan members using product will be grandfathered for continued use Specialty Pharmacy Program Prior Authorization added (current utilizers grandfathered for continued use)	N	2	3	0



Intron-A (interferon alfa-2b, recombinant) for injection Used for the treatment of hairy cell leukemia, malignant melanoma, and follicular lymphoma. Removed from preferred status; select plan members using product will receive a tier change notification letter; closed plan members using product will be grandfathered for continued use Specialty Pharmacy Program Prior Authorization added (current utilizers grandfathered for continued use)	N	2	3	0



*Proleukin (aldesleukin)* for injection** Used in the treatment of metastatic melanoma and metastatic renal cancer. Removed from preferred status; select plan members using product will receive a tier change notification letter; closed plan members using product will be grandfathered for continued use Specialty Pharmacy Program Prior Authorization added (current utilizers grandfathered for continued use)	N	2	3	0



Reglan (metoclopramide) solution for injection Used used in the treatment of gastrointestinal disorders such as nausea, vomiting, and diabetic gastroparesis. Long term use has been associated with an adverse effect known as tardive dyskinesia. Removed from preferred status due to availability of FDA approved generic equivalent products; current members utilizing products moving to nonpreferred status will receive tier change notification letter Specialty Pharmacy Program Added to Quantity Limits program: limited to 12 weeks of therapy per 180 days	N	2	3	0



Rituxan (rituximab) injection for IV use Used in the treatment of non-Hodgkin's lymphoma (NHL), chronic lymphocytic leukemia (CLL), and rheumatoid arthritis (RA). Removed from preferred status; select plan members using product will receive a tier change notification letter; closed plan members using product will be grandfathered for continued use Specialty Pharmacy Program Prior Authorization added (current utilizers grandfathered for continued use)	N	2	3	0



vancomycin hcl for injection 750 mg, 1 gm, 5 gm, 10 gm An antibiotic used in the treatment of serious or severe infections caused by susceptible strains of of bacteria. Added to Specialty Pharmacy Program (effective April1, 2010)	N	2	3	0



Vectibix (panitumumab) solution for IV infusion Used in the treatment of metastatic colorectal cancer. Removed from preferred status; select plan members using product will receive a tier change notification letter; closed plan members using product will be grandfathered for continued use Specialty Pharmacy Program Prior Authorization added (current utilizers grandfathered for continued use)	N	2	3	0


	Special Announcement: Name change for Kapidex



	Takeda Pharmaceuticals announced March 4, 2010 that a proton pump inhibitor medication made by them for the treatment of acid reflux disease is getting a name change. Occurring in late April, 2010, brand name Kapidex (dexlansoprazole) will be changed to Dexilant. The chemical composition and formulation of the product will remain unchanged. The name change is meant to avoid confusion with similarly named products such as AstraZeneca’s prostate cancer drug Casodex (bicalutamide) and Actavis’ painkiller Kadian (morphine sulfate). Effective May 1, 2010 Innoviant brochures containing references to Kapidex will be updated to reflect the name change to Dexilant.