|
|
|
|
April 2007
The HealthPartners Pharmacy and Therapeutics Committee updates the preferred drug list every three months. This listing represents changes implemented April 1, 2007. All drug additions and changes are the same for the HealthPartners Medicare 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 also available within the ePocrates database at no charge to users. This electronic 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.
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.
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.
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.
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
Several medications are now available as generics, and most members will pay a lower generic co-pay for these medications. Members who choose to continue using brand-name medications when a generic is available may pay a higher co-pay. Recent generics include:- azithromycin 1gm packs (Zithromax)
- bupropion extended release 300mg strength only (Wellbutrin XL). The 150mg strength is not available generically
- fentanyl 12.5mg patch (Duragesic). All strengths of Duragesic are now available generically.
- metronidazole vaginal gel (Metrogel Vaginal)
- ondansetron swallow tablet, solution and dissolve tablet (Zofran, Zofran ODT)
- oxybutynin extended release (Ditropan XL)
- paroxetine suspension (Paxil)
- potassium citrate (Urocit-K)
- propranolol sustained release (Inderal LA)
- sulfacetamide sodium lotion (Klaron)
- trimipramine (Surmontil) HealthPartners Medicare Formulary only
All brands for the new generics listed above will be removed from the HealthPartners Medicare Formulary effective July 1, 2007.
ADDITIONS TO THE PREFERRED DRUG LIST
Nefazodone
Medication Category: Mental Health / Antidepressants for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug with prior approval
Nefazodone, an antidepressant, is reserved for patients: (1) with an inadequate response to several other antidepressants (at least three SSRIs such as citalopram, fluoxetine, Lexapro, paroxetine or sertraline AND at least one SSNRI such as Cymbalta or venlafaxine / Effexor XR AND at least one other antidepressant such as bupropion, mirtazapine, phenelzine, or tranylcypromine); OR (2) previously stable on this medication.
Nefazodone is currently included on the HealthPartners Medicare Formulary with no restrictions. Prior approval criteria will be added effective July 1, 2007 for Medicare Part D.
Telbivudine (Tyzeka)
Medication Category: Anti-Infectives / Antivirals for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list with physician-edit
Tyzeka is reserved for prescribing by gastroenterologists and infectious disease specialists.
It is an antiviral medication used for treating chronic hepatitis B in adults.
Pioglitazone-Glimepiride (Duetact)
Medication Category: Diabetes Products / Blood Glucose Regulators for HealthPartners Medicare Formulary
Preferred Drug List Status: On the preferred drug list with step therapy
Duetact is reserved for patients who have tried a sulfonylurea or a TZD such as pioglitazone (Actos) or rosiglitazone (Avandia). It is a combination of pioglitazone (Actos) and glimepiride (Amaryl), used for diabetes. Costs are similar to the products given separately.
Paliperidone (Invega).
Medication Category: Antipsychotics for HealthPartners Medicare Formulary ONLY
Preferred Drug List Status: On the HealthPartners Medicare Formulary with prior approval
Invega, a recently FDA-approved antipsychotic medication, is reserved for: (1) new start patients who have tried and failed several other atypical antipsychotic medications (such as Abilify, Geodon, Risperdal, Seroquel and Zyprexa); or (2) patients previously stable on this medication. Efficacy data is limited, and there are no comparisons to currently-used products.
CHANGES TO THE PREFERRED DRUG LIST
Aprepitant (Emend) Emend is prescribed by oncologists to prevent nausea and vomiting and is now available on the preferred drug list without restrictions. Prior approval criteria has been removed.
HealthPartners Medicare Formulary: Prior approval medical criteria has been removed. However, a prior approval status will remain for Emend on the HealthPartners Medicare Formulary only for the purpose of determining coverage under Part B or Part D benefits. Emend is covered under Part B benefits if prescribed with dexamethasone and ondansetron within 48 hours of a chemotherapy treatment and is covered under Part D benefits for all other uses.
Sodium Chloride nebulization solution. HealthPartners Medicare Formulary Only: Prior approval will be added to sodium chloride nebulization solution only for the purpose of determining coverage under Part B or Part D benefits effective July 1, 2007.
MEDICATION REVIEWED BUT NOT ADDED
Nabilone (Cesamet). Cesamet is an oral cannabinoid used for refractory chemotherapy-induced nausea and vomiting. Unique situations requiring Cesamet can be requested as an exception to the preferred drug list.
Paliperidone (Invega). Paliperidone, a metabolite of risperidone (Risperdal), is a recently FDA-approved antipsychotic medication. Efficacy data is limited, and there are no comparisons to currently-used products. Unique situations requiring paliperidone can be requested as an exception to the preferred drug list and can be requested for patients currently receiving paliperidone. Please note above that Invega was added to the HealthPartners Medicare Formulary with prior approval.
DELETIONS TO THE PREFERRED DRUG LIST
None.
MEDICAL POLICIES
No updates.
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.
|
|
|
|
|
|
