HealthPartners.com - July 2008 Preferred Drug List Updates

July 2008 Preferred Drug List Updates

Definitions

Additions to the Preferred Drug List (Formulary)

Changes to the Preferred Drug List (Formulary)

Deletions from the Preferred Drug List (Formulary)

Legal Disclaimer

The HealthPartners Pharmacy and Therapeutics Committee updates the preferred drug list every three months. This listing represents additions and changes implemented July 1, 2008 unless otherwise stated. All drug additions and changes are the same for the HealthPartners Medicare Formulary unless otherwise stated in this update.

This summary was written for healthcare 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.

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

Generic Update: Most members have a lower copay for generic medications. Members who choose to continue using brand name medications when a generic is available may pay a higher copay. Recent generics for preferred (formulary) products include:

ropinirole (Requip), for Parkinson's disease and for restless legs
acarbose (Precose), for diabetes
bupropion XL (Wellbutrin XL) 150mg, for depression. All forms of bupropion are now available generically.

PREFERRED DRUG LIST (FORMULARY) REPLACEMENTS

Albuterol HFA. ADD Ventolin HFA. DELETE Proventil HFA.

ProAir HFA and Ventolin HFA will be the preferred albuterol HFA inhalers on the preferred drug list.

Albuterol inhalers containing CFCs will remain on the preferred drug list (formulary) only until December 31, 2008, at which time they will be removed from the market due to a government-mandated change intended to reduce chlorofluorocarbons (CFCs) which can be harmful to the earth's ozone layer.

Commercial Drug Formulary – Add Ventolin HFA July 1, 2008. Delete Proventil HFA after appropriate notifications (no prescriptions will be allowed starting August 1, 2008). Albuterol HFA replacements are often done by pharmacies, without requiring a new prescription.

HealthPartners Medicare Formulary – Add Ventolin HFA January 1, 2009. Proventil HFA will remain non-formulary. ProAir HFA will remain on the HealthPartners Medicare Formulary as the only albuterol HFA product until January 1, 2009.

Growth Hormone. ADD Omnitrope. DELETE Nutropin and Nutropin AQ.

Preferred growth hormones are Norditropin and Omnitrope.

Commercial Covered Growth Hormone Products – Add Omnitrope to the preferred list of covered growth hormone products on July 1, 2008. Nutropin and Nutropin AQ will be deleted after appropriate notifications (no new patients starting September 1, 2008). Patients currently using Nutropin will be grandfathered through December 31, 2008, to allow changes and teaching at a scheduled appointment.

HealthPartners Medicare Formulary – Add Omnitrope January 1, 2009. Delete Nutropin and Nutropin AQ on December 31, 2008. Additional notifications will be sent to affected members.

Infertility. ADD Follistim AQ (follitropin beta). DELETE Gonal-F (follitropin alpha).

The preferred follitropin product is Follistim AQ.

Commercial Covered Infertility Products – Follistim AQ will be added to the preferred list of covered infertility products on July 1, 2008. Gonal-F will be deleted after appropriate notifications (no new patients starting September 1, 2008). Patients currently using Gonal-F will be grandfathered through February 2009 to allow patients to finish therapy, with no changes required.

HealthPartners Medicare Formulary – No changes, infertility treatments are excluded from coverage under Part D.

Nasal Steroids. ADD Veramyst (fluticasone furoate). DELETE Rhinocort AQ (budesonide).

Generic fluticasone (Flonase), Nasonex (mometasone), and Veramyst (fluticasone furoate) are the preferred nasal inhaled steroids on the preferred drug list.

Exceptions for Rhinocort AQ can be requested if medically necessary (e.g. during pregnancy).

Commercial Drug Formulary – Add Veramyst July 1, 2008. Delete Rhinocort AQ after appropriate notifications (no new patients starting September 1, 2008). Current members will be grandfathered through September 30, 2008, to allow for notifications and consideration of preferred products.

HealthPartners Medicare Formulary – Add Veramyst January 1, 2009. Delete Rhinocort AQ January 1, 2009. Additional notifications will be sent to affected members.

ADDITIONS TO THE PREFERRED DRUG LIST (FORMULARY)

Azithromycin eye drops (AzaSite)

Medication Category:

Eyes, Ears and Nose
Ophthalmic Agents (Eye Preparations) for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list with a physician-edit.

AzaSite is an antibiotic eye drop which is reserved for prescribing by ophthalmologists.

Commercial Drug Formulary – Add with a physician-edit July 1, 2008.
HealthPartners Medicare Formulary – Add with a physician-edit January 1, 2009.

Brimonidine/ Timolol combination eye drops (Combigan)

Medication Category:

Eyes, Ears and Nose
Ophthalmic Agents (Eye Preparations) for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list without restriction

Combigan is a combination eye drop used for glaucoma.

Commercial Drug Formulary – Add July 1, 2008.
HealthPartners Medicare Formulary – Add July 1, 2008.

Bromfenac eye drops (Xibrom)

Medication Category:

Eyes, Ears and Nose
Ophthalmic Agents (Eye Preparations) for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list without restriction

Xibrom is an anti-inflammatory eye drop used during eye surgery.

Commercial Drug Formulary – Add July 1, 2008.
HealthPartners Medicare Formulary – Add July 1, 2008.

Budesonide/ Formoterol combination (Symbicort)

Medication Category:

Respiratory Drugs
Respiratory Tract Agents for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list without restriction

Symbicort, a combination bronchodilator and corticosteroid medication for inhalation, is used for treating asthma. Like Advair, Symbicort should only be used for patients not adequately controlled on other asthma-controller medications (e.g., low to medium dose inhaled corticosteroids) or whose disease severity clearly indicates the start of treatment with two maintenance therapies is needed.

Commercial Drug Formulary – Add July 1, 2008.
HealthPartners Medicare Formulary – Add July 1, 2008.

Carvedilol controlled release (Coreg CR)

Medication Category:

Cardiovascular Drugs
Cardiovascular Agents for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list with step-therapy

Coreg CR will be reserved for patients who have had an inadequate response to generic carvedilol regular release.

Commercial Drug Formulary – Add with step-therapy July 1, 2008.
HealthPartners Medicare Formulary – No changes. Coreg CR is already on the HealthPartners Medicare Formulary with step-therapy.

Ciclopirox nail lacquer (Penlac)

Medication Category:

Dermatologic Medications
Dermatological Agents (Skin Products) for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list without restriction

Penlac is used for treating fungal infection of the nails (onychomycosis) and is now available as a low-cost generic product.

Commercial Drug Formulary – Add July 1, 2008.
HealthPartners Medicare Formulary – Change from "formulary with prior approval" to "formulary with no restrictions" on July 1, 2008.

Clobetasol emulsion foam (Olux-E)

Medication Category:

Dermatologic Medications
Dermatological Agents (Skin Products) for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list with prior approval

Olux-E foam is reserved for patients who have tried and failed other potent topical steroids on the preferred drug list.

Commercial Drug Formulary – Add with prior approval July 1, 2008.
HealthPartners Medicare Formulary – No changes. Olux-E is already on the HealthPartners Medicare Formulary with prior approval.

Dalteparin (Fragmin)

Medication Category:

Blood Modifiers
Blood Products/Modifiers/Volume Expanders for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list with a quantity limit

Fragmin is added to the formulary with a quantity limit of 14 days. The 14 day quantity limit is intended to encourage transitions to oral warfarin. Exceptions can be requested for patients needing longer therapy (e.g. during pregnancy, and for oncology patients).

Enoxaparin (Lovenox) and fondaparinux (Arixtra) are also on the preferred drug list with a quantity limit of 14 days.

Commercial Drug Formulary – Add with a quantity limit July 1, 2008.
HealthPartners Medicare Formulary – Add with a quantity limit on January 1, 2009.

Dexmethylphenidate (Focalin XR)

Medication Category:

Attention Deficit / Hyperactivity Disorder (ADHD) Drugs
Central Nervous System Agents for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list with step-therapy

Focalin XR is reserved for patients with an inadequate response to Concerta for treating attention deficit / hyperactivity disorder (ADHD). Concerta is the preferred long-acting methylphenidate product for ADHD on the preferred drug list.

Commercial Drug Formulary – Add with step-therapy July 1, 2008.
HealthPartners Medicare Formulary – Add with step-therapy July 1, 2008.

Dutasteride (Avodart)

Medication Category:

Miscellaneous Products
Genitourinary Agents for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list without restriction

Avodart provides another option for treating enlargement of the prostate (benign prostatic hypertrophy or BPH). Finasteride (generic Proscar) remains on the preferred drug list with no restrictions.

Commercial Drug Formulary – Add July 1, 2008.
HealthPartners Medicare Formulary – Add July 1, 2008.

Flunisolide nasal spray (Nasarel)

Medication Category:

Respiratory Drugs
Respiratory Tract Agents for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list without restriction

Flunisolide nasal spray (generic for Nasarel) provides another low-cost generic nasal steroid spray for allergic rhinitis. Fluticasone nasal spray (generic for Flonase), Nasonex (mometasone), and Veramyst (fluticasone furoate) are also on the preferred drug list.

Commercial Drug Formulary – Add July 1, 2008.
HealthPartners Medicare Formulary – Add July 1, 2008.

Fondaparinux (Arixtra)

Medication Category:

Blood Modifiers
Blood Products/Modifiers/Volume Expanders for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list with a quantity limit

Fragmin is added to the formulary with a quantity limit of 14 days. The 14 day quantity limit is intended to encourage transitions to oral warfarin. Exceptions can be requested for patients needing longer therapy (e.g. during pregnancy, and for oncology patients).

Enoxaparin (Lovenox) and dalteparin (Fragmin) are also on the preferred drug list with a quantity limit of 14 days.

Commercial Drug Formulary – Add with a quantity limit July 1, 2008.
HealthPartners Medicare Formulary – Add with a quantity limit on January 1, 2009.

Levofloxacin (Iquix)

Medication Category:

Eyes, Ears and Nose
Ophthalmic Agents (Eye Preparations) for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list with a physician-edit.

Iquix is an antibiotic eye drop which is reserved for prescribing by ophthalmologists.

Commercial Drug Formulary – Add with a physician-edit July 1, 2008.
HealthPartners Medicare Formulary – Add with a physician-edit January 1, 2009.

Retapamulin (Altabax)

Medication Category:

Dermatologic (Skin) Medications
Dermatological Agents (Skin Products) for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list with step-therapy

This topical antibiotic will be reserved for patients with an inadequate response to generic mupirocin ointment (generic for Bactroban).

Commercial Drug Formulary – Add with step-therapy July 1, 2008.
HealthPartners Medicare Formulary – Add with step-therapy July 1, 2008.

Risedronate (Actonel)

Medication Category:

Osteoporosis Drugs
Metabolic Bone Disease for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list with step-therapy

Actonel, a bisphosphonate used for treating osteporosis, will be reserved for patients who have tried and failed generic alendronate. Alendronate (generic for Fosamax) is the preferred bisphosphonate on the preferred drug list for treating osteoporosis.

Commercial Drug Formulary – Add with step-therapy July 1, 2008. Patients currently using Actonel will be grandfathered (no changes required).
HealthPartners Medicare Formulary – Add with step-therapy January 1, 2009. Patients currently using Actonel will be grandfathered (no changes required).

Sevelamer (Renvela)

Medication Category:

Miscellaneous Products
Genitourinary Agents for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list without restriction

Renvela is used to treat high concentration of phosphates in the blood (hyperphosphatemia) for patients on dialysis. Renagel, also a sevelamer product, is also on the preferred drug list.

Commercial Drug Formulary – Add July 1, 2008.
HealthPartners Medicare Formulary – Add July 1, 2008.

Tamsulosin (Flomax)

Medication Category:

Miscellaneous Products
Genitourinary Agents for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list without restriction

Flomax provides another option for treating enlargement of the prostate (benign prostatic hypertrophy or BPH). Uroxatral (alfuzosin) remains on the preferred drug list with no restrictions.

Commercial Drug Formulary – Add July 1, 2008.
HealthPartners Medicare Formulary – Add January 1, 2009.

Trospium (Sanctura and Sanctura XR)

Medication Category:

Miscellaneous Products
Genitourinary Agents for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list without restriction

Sanctura provides a second option for overactive bladder on the preferred drug list. Tolterodine (Detrol and Detrol LA) remains on preferred drug list with no restrictions.

Commercial Drug Formulary – Add July 1, 2008.
HealthPartners Medicare Formulary – Add January 1, 2009.

Vancomycin injection

Medication Category:

Anti-Infectives
Antibacterials for HealthPartners Medicare Formulary

Preferred Drug List Status: On the preferred drug list without restriction

Vancomycin injection is added to the preferred drug list for the purpose of mixing (compounding) an oral solution that is less costly than oral capsules.

Commercial Drug Formulary – Add July 1, 2008.
HealthPartners Medicare Formulary – No changes. Vancomycin injection is already on the HealthPartners Medicare Formulary

CHANGES TO THE PREFERRED DRUG LIST (FORMULARY)

Adalimumab (Humira) Prior approval criteria have been added for psoriasis, and modified for rheumatology. Criteria depend on its indication for use:

Rheumatology and related inflammatory disorders: Reserved for prescribing by rheumatologists for patients who have tried and failed methotrexate or have medical contraindications to its use. Humira has a dose limit of 40mg every other week. Exceptions can be requested for higher doses for patients with an inadequate response to usual doses.
Psoriasis: Reserved for prescribing by dermatologists for patients with severe psoriasis who have tried and failed either UVB phototherapy or systemic therapy (methotrexate or cyclosporine or Soriatane) or have medical contraindications to their use.
Initial approvals are for three months for FDA-approved doses of 80mg once, then 40mg every two weeks starting one week after the initial dose. Patients with a positive response will be approved for FDA-approved doses of 40mg every other week. Exceptions can be requested for higher doses for patients with an inadequate response to usual doses.
Crohn's Disease: Reserved for prescribing by gastroenterologists for patients with moderately to severely active Crohn's Disease who have had an inadequate response to conventional therapy (such as 6-mercaptopurine, azathioprine, cyclosporine, or methotrexate), or have medical contraindications to their use. Approvals are for FDA-approved doses of 160mg once, then 80mg at week 2, then 40mg every two weeks. Exceptions can be requested for higher doses for patients with an inadequate response to usual doses.

Commercial Drug Formulary – Change prior approval criteria July 1, 2008.
HealthPartners Medicare Formulary – Change prior approval criteria January 1, 2009.

Alendronate solution and combination with vitamin D (Fosamax solution and Fosamax plus D) will change from "formulary with no restrictions" to "formulary with step-therapy." These alendronate products are reserved for patients who have tried and failed generic alendronate tablets.

Alendronate tablet (generic Fosamax) is the preferred bisphosphonate on the preferred drug list for treating osteoporosis.

Commercial Drug Formulary – Add step-therapy after appropriate notifications (no first-line use for new patients starting September 1, 2008). Patients currently using Fosamax solution and Fosamax plus D will be grandfathered (no changes required).
HealthPartners Medicare Formulary – Add step-therapy January 1, 2009. Patients currently using Fosamax solution and Fosamax plus D will be grandfathered (no changes required).

Anakinra (Kineret) Prior approval criteria have been modified. Kineret is reserved for prescribing by rheumatologists for patients who have tried and failed Enbrel AND Humira or with medical contraindications to their use. Approvals are for FDA-approved doses of 100mg daily.

Commercial Drug Formulary – Change prior approval criteria July 1, 2008.
HealthPartners Medicare Formulary – Change prior approval criteria January 1, 2009.

Duloxetine (Cymbalta) Step-therapy criteria have been modified to extend step-therapy for neuropathic pain. The step-therapy criteria for Cymbalta is:

Depression and anxiety: Reserved for patients who have had an inadequate response to a generic SSRI antidepressant medication or generic bupropion or generic mirtazapine. Cymbalta is also available for patients previously stable on this medication.
Diabetic peripheral neuropathic pain: Reserved for patients who have tried and failed generic gabapentin.

Commercial Drug Formulary – Change step-therapy criteria July 1, 2008.
HealthPartners Medicare Formulary – Change step-therapy criteria July 1, 2008.

Efalizumab (Raptiva) Prior approval criteria have been modified. Raptiva is reserved for prescribing by dermatologists for patients who have tried and failed Enbrel AND Humira or with medical contraindications to their use. Initial approvals are for three months, then indefinitely for patients with a positive response.

Commercial Drug Formulary – Change prior approval criteria July 1, 2008.
HealthPartners Medicare Formulary – Change prior approval criteria January 1, 2009.

Etanercept (Enbrel) Prior approval criteria have been modified. Prior approval criteria are:

Rheumatology and related inflammatory disorders: Reserved for prescribing by rheumatologists for patients who have tried and failed methotrexate or with medical contraindications to its use. Approvals are for FDA-approved doses of 50mg weekly. Exceptions can be requested for higher doses for patients with an inadequate response to usual doses.
Psoriasis: Reserved for prescribing by dermatologists for patients with severe psoriasis who have tried and failed either UVB phototherapy or systemic therapy (methotrexate or cyclosporine or Soriatane) or with medical contraindications to their use.
Initial approvals are for FDA-approved doses of 100mg weekly for three months. Patients with a positive response will be approved for FDA-approved doses of 50mg weekly. Exceptions can be requested for higher doses for patients with an inadequate response to usual doses.

Commercial Drug Formulary – Change prior approval criteria July 1, 2008.
HealthPartners Medicare Formulary – Change prior approval criteria January 1, 2009.

Ezetimibe (Zetia) will change from "formulary with no restrictions" to "formulary with step-therapy" for patients failing to reach cholesterol goals with a statin drug alone such as simvastatin, Lipitor, pravastatin, lovastatin.

Recent study data and recommendations suggest that ezetimibe is a second-line medication for patients failing to reach cholesterol goals despite maximum doses of a potent "statin" medication and for patients with a low tolerance to statin medications.

Commercial Drug Formulary – Add step-therapy after appropriate notifications (no first-line use for new patients starting September 1, 2008). Current members will be grandfathered (no changes required).
HealthPartners Medicare Formulary – Add step-therapy January 1, 2009 and pending CMS approval for 2008. Current members will be grandfathered (no changes required). Refer to the 2008 HealthPartners Medicare Formulary on our website to determine the current formulary status.

Gatifloxacin (Zymar). The physician-edit will change to ophthalmology only (optometry is no longer included with this physician-edit). Other providers can request this antibiotic eye drop as an exception.

Commercial Drug Formulary – Change physician-edit July 1, 2008.
HealthPartners Medicare Formulary – Change physician-edit pending CMS approval for both 2008 and 2009. Refer to the applicable HealthPartners Medicare Formulary on our website to determine the current formulary status.

Lidocaine patch (Lidoderm). In addition to the physician-edit, step-therapy has been added when possible.

The new Lidoderm criteria are: Reserved for: (1) prescribing by providers who specialize in chronic pain management (claims from providers with this specialty code will process automatically, without needing prior approval); or (2) neuropathic pain as a step-therapy medication for patients with an inadequate response to gabapentin; or (3) localized persistent pain with prior approval.

There are no restrictions when prescribing Lidoderm for post-herpetic neuralgia. However, because Lidoderm has both a provider edit and step-therapy, the provider may need to call to have an override entered for post-herpetic neuralgia.

Commercial Drug Formulary – Add step-therapy July 1, 2008.
HealthPartners Medicare Formulary – Add step-therapy July 1, 2008.

Methylphenidate (Metadate CD) will change from "formulary with no restrictions" to "formulary with step-therapy." Metadate CD is reserved for patients with an inadequate response to Concerta for treating attention deficit / hyperactivity disorder (ADHD). Concerta is now the preferred long-acting methylphenidate product for ADHD.

Commercial Drug Formulary – Add step-therapy after appropriate notifications (no new patients starting September 1, 2008). Current patients will be grandfathered (no changes required).
HealthPartners Medicare Formulary – Add step-therapy January 1, 2009. Current members will be grandfathered (no changes required).

Moxifloxacin (Vigamox). The physician-edit will change to ophthalmology only (optometry is no longer included with this physician-edit). Other providers can request this antibiotic eye drop as an exception.

Commercial Drug Formulary – Change physician-edit July 1, 2008.
HealthPartners Medicare Formulary – Change physician-edit pending CMS approval for both 2008 and 2009. Refer to the applicable HealthPartners Medicare Formulary on our website to determine the current formulary status.

Pegylated interferon alpha-2a (Pegasys) will change from "formulary with prior approval" to "formulary with no restrictions." Pegasys is used for treating hepatitis C. Peg-Intron continues to be available, on the preferred drug list with no restrictions.

Commercial Drug Formulary – Change to "formulary with no restrictions" July 1, 2008.
Medicare Part D – Change to "formulary with no restrictions" January 1, 2009.

Pregabalin (Lyrica) will change from "formulary with prior approval" to "formulary with step-therapy."

The new step-therapy criteria are: Reserved for diabetic peripheral neuropathic pain, post-herpetic neuralgia, and fibromyalgia for patients who have tried and failed gabapentin. An accurate diagnosis of fibromyalgia using the American College of Rheumatology (ACR), or other similar criteria is encouraged. There are no restrictions for Lyrica when prescribed for seizures. However, because Lyrica is a step-therapy medication, the provider may need to call to have an override entered when prescribing for seizures.

Commercial Drug Formulary – Change to step-therapy July 1, 2008.
Medicare Drug Formulary – Change to step-therapy pending CMS approval for both 2008 and 2009. Refer to the applicable HealthPartners Medicare Formulary on our website to determine the current formulary status.

Triptans (Imitrex, Maxalt, Maxalt MLT, Relpax) Add quantity limits. Limits are intended to provide quantities sufficient to treat up to eight migraine headaches per month while accommodating various package sizes. Exceptions can be requested for greater quantities if medically necessary.

Triptan Medication	Formulary Status	Quantity Limit Per Month
sumatriptan (Imitrex)	Formulary	12 tablets, 8 syringes or 10 vials of injection, 12 nasal sprays
rizatriptan (Maxalt, Maxalt MLT)	Formulary	12 tablets
eletriptan (Relpax)	Formulary	12 tablets
almotriptan (Axert)	Non-Formulary	12 tablets
frovatriptan (Frova)	Non-Formulary	12 tablets
naratriptan (Amerge)	Non-Formulary	12 tablets
zolmitriptan (Zomig, Zomig ZMT)	Non-Formulary	12 tablets, 12 nasal sprays

Commercial Drug Formulary – Add quantity limit September 1, 2008. Additional notifications will be sent to patients affected by this quantity limit.
HealthPartners Medicare Formulary – Add quantity limit pending CMS approval for both 2008 and 2009. Refer to the applicable HealthPartners Medicare Formulary on our website to determine the current formulary status.

Teriparatide (Forteo). Prior approval criteria have been modified. Forteo is reserved for:

Severe osteoporosis (T-score of spine, hip, or femoral neck minus 3.5 or lower), or
Osteoporosis (T-score minus 2.5 or lower) and
1. Previous fracture (spine or hip), or
2. Intolerance or contraindication to oral and intravenous bisphosphonate (such as alendronate) therapy, or
3. Progressive bone loss (bone loss >= 3% over two years) despite therapy with bisphosphonates (compliance >= 75%), adequate calcium, and adequate vitamin D intake (serum levels >= 30 ng/ mL).

Commercial Drug Formulary – Change prior approval criteria July 1, 2008.
HealthPartners Medicare Formulary – Change prior approval criteria January 1, 2009.

Vytorin (simvastatin/ Zetia) Prior approval criteria have been added. Vytorin is reserved for patients failing to reach goals despite maximum doses of Lipitor or maximum tolerated doses of Lipitor.

Recent study data and recommendations suggest that ezetimibe is a second-line medication for patients failing to reach cholesterol goals despite maximum doses of a potent "statin" medication and for patients with a low tolerance to statin medications.

Commercial Drug Formulary – Add prior approval criteria after appropriate notifications (no new patients starting September 1, 2008). Patients currently using Vytorin will be grandfathered indefinitely with letters sent suggesting changes to preferred products.
HealthPartners Medicare Formulary – Add prior approval criteria January 1, 2009 and pending CMS approval for 2008. Refer to the 2008 HealthPartners Medicare Formulary on our website to determine the current formulary status. Patients currently using Vytorin will be grandfathered (no changes required).

DELETIONS FROM THE PREFERRED DRUG LIST (FORMULARY)

Gentamicin eye drops. Other options for this antibiotic eye drop are available on the preferred drug list such as tobramycin with similar effect and a better safety profile.

Commercial Drug Formulary – Delete after appropriate notifications (no prescriptions will be allowed starting September 1, 2008). Additional communications will be sent to providers with recent prescriptions.
HealthPartners Medicare Formulary – Delete pending CMS approval for both 2008 and 2009. Refer to the applicable HealthPartners Medicare Drug Formulary on our website to determine the current formulary status.

Rosiglitazone & Rosiglitazone combinations (Avandia, Avandamet, Avandaryl) are being deleted from the preferred drug list for safety reasons.

A meta-analysis showed an increased risk of myocardial ischemic events such as angina or myocardial infarction. HealthPartners has determined that a similar medication is available that has not been associated with this risk. Pioglitazone (Actos) will remain on the preferred drug list with step therapy. Actos is reserved for patients with Type II diabetes who have tried metformin, or a sulfonylurea, or insulin.

Commercial Drug Formulary – No changes to previous announcement of this deletion. There will be no new prescriptions for these Avandia containing products starting July 1, 2008. Patients currently using Avandia containing products have been grandfathered through December 31, 2008. Communications have been sent to affected providers and patients.
HealthPartners Medicare Formulary – Avandia containing products will be deleted after appropriate notifications (no new patients starting September 1, 2008). Patients currently using Avandia containing products will be grandfathered through December 31, 2008, and are asked to consider alternative medications (such as Actos or Actos combination products). Exceptions can be requested for patients needing to stay on Avandia products. Additional communications will be sent to affected providers and patients.

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.