Pharmacy

Generic drug news
Generic Ortho Tri-Cyclen Lo (norgestimate/ethinyl estradiol) is now available! Generic Ortho Tri-Cyclen Lo is indicated for the prevention of pregnancy.

Asthma long-term controllers moving to generic copay
Effective Sept. 1, 2009, Pulmicort and QVAR inhalers became available on the Priority Health commercial formulary (HMO, PPO, POS) for a generic copay! It’s a win-win for members and providers:

• Members will save, on average, $30 per month on their copay.
• These medications (filled after 09/01/09) will now count as generics for the PIP generic measure for providers.
• By decreasing a possible cost barrier, this change is an opportunity to improve adherence to long term controller medications and also positively impact providers’ 2:1 asthma PIP incentive.

FloVent remains as a name brand.

Positive changes to more than 100 drugs
We’re making changes to more than 100 drugs that will positively impact providers and members. These changes are in addition to the more than 50 positive changes we made in 2008.

Changes were effective September 1, 2009. A complete list of the changes is available online. Here are the highlights:

• Positive changes have been made to approximately 48% of PA requests for the commercial (HMO, PPO, POS) formulary, 24% of Medicaid requests, and 10% of Medicare requests.
• These changes impact approximately 55 drugs on the commercial formulary, 80 drugs on the Medicaid formulary, and 30 drugs on the Medicare formulary.
• We’ve removed step therapy requirements for our number one requested drug, Crestor. Members no longer need to try simvastatin first. We do encourage you to continue using simvastatin and other generic statins in members needing less than a 40% reduction in LDL. This saves members on average $30 per month!

New drugs reviewed at July P&T
The Pharmacy and Therapeutics (P&T) Committee met on July 21, 2009, and reviewed several new drugs. The following information summarizes the recommendations made at the P&T meeting.

Therapeutic Class	Drug	Change applies to:			P&T recommendation	Effective date
		Commercial	Medicaid	Medicare
Oncology	Afinitor (everolimus)	+	+	+	Added to formulary with ST (Nexavar or Sutent first)	9/1/09
Cardiology	Azor (amlodipine/ olmesartan)			+	Added to formulary (T3)	9/1/09
Cardiology	ExforgeHCT (amlodipine/valsartan/ HCTZ)	+	+	+	Added to formulary	9/1/09
Urology	Gelnique (oxybutynin gel)			+	Added to formulary (T3)	9/1/09
Hematology	Mozobil (plerixafor)	+*	+*	+*	Added to formulary	9/1/09
CNS	Nuvigil	+	+	+	Not added to formulary	9/1/09
Pain Management	Ryzolt (tramadol ER)			+	Added to formulary (T3)	9/1/09
CNS	Savella (milnacipran)	+	+	+	Add to formulary with ST (gabapentin first)	9/1/09
Biologic	Simponi (golimumab)	+	+	+	Not added to formulary	9/1/09
CNS	Vimpat (lacosamide)			+	Added to formulary (T3)	9/1/09

PA = Prior Authorization
ST = Step Therapy
+ Indicates the change applies to this formulary
* Indicates drug is covered under the medical benefit

Step therapy
Priority Health has some drug categories that require a therapeutic trial of a specific drug or drug(s) before authorization will be granted for other medications. This process is commonly referred to as step therapy.

Here are some examples of common drug classes for the commercial formulary (HMO, PPO, POS) that require step therapy:

• Angiotensin Receptor Blockers: Requires the documented therapeutic trial and clinical failure of an ACE inhibitor, except when the patient has diabetes.
• Nasal Steroids: Requires use of fluticasone or flunisolide first-line, followed by Nasacort AQ or Rhinocort AQ as second-line. Non-formulary nasal steroids include Nasonex, Veramyst, Omnaris and Beconase AQ.
• Antidepressants: Requires the use of one generic antidepressant before a claim for Effexor XR, Lexapro or Cymbalta is allowed.

Availability of physician and pharmacist reviewers
Questions or concerns regarding processes or utilization management decisions made by Priority Health can be referred to your PAE or the Health Management department at 800 942-4765. Physician and pharmacist reviewers can be used to assist you.