Pharmacy and Therapeutics Committee Formulary Update

On May 18, 2010, the Pharmacy and Therapeutics (P&T) Committee met and reviewed several drugs, policies and prior authorization criteria. The following information summarizes the recommendations made at the P&T meeting. It doesn’t represent a comprehensive list of all drugs included on our approved drug list.

Therapeutic Class	Drug	Formulary designations			Comments	Effective date
		Commercial	Medicaid	Medicare
Neurology	Ampyra (dalfampridine)	Nonpreferred specialty (T5)	Formulary	T4	Requires PA, Diplomat Specialty Pharmacy required	7-1-2010
Infectious disease	Cayston (aztreonam for inhalation)	Preferred Specialty (T4)	Formulary	T4 B vs. D	Limited distribution specialty pharmacy required	7-1-2010
Oncology	Oforta (fludarabine)	Nonpreferred specialty (T5)	Non-formulary	Part B*	Requires PA, Limited distribution specialty pharmacy required	7-1-2010
Endocrine	Somatuline Depot (lanreotide)	Preferred specialty (T4)	Formulary	T4 B vs. D	If not self-administered, covered under medical benefit	7-1-2010
Infectious disease	Spectracef (cefditoren pivoxil)	Nonpreferred brand (T3)	Non-formulary	T3	Requires ST (generic cephalosporin first)	7-1-2010
Cardiovascular	Twynsta (telmisartan/ amlodipine)	Nonpreferred brand (T3)	Non-formulary	T3	Requires ST (generic ACE inhibitor and preferred ARB first) Medicare: preferred ARB not required first	7-1-2010
Endocrine	Victoza (liraglutide)	Preferred brand (T2)	Formulary	T2	Requires ST (concurrent metformin use)	7-1-2010
Endocrine	Vpriv (velaglucerase alfa)	Preferred Specialty (T4)*	Formulary*	Part B*		7-1-2010

PA= Prior Authorization
ST= Step Therapy
* indicates drug is covered under the medical benefit

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