Pharmacy and Therapeutics Committee formulary update

On March 16, 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. Please visit priorityhealth.com and click on "Approved Drug List" for detailed information regarding drug coverage.

March 16, 2010 P&T changes: At a glance
Alphabetized by drug name

Therapeutic Class	Drug	Change applies to			P&T recommendation	Effective Date
		Commercial	Medicaid	Medicare
Rheumatology	Actemra (tocolizumab)	x *	x *	x *	Add to medical benefit coverage with Prior Authorization	5-1-2010
CNS	Ambien Cr (zolpidem)	x		x	Revised ST: either zolpidem (generic Ambien) or zaleplon (generic Sonata) first	5-1-2010
Respiratory	Aralast (alpha 1-Proteinase inhibitor)	x *	x *	x *	Add Prior Authorization	5-1-2010
Hematology	Feraheme (ferumoxytol)	x *	x *	x *	Add to medical benefit coverage	5-1-2010
Oncology	Folotyn (pralatrexate)	x *	x *	x *	Add to medical benefit coverage	5-1-2010
CNS	Lunesta (eszopiclone)	x		x	Revised ST: either zolpidem (generic Ambien) or zaleplon (generic Sonata) first	5-1-2010
Ophthalmology	Ozurdex (dexamethasone intravitreal implant)	x *	x *	x *	Add to medical benefit coverage	5-1-2010
Respiratory	Prolast (alpha 1-Proteinase inhibitor)	x *	x *	x *	Add Prior Authorization	5-1-2010
CNS	Rozerem (ramelteon)	x		x	Revised ST: either zolpidem (generic Ambien) or zaleplon (generic Sonata) first	5-1-2010
Dermatology	Synera (lidocaine/tetracaine patch)	x		x	Add to formulary	5-1-2010
Anti-infective	Vibativ (telavancin)	x *	x *	x *	Add to medical benefit coverage with Prior Authorization	5-1-2010
Respiratory	Zemaira (alpha 1-Proteinase inhibitor)	x *	x *	x *	Add Prior Authorization	5-1-2010

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

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