3q18 minutes 07.24...added iv form of bisphosphonate as option for therapeutic failure added tymlos...

Aetna Better Health® of Kentucky Pharmacy and Therapeutics Committee (P&T)

3Q18 Meeting Minutes

Date: 5/23/18 Time: 8:00am EST Presiding: Vaughn Payne, MD, Chief Medical Officer Location: Founders Building, University of Louisville Shelby Campus

Attendance: Vaughn Payne, MD, Chief Medical Officer Ted Cummings, RPh, Sr. Director of Pharmacy Elizabeth Stucker, MD, Medical Director Jeb Teichman, MD, Medical Director Jeff Giese, MD, Medical Director

Guest Attendance: Robert Coalson, Pharm. D., Pharmacy Director, VA Mark DeMary, Pharm. D., Pharmacy Director, WVA Ramie Ramirez, Pharm. D., Pharmacy Director, TX

Absent: Lora Abell, MD, Medical Director Michelle Brooks, MD, Medical Director Richard Schultz, Director Clinical Services John Van Arsdall II, MD, Medical Director

TOPIC FOR DISCUSSION SPEAKER DISCUSSION ACTION

I.

Call to Order Vaughn Payne Dr. Payne called the meeting to order at 8:02am EST.

II. Review and Approval of Minutes

Ted Cummings Minutes presented from 4/25/18. Dr. Teichman motioned for approval, second by Dr. Giese.

The P&T meeting minutes from 4/25/18 were

Pharmacy and Therapeutics Committee 1 of 11 Proprietary and Confidential 02/08/17


approved as presented.

III. Old Business Ted Cummings None

IV. New Business A. Formulary Change

Proposals

Ted Cummings Report to P&T of New Generics Added in the Previous Quarter: The following generics were added to the Aetna Medicaid formularies where permitted by state regulations, as they provided a value add to our members with no negative impact.

Formulary Change Proposals- New Generics added in the previous quarter

Praziquantel Tab Phytonadione Tab

Formulary Change- Generics that were NOT added in the previous quarter Sulfur/Resorcinol Lotion 5-2% (brand Rezamid) Selenium Sulfide Shampoo 2.3% (brand SelRx) Metopic Cream 41% (Urea) (brand Utopic) Clozapine Tab 12.5 ODT (brand Fazaclo) Miglustat Cap 100mg (brand Zavesca) Luliconazole Cream 1% Colesevelam HCl tab 625mg (brand Welchol) Cocaine HCl Nasal Sol 40mg/mL (brand Goprelto) Hydroxyprogesterone Inj 250mg/mL (brand Makena) Buprenorphine/Naloxone SL Film 8-2mg (brand Suboxone Film) Clindam/Benz Gel 1.2-2.5% (brand Acanya Gel)

Miscellaneous Formulary Updates

New Generic Report

o Epogen Biosimilar



B. Drug Class Reviews Ted Cummings Drug Class Review The following class of agents were reviewed and the formulary recommendations were based on clinical efficacy, safety and national treatment guideline recommendations.

The following Drug Classes underwent review WITHOUT formulary changes:

Iron Chelators

PPIs

Leukotriene Inhibitors

Oral Immunosuppressants

Somatostatin Analogs

Anaphylaxis

Oral Anticoagulants

Macrolides

Biologics for Asthma

Topical Antivirals

Injectable Anticoagulants

ADHD Stimulants The following Drug Classes were reviewed WITH formulary change recommendations.

Angina Recommended Changes:

•

Remove Nitro-Bid 2% ointment packets: GF = Y

• Nitro-Bid 2% ointment tubes are more cost-effective and will remain formulary

Anti-Emetics Recommended Changes:

• Remove trimethobenzamide 300mg capsule GF = Y • Low utilization and other formulary anti-emetics are

more cost-effective • Increase QL on ondansetron (currently 21 tabs per month)

• 4mg and 8mg tablets: 3 per day (dose optimization) • Decrease QL on ondansetron 4mg ODT from 6 tablets per



day to 3 tablets •

Dose optimization

Hypnotics and Anxiolytics Recommended Changes:

• Remove triazolam: GF = Y • Higher incidence of side effects and not

recommended for use >3 weeks. Other formulary benzodiazepines are more cost-effective

• Remove alprazolam ODT: GF = Y • Alprazolam IR is more cost-effective

• Remove clorazepate: GF = Y • Oxazepam and chlordiazepoxide are more cost-

effective for treatment of alcohol withdrawal • Remove meprobamate: GF = Y

• Multiple other formulary agents are more cost-effective

• Add appropriate QL and Age Limits where missing: • Alprazolam ER: Add minimum age limit of 18 • Alprazolam IR: Add QL: 0.25mg and 5mg 4 tabs per

day, 1mg 6 tabs per day, and 2mg 5 tabs per day • Lorazepam: Add QL: 0.5mg 4 tabs per day, 1mg 6

tabs per day, and 2mg 5 tabs per day • Hydroxyzine: Add QL: 4 tabs per day on all strengths • Oxazepam: Add QL: 4 caps per day on all strengths • Chlordiazepoxide: Add QL: 5mg and 10mg 4 tabs per

day, 25mg 12 tabs per day

Rectal Corticosteroids Recommended Changes:

• Remove Cortifoam, Lidocaine/HC 3%-1% Kit, and Lidocaine/HC 20x7GM Kit: GF = Y

• Low utilization and other formulary alternatives are more cost-effective

Topical Psoriasis Recommended Changes:



•

Remove Calcitriol Ointment: GF = Y • Low utilization and calcipotriene is more cost-

effective • Add Tazarotene 0.1% cream with QL of 90gm per month

• !llows steerage of tazarotene Rx’s to the most cost-effective formulation (all others are only available as brand)

• Similar cost as vitamin D analogs • Once daily application versus twice daily for vitamin

D analogs • Add QL of 200gm per month on all calcipotriene products: GF = Y

Chelators for Wilson’s Recommended Changes:

• Remove Cuprimine: GF = Y • Low utilization (Wilson disease is very rare,

estimated prevalence of 1 case per 30,000 live births)

• Poorly tolerated • The tablet formulation, Depen is more cost-effective

(currently negatively steering to less cost-effective product)

• Review requests based on medical necessity for FDA-approved indication

Vaginal Anti-Infectives Recommended Changes:

• Remove Cleocin Ovules • Metronidazole gel and clinidamycin cream are more

cost-effective • Remove miconazole and terconazole 3-day suppositories

• Other formulations are more cost-effective

Muscle Relaxers Recommended Changes:

• Add tizanidine tablets with QL • 2mg: 3 tablets per day (dose optimization)



• 4mg: 6 tablets per day • Provides an additional cost-effective formulary

product

Anti-Platelet Recommended Changes:

• Add prasugrel with QL of 1 tablet per day

Prenatal Vitamins Recommended Changes:

• Add PRENATAL TAB LOW IRON 27-0.8MG, PRENATAL TAB 28-0.8MG, PRENATABS FA TAB 29-1MG, PRENATAL CHW 29-1MG, PROVIDA OB CAP 20-20-1.25MG, CONCEPT OB CAP 130-92.4-1MG, COMPLETE NAT PAK DHA 29-1-200-250MG, PRENATAL MV MIS + DHA 28-0.8-200MG

• Remove : VITAFOL-OB TAB 65-1MG, PNV-SELECT TAB, SELECT-OB TAB CHEW/PO, DOTHELLE DHA CAP, CONCEPT DHA CAP, PNV-DHA CAP, PNV-DHA CAP DOCUSATE

• Grandfather members for duration of pregnancy on removed products

CMV Recommended Changes:

• Add valganciclovir tablets 450mg with QL of 2 tablets per day

Acute Headache Recommended Changes:

• Ergotamines: remove all; GF current users • Butalbital products

• QL : CHANGE QL to 60 doses limit/30days (@6dose per day for 10 days per month)

• Combo products increase the risk of MOH when used more than 10days /mo

• Cod products are part of SA opioid edits - no change needed



Rapid-acting Insulins Recommended Changes:

•

Remove HUMALOG, NOVOLOG. Remove APIDRA (vials and pens) in MI.

• ADMELOG and ADMELOG SOLOSTAR are preferred products with age PA for SoloStar pen

• Custom reject messaging for Humalog/Novolog vials/pens along with letter campaign to assist conversion.

C. Formulary Updates Ted Cummings ADHD Non-Formulary QL update Updates to QL for select ADHD meds reviewed and supported

Opioid Age Limit update Recommended Changes:

• Implement a 12 year age threshold on all opioids or tramadol preparations including cough and cold products.

• Grandfathering recommended



Condylox update Recommended Changes:

• Remove Condylox gel from formulary and steer to preferred products podofilox solution or imiquimod cream

Elidel update Recommended Changes:

• Remove Elidel 1% cream from formulary and steer to preferred product generic tacrolimus 0.1% or 0.03% ointment while maintaining existing UM step therapy and QL on tacrolimus products.

Admelog update Recommended Changes:

• Remove Humalog (vials and pens) and Novolog (vials and pens) from formulary and steer to preferred products Admelog vial and Admelog SoloStar pen.

D. Annual Guideline Reviews

Ted Cummings No Changes Compounds

Growth hormone Idiopathic Pulmonary Fibrosis Ranexa Restasis and Xidra Sucraid

With Changes

Anticoagulants-injectableAdded criteria for Iprivask

Anticoagulants-oral Removed the criteria ‘dosing is appropriate for renal function’

Antidementia Retire guideline



Ted Cummings

Daliresp

Added long-acting beta-agonist (LABA) + long-acting muscarinic antagonist (LAMA) as another trial and failure option

Added a long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) as single agent options to be used in conjunction with Daliresp

Diabetic Testing Supplies

Removed One Touch Verio IQ from criteria for non-formulary diabetic supplies due to formulary product

Updated criteria to receive greater than 150 test strips per month for children with diabetes to less than 18 years; previously listed as 12 years

Osteoporosis – injectable

Added IV form of bisphosphonate as option for therapeutic failure

Added Tymlos as a preferred agent; requests for Forteo require trial and failure of Tymlos in addition to clinical criteria

Insulin pens

Listed Admelog and Admelog Solostar as formulary rapid acting insulin

Added Fiasp FlexTouch to the rapid acting insulin section

Added Toujeo Max Solostar to the basal insulin section; will follow the Toujeo criteria

Novolin N Innolet was discontinued; removed from the guideline

Interlukin 5 antagonists Added criteria for Eosinophilic Granulmatosis with Polyangiitis (EGPA) for Nucala

Nuedexta Added the Pathological Laughter and Crying Scale (PLACS) as a cognitive assessment evaluation tool option



Platelet inhibitors

Prasugrel was added to formulary and removed from guideline

Removed the requirement for failure or contraindication/intolerance to clopidogrel for the Brilinta criteria

Proton Pump Inhibitors Added lansoprazole orally disintegrating tablet (ODT) to list of formulary with prior authorization proton pump inhibitors (PPIs)

Pulmonary Arterial Hypertension Quantity Limits Added

Somatostatin Analogs

Added requirement of attestation that gallbladder ultrasound has been performed for Signafor and Signifor LAR

Added radiotherapy as a previous therapy option for Acromegaly For carcinoid tumor, added the language: to reduce the frequency of short-acting somatostatin analog rescue therapy for clarification

Synagis Added criteria for children with Cystic Fibrosis

Xolair

Updated diagnosis to moderate to severe persistent asthma

Updated the Immunoglobulin E (IgE) range to between 30 and 1300 IU/mL

New Guideline Reviews

Tavalisse Immune Globulin

E. New Drug Reviews New Drug Reviews


11 of 11

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New drugs and their recommendations to be formulary or non-formulary were presented to the Committee including detail for indication, mechanism, dosing/administration, safety, efficacy/clinical trials, treatmentoptions, advantages, and disadvantages:

Andexxa

Almovig

Olumiant

Crysvita

Palynziq

Lucemyra

Doptelet

Tavalisse

All were recommended to be added as non-preferred.

V. Adjournment Vaughn Payne Meeting adjourned at 8:49am EST (motioned by Dr. Giese, 2nd by Dr. Abell)

VI. Next Meeting Ted Cummings Future Meetings: 4Q18 October 24, 2018

APPROVED: Vaughn Payne, MD

Committee Chair April Cox, PharmD

Scribe

Date: April 25, 2018

Pharmacy and Therapeutics Committee Proprietary and Confidential 02/08/17

3q18 minutes 07.24...added iv form of bisphosphonate as option for therapeutic failure added tymlos...

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