MHS Preferred Drug List (PDL) Updates - Q4 2015
Date: 04/12/16
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MHS routinely reviews the medications available on the Preferred Drug List (PDL). Items are added, removed or modified periodically due to industry standards, market availability, and assessment of use. Below is a list of changes that were approved by the MHS P&T Committee this quarter. MHS will transition members to preferred alternatives by working directly with the prescriber and only as approval is granted.
Table 1: Summary of Medicaid PDL changes based upon therapeutic class review.
Add to Preferred | Move to Non-Preferred | Preferred Options |
|---|---|---|
Antiarrhythmic Agents | ||
| Tikosyn (dofetilide) | Multaq (dronedarone)Rhytmol SR (propafenone) | amiodarone, disopyramide, Tikosyn, flecainide, mexiletine, propafenone IR, quinidine |
Antidiarrheals | ||
| Motofen (difenoxin/atropine) | Bismuth subsalicylate, diphenoxylate/atropine, loperamide | |
Antiemetic Agents | ||
| Ondansetron 2mg/ml injection | Anzemet tabs (dolasetron)Zuplenz (ondansetron)Sancuso (granisetron)Emend (aprepitant)Cesamet (nabilone)
Diclegis (doxylamine/pyridoxime) Transderm-Scop (scopolamine) | Ondansetron, chlorpromazine, dronabinol, metoclopramide, perphenazine, prochlorperazine, promethazine, trimethobenzamide |
Antihyperlipidemic Agents | ||
| Cholestyramine Light powder | Welchol (colesevelam HCl)Antara (fenofibrate micro)Fenoglide (fenofibrate)Triglide (fenofibrate) | Cholestyramine powd., colestipol, fenofibrate (Lofibra, Lipofen, Tricor), Fibricor (fenofibric acid), gemfibrozil, Omega 3, niacin |
Antiparkinson Agents | ||
| Apokyn (apomorphine)Azilect (rasagiline mesylate)Zelapar (selegiline)Neupro (tolcapone) | Amantadine, bromocriptine, carbidopa/levodopa, entacapone, Lodosyn, selegiline, carbidopa/levodopa/entacapone, pramipexole IR/ER, ropinirole IR/ER | |
Angiotensin Receptor Antagonists (ARBs) | ||
| Benicar (olmesartan)Benicar HCT (olmesartan/HCTZ)Edarbi (azilsartan)Eprosartan (Teveten) | Candesartan, valsartan, irbesartan, losartan, telmisartan, | |
Add to Preferred | Move to Non-Preferred | Preferred Options |
|---|---|---|
BPH Agents | ||
| Rapaflo (silodosin)Jalyn (dutasteride/tamsulosin) | Doxazosin, prazosin, tamsulosin, terazosin, alfuzosin, finasteride | |
Constipation Treatments | ||
| Amitiza (lubiprostone) | Bisacodyl, calcium polycarbophil, docusate sodium, docusate calcium, glycerin, lactulose, magnesium citrate, polyethylene glycol, psyllium, sennosides, sorbitol, sodium phosp. | |
COPD Agents | ||
| Foradil (formoterol)Perforomist (formoterol)Spiriva Respimat (tiotropium) | Serevent, Atrovent HFA, ipratropium, Spiriva HandiHaler, Combivent, ipratropium/albuterol, Tudorza | |
Direct Renin Inhibitors | ||
| Tekturna (aliskiren) | Other treatment classes; ACE/ARB, beta blockers, calcium channel blocker | |
Diuretics | ||
| Acetazolamide (Diamox 125mg tab) | Edecrin (ethacrynate)Dyrenium (triamterene)Diuril Suspension (chlrothiazide)Thalitone (chlorthalidone 15mg tab)Aldactazide (spironolactone/HCTZ 50mg/50mg branded only) | Bumetanide, furosemide, torsemide, amiloride, spironolactone, chlorthalidone, HCTZ, methyclothiazide, metolazone, acetazolamide, amiloride/HCTZ, triamterene/HCTZ |
Immunosuppressants | ||
| Zotress (everolimus) | Azathioprine, cyclosporine, mycophenolate, sirolimus, tacrolimus | |
Inflammatory Bowel Disease | ||
| Apriso (mesalamine),Asacol HD, Canasa (mesalamine), Dipetum (olsalazine),Giazo (blasalazide 1.1gm),Lialda (mesalamine delayed release), Entocort EC (budesonide) | Asacol (mesalamine), balsalazide, Pentasa, Delzicol, sulfasalazine,
hydrocortisone enema, mesalamine enema, prednisone | |
Inhaled Corticosteroids | ||
| Breo Ellipta 200 mcg | Alvesco (ciclesonide),Asmanex (mometasone),Arnuity Ellipta (fluticasone),QVAR (beclomethasone) | Pulmicort (budesonide), Flovent (fluticasone), Advair (fluticasone/salmeterol), Breo Ellipta (fluticasone/vilanterol), Dulera (formoterol/mometasone),
Symbicort (budesonide/formoterol) |
Add to Preferred | Move to Non-Preferred | Preferred Options |
|---|---|---|
Narcotic Analgesics | ||
| Oxycodone 4.834/aspirin 325mg | Butorphanol (Stadol),Subsys (fentanyl),Exalgo (hydromorphone),Kadian, (morphine ER),Xartemis XR (oxycodone/APAP),
Opana IR/ER (oxymorphone), OxyContin (oxycodone ER) Talwin Solution (pentazocine) Nucynta IR/ER (tapentadol), Rybix (tramadol), Butrans (buprenorphine) | Short acting preferred opioids:
Long acting preferred opioids:
|
Nasal Steroids, Antihistamines and Mast Cell Stabilizers | ||
| Nasonex, Veramyst, Dymista | Flunisolide, fluticasone (Flonase), triamcinolone (Nasacort), azelastine (Astelin, Astepro), cromolyn | |
Treatment of Angina | ||
| Dilatrate, Titradose | Isosorbide dinitrate, isosorbide mononitrate (IR/ER), nitroglycerin | |
Non-Sedating Antihistamines | ||
| Desloratadine, levocetirizine | Cetirizine, fexofenadine, loratadine | |
Thyroid Agents | ||
| Tirosint | Levothyroxine, liothyronine, Armour thyroid, Thyrolar | |
Triptans | ||
| Frova, Sumavel DosePro, Treximet | Naratriptan, rizatriptan, sumatriptan, zolmitriptan | |
Table 2: Miscellaneous PDL Revisions
| Medication | Change | Notes |
|---|---|---|
| Ventolin HFA (albuterol MDI) | Add to preferred | Move Proair HFA, Proventil HFA to non-preferred status. |
| Jadenu (deferasirox) | Add to preferred with PI based PA | |
| Glatopa (glatiramer acetate) | Add to preferred with PI based PA | |
| Dyanavel XR (amphetamine ER oral susp.) | Add to preferred |