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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:

 

  • Acetaminophen/codeine
  • Butalbital/APAP
  • Hydrocodone/APAP
  • Hydromorphone (Dilaudid)
  • Meperidine (Demerol)
  • Morphine IR
  • Oxycodone, Oxycodone/APAP
  • Tramadol, Tramadol/APAP

 

Long acting preferred opioids:

  • Methadone
  • Morphine ER tabs (MS Contin)
  • Fentanyl patches

 

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