AHCCCS Pharmacy and Therapeutics Committee Recommendations 19 May

Committee Recommendations PDL Recommendation Key: • Products currently preferred and remaining preferred are listed

P&T Public Class Vote: Analgesics, Narcotics Long Reaching across Arizona to provide comprehensive quality

Analgesics, Narcotics Long PDL Recommendations (preferred products): • Butrans*^ • Embeda* † • fentanyl

P&T Public Class Vote: Antibiotics, Inhaled Reaching across Arizona to provide comprehensive quality health

Antibiotics, Inhaled PDL Recommendations (preferred products): • Bethkis* • Kitabis Pak* No Changes Reaching

P&T Public Class Vote: Anticoagulants Reaching across Arizona to provide comprehensive quality health care

Anticoagulants PDL Recommendations (preferred products): • Oral Agents Eliquis*, Eliquis Dose Pack* o Pradaxa*

P&T Public Class Vote: Antimigraine Agents, Other Reaching across Arizona to provide comprehensive quality

Antimigraine Agents, Other PDL Recommendations (preferred products): Ajovy • Emgality Syringe 120 mg* •

P&T Public Class Vote: Antipsychotics, Oral Atypical Reaching across Arizona to provide comprehensive quality

Antipsychotics, Oral Atypical PDL Recommendations (preferred products): • Oral Agents o aripiprazole tablet* o

P&T Public Class Vote: Antipsychotics, Atypical Long-Acting Injectable Reaching across Arizona to provide comprehensive

Antipsychotics, Atypical Long-Acting Injectable PDL Recommendations (preferred products): • Long-Acting Injectable Agents o o

P&T Public Class Vote: COPD Agents Reaching across Arizona to provide comprehensive quality health

COPD Agents PDL Recommendations (preferred products): • Antimuscarinics - Short-Acting Atrovent* o ipratropium nebulizer*

P&T Public Class Vote: Cytokine and CAM Antagonists Reaching across Arizona to provide comprehensive

Cytokine and CAM Antagonists PDL Recommendations (preferred products): • Xeljanz (immediate release) with PA

P&T Public Class Vote: Epinephrine, Self-Injected Reaching across Arizona to provide comprehensive quality health

Epinephrine, Self-Injected PDL Recommendations (preferred products): • epinephrine 0. 15 mg (generic Epi. Pen

P&T Public Class Vote: Glucocorticoids, Inhaled Reaching across Arizona to provide comprehensive quality health

Glucocorticoids, Inhaled PDL Recommendations (preferred products): • Single Agent Products o o o •

P&T Public Class Vote: Growth Hormone Reaching across Arizona to provide comprehensive quality health

Growth Hormone PDL Recommendations (preferred products): • Genotropin Cartridge*, Genotropin Disp Syringe* • Norditropin

P&T Public Class Vote: Hepatitis C Agents Direct Acting Reaching across Arizona to provide

Hepatitis C Agents (Direct Acting) PDL Recommendations (preferred products): Mavyret* o sofosbuvir/velpatasvir (AG)* o

P&T Public Class Vote: Hypoglycemics, Incretin Mimetics/Enhancers Reaching across Arizona to provide comprehensive quality

Hypoglycemics, Incretin Mimetics/Enhancers PDL Recommendations (preferred products): • Amylin Analogues o Symlin Pens* •

P&T Public Class Vote: Hypoglycemics, Insulin and Related Agents Reaching across Arizona to provide

Hypoglycemics, Insulin and Related Agents PDL Recommendations (preferred products): • o o • o

P&T Public Class Vote: Opioid Dependence Treatments Reaching across Arizona to provide comprehensive quality

Opioid Dependence Treatments PDL Recommendations (preferred products): • Buprenorphine/Naloxone Products buprenorphine/naloxone sublingual tablet o

P&T Public Class Vote: Pancreatic Enzymes Reaching across Arizona to provide comprehensive quality health

Pancreatic Enzymes PDL Recommendations (preferred products): • Creon* • Zenpep* No Changes Reaching across

P&T Public Class Vote: Progestational Agents Reaching across Arizona to provide comprehensive quality health

Progestational Agents PDL Recommendations (preferred products): • Makena Auto Injector* • Makena MDV*^ •

P&T Public Class Vote: Stimulants and Related Agents Reaching across Arizona to provide comprehensive

Stimulants and Related Agents PDL Recommendations (preferred products): • • • Adderall XR*^ amphetamine

New Drug Recommendations (Non-Supplemental) • Adakveo - Nonpreferred • Avyakit - Nonpreferred • Nexletol

Slides: 39

Download presentation

AHCCCS Pharmacy and Therapeutics Committee Recommendations 19 May 2020

Committee Recommendations PDL Recommendation Key: • Products currently preferred and remaining preferred are listed in Black • Products currently new, not previously reviewed or non-preferred and recommended to be preferred are listed in Blue • Products currently new, not previously reviewed or preferred and recommended to be nonpreferred are listed in Red • Products currently included on the AHCCCS approved drug list are noted with an asterisk (*) • Classes where grandfathering is recommended will have a notation on the preferred recommendations page Reaching across Arizona to provide comprehensive quality health care for those in need 2

P&T Public Class Vote: Analgesics, Narcotics Long Reaching across Arizona to provide comprehensive quality health care for those in need 3

Analgesics, Narcotics Long PDL Recommendations (preferred products): • Butrans*^ • Embeda* † • fentanyl transdermal (not including the 37. 5 mg, 62. 5 mg & 87. 5 strengths)* • morphine ER tablet* • tramadol ER (generic Ultram ER)* • Xtampza ER*^ No Changes ^Brand is preferred over generic Voluntarily stopped sale and distribution in October 2019 † Reaching across Arizona to provide comprehensive quality health care for those in need 4

P&T Public Class Vote: Antibiotics, Inhaled Reaching across Arizona to provide comprehensive quality health care for those in need 5

Antibiotics, Inhaled PDL Recommendations (preferred products): • Bethkis* • Kitabis Pak* No Changes Reaching across Arizona to provide comprehensive quality health care for those in need 6

P&T Public Class Vote: Anticoagulants Reaching across Arizona to provide comprehensive quality health care for those in need 7

Anticoagulants PDL Recommendations (preferred products): • Oral Agents Eliquis*, Eliquis Dose Pack* o Pradaxa* o Xarelto*, Xarelto Dose Pack* o warfarin* o • Injectable Agents enoxaparin syringe*, enoxaparin syringe* (AG) o enoxaparin vial* (AG) o No Changes Reaching across Arizona to provide comprehensive quality health care for those in need 8

P&T Public Class Vote: Antimigraine Agents, Other Reaching across Arizona to provide comprehensive quality health care for those in need 9

Antimigraine Agents, Other PDL Recommendations (preferred products): Ajovy • Emgality Syringe 120 mg* • Emgality Pen* • PDL Recommendations (non-preferred products): • • • Aimovig* Emgality Syringe 100 mg Nurtec ODT Reyvow Ubrelvy Vyepti Grandparenting – No Reaching across Arizona to provide comprehensive quality health care for those in need 10

P&T Public Class Vote: Antipsychotics, Oral Atypical Reaching across Arizona to provide comprehensive quality health care for those in need 11

Antipsychotics, Oral Atypical PDL Recommendations (preferred products): • Oral Agents o aripiprazole tablet* o clozapine ODT*, clozapine ODT* (AG), clozapine tablet* o Latuda* o olanzapine ODT*, olanzapine tablet* o quetiapine tablet* o risperdone ODT*, risperidone solution*, risperidone tablet* o ziprasidone capsule* No Changes Reaching across Arizona to provide comprehensive quality health care for those in need 12

P&T Public Class Vote: Antipsychotics, Atypical Long-Acting Injectable Reaching across Arizona to provide comprehensive quality health care for those in need 13

Antipsychotics, Atypical Long-Acting Injectable PDL Recommendations (preferred products): • Long-Acting Injectable Agents o o o Abilify Maintena* Aristada Initio* Invega Sustenna* Invega Trinza* Risperdal Consta* No Changes Reaching across Arizona to provide comprehensive quality health care for those in need 14

P&T Public Class Vote: COPD Agents Reaching across Arizona to provide comprehensive quality health care for those in need 15

COPD Agents PDL Recommendations (preferred products): • Antimuscarinics - Short-Acting Atrovent* o ipratropium nebulizer* o • Antimuscarinics - Long-Acting • Beta Agonist/Antimuscarinic Combination - Long-Acting Bevespi Aerosphere* o Stiolto Respimat* o No Changes Spiriva Handi. Haler* o Tudorza Pressair o • Beta Agonist/Antimuscarinic Combination - Short-Acting o ipratropium/albuterol nebulizer* o Combivent Respimat* Reaching across Arizona to provide comprehensive quality health care for those in need 16

P&T Public Class Vote: Cytokine and CAM Antagonists Reaching across Arizona to provide comprehensive quality health care for those in need 17

Cytokine and CAM Antagonists PDL Recommendations (preferred products): • Xeljanz (immediate release) with PA • Enbrel Kit*, Enbrel Syringe*, Enbrel Pen*, Enbrel Mini Cartridge* with PA • Humira Kit*, Humira Pen Kit* with PA • Otezla* with PA No Changes Reaching across Arizona to provide comprehensive quality health care for those in need 18

P&T Public Class Vote: Epinephrine, Self-Injected Reaching across Arizona to provide comprehensive quality health care for those in need 19

Epinephrine, Self-Injected PDL Recommendations (preferred products): • epinephrine 0. 15 mg (generic Epi. Pen Jr. )* • epinephrine 0. 3 mg (generic Epi. Pen)* PDL Recommendations (products moving to nonpreferred products): • Symjepi Grandparenting - No Reaching across Arizona to provide comprehensive quality health care for those in need 20

P&T Public Class Vote: Glucocorticoids, Inhaled Reaching across Arizona to provide comprehensive quality health care for those in need 21

Glucocorticoids, Inhaled PDL Recommendations (preferred products): • Single Agent Products o o o • PDL Recommendations (products moving to nonpreferred): • Asmanex* budesonide 1 mg respules* Flovent HFA* Flovent Diskus Pulmicort Flexhaler* budesonide 0. 25 and 0. 5 mg Respules Single Agent Products o Pulmicort 0. 25, 0. 5 mg Respules* Grandparenting - No Combination Products Advair Diskus*^ o Advair HFA* o Dulera* o Symbicort* o ^Brand is preferred over generic Reaching across Arizona to provide comprehensive quality health care for those in need 22

P&T Public Class Vote: Growth Hormone Reaching across Arizona to provide comprehensive quality health care for those in need 23

Growth Hormone PDL Recommendations (preferred products): • Genotropin Cartridge*, Genotropin Disp Syringe* • Norditropin Pen* No Changes Reaching across Arizona to provide comprehensive quality health care for those in need 24

P&T Public Class Vote: Hepatitis C Agents Direct Acting Reaching across Arizona to provide comprehensive quality health care for those in need 25

Hepatitis C Agents (Direct Acting) PDL Recommendations (preferred products): Mavyret* o sofosbuvir/velpatasvir (AG)* o No Changes Reaching across Arizona to provide comprehensive quality health care for those in need 26

P&T Public Class Vote: Hypoglycemics, Incretin Mimetics/Enhancers Reaching across Arizona to provide comprehensive quality health care for those in need 27

Hypoglycemics, Incretin Mimetics/Enhancers PDL Recommendations (preferred products): • Amylin Analogues o Symlin Pens* • Dipeptidyl Peptidase-4 Enzyme Inhibitors (DPP-4 s) o Glyxambi* o Janumet XR* o Januvia* o Jentadueto* o Kombiglyze XR* o Onglyza* o Tradjenta* • Glucagon-Like Peptide-1 Receptor Agonists (GLP-1 s) o Bydureon Pens*, Bydureon Vials (discontinued) o Byetta Pens* o Victoza* No Changes Reaching across Arizona to provide comprehensive quality health care for those in need 28

P&T Public Class Vote: Hypoglycemics, Insulin and Related Agents Reaching across Arizona to provide comprehensive quality health care for those in need 29

Hypoglycemics, Insulin and Related Agents PDL Recommendations (preferred products): • o o • o Humalog Cartridge, Humalog Pens*, Humalog Junior Kwikpen, Humalog Vials* Novolog Cartridge*, Novolog Pens*, Novolog Vials* o • Intermediate-Acting Insulins o o Humulin R*, Humulin Pen OTC Humulin 500 Pens*, Humulin 500 Vials* Humulin N* • Lantus Vial* Lantus Solostar Pen* Levemir Pens*, Levemir Vials* Rapid/Intermediate-Acting Combination Insulins o Regular Insulins o Long-Acting Insulins o Rapid-Acting Insulins o • • Humalog Mix Pens*, Humalog Mix Vials* Novolog Mix Vials* Regular/Intermediate-Acting Combination Insulins o Humulin Pen 70/30 Pen OTC, Humulin 70/30 Vials* PDL Recommendations (nonpreferred products): o o o Lispro Junior Kwikpen Lispro Protamine Mix Kwikpen Novolin 70/30 Vial OTC Grandparenting - No Reaching across Arizona to provide comprehensive quality health care for those in need 30

P&T Public Class Vote: Opioid Dependence Treatments Reaching across Arizona to provide comprehensive quality health care for those in need 31

Opioid Dependence Treatments PDL Recommendations (preferred products): • Buprenorphine/Naloxone Products buprenorphine/naloxone sublingual tablet o Suboxone Film*^ o • Buprenorphine Products buprenorphine sublingual tablet – PA required unless member is pregnant* o Sublocade subcutaneous – with PA (Statewide PA criteria to be developed) o • Naloxone Products naloxone syringe*, naloxone vials* o Narcan Nasal* o • Naltrexone Products naltrexone tablets* o Vivitrol* o • Alpha Agonist Products o clonidine tablet* No Changes Reaching across Arizona to provide comprehensive quality health care for those in need ^Brand is preferred over generic 32

P&T Public Class Vote: Pancreatic Enzymes Reaching across Arizona to provide comprehensive quality health care for those in need 33

Pancreatic Enzymes PDL Recommendations (preferred products): • Creon* • Zenpep* No Changes Reaching across Arizona to provide comprehensive quality health care for those in need 34

P&T Public Class Vote: Progestational Agents Reaching across Arizona to provide comprehensive quality health care for those in need 35

Progestational Agents PDL Recommendations (preferred products): • Makena Auto Injector* • Makena MDV*^ • Makena SDV*^ No Changes ^Brand is preferred over generic Reaching across Arizona to provide comprehensive quality health care for those in need 36

P&T Public Class Vote: Stimulants and Related Agents Reaching across Arizona to provide comprehensive quality health care for those in need 37

Stimulants and Related Agents PDL Recommendations (preferred products): • • • Adderall XR*^ amphetamine salt combination* Aptensio XR* atomoxetine, atomoxetine (AG)* clonidine ER* Concerta*^ Daytrana* Dexmethylphenidate*, dexmethylphenidate (AG)* dextroamphetamine tablet* Focalin XR*^ guanfacine ER* • • • Methylin Solution*^ methylphenidate* methylphenidate CD*, methylphenidate CD (AG)* methylphenidate ER (generic Ritalin LA)* Ritalin LA 10 mg capsule* Vyvanse Capsule*, Vyvanse Chewable Tablet* ^Brand is preferred over generic PDL Recommendations (products moving to nonpreferred): • Dyanavel XR* • Quillichew ER* • Quillivant XR* Grandparenting - No Reaching across Arizona to provide comprehensive quality health care for those in need 38

New Drug Recommendations (Non-Supplemental) • Adakveo - Nonpreferred • Avyakit - Nonpreferred • Nexletol - Nonpreferred • Oxbryta - Nonpreferred • Palforzia - Nonpreferred • Reyvow - Nonpreferred Reaching across Arizona to provide comprehensive quality health care for those in need 39

Related presentations