P&t formulary decisions - july 2013

From: Sheireen Huang, Pharm.D.
Pharmacy Co-Chair, Physician Co-Chair, Regional P&T Committee CC: Pharmacy
Date: July 5, 2013
Re: July P&T Committee Formulary Decisions
The chart below outlines KPMAS commercial formulary decisions from the July 2013 KPMAS Regional Pharmacy & Therapeutics Committee meeting. Detailed evidence-based drug monographs used when evaluating these products are available by request. In addition, please see the attached for summary of tips on how to find formulary information online and the formulary review process. Please feel free to contact Sheireen Huang, PharmD and/or Carol Forster, MD via email at [email protected] and/or [email protected] if there are any questions. Commercial and Medicare Part D (MPD) Formulary Decisions
DRUG AND STRENGTH
RESTRICTION/COMMENT
 As a multi-source generic, sildenafil 20 mg provides a cost-effective phosphodiesterase type 5 inhibitor for the treatment of erectile dysfunction (off-label) and pulmonary arterial hypertension (PAH) in adults.  Reviewed and voted to MAINTAIN generic Revatio on
the commercial formulary with prescribing for the treatment of PAH restricted to Cardiology and Pulmonology but unrestricted for all other uses.  When prescribed for erectile dysfunction, the following quantity limits will apply per 30 day-supply based on the dose of Viagra: o Viagra 25 mg = sildenafil 20 mg, 8 tablets o Viagra 50 mg = sildenafil 20 mg, 24 tablets o Viagra 100 mg = sildenafil 20 mg, 40 tablets  Maintain generic Revatio on Tier 2 of the MPD  Adcirca has similar efficacy and safety compared to sildenafil 20 mg (generic Revatio), which is the KPMAS-preferred option for treating patients with pulmonary arterial hypertension.  Reviewed and voted to REMOVE from the commercial
 Adcirca will be available via the formulary exception  Maintained on Tier 5 of the MPD formulary. Regional Pharmacy & Therapeutics Committee July 2013 Formulary Decisions Submitted by: Paulette E. Crawford, PharmD, CGP Commercial and Medicare Part D (MPD) Formulary Decisions (cont’d)
DRUG AND STRENGTH
RESTRICTION/COMMENT
 Preservative-free (sulfite-free) epinephrine 1 mg/mL injection for intracameral injection is on manufacturer  Reviewed and voted to ADD compound lidocaine 1%
and phenylephrine 1.5 %/1 mL injection as an alternative; effective 8/5/2013.  Compounding will be outsourced to Leiter’s Pharmacy  Product is exempt from MPD formulary.  Given use in clinic, ADD Gelfoam (absorbable gelatin
sponge) size 12 (2 x 7 mm), and size 100 (8 x 12.5 cm) to the commercial formulary; effective 8/5/2013.  Product is exempt from MPD formulary. Class Review: Platelet-aggregation  No changes recommended. Class Review: Thrombolytic Agents  No changes recommended. Class Review: Antiarrythmic Agents  No changes recommended. Class Ia, Class Ib, Class Ic, Class III, Class IV Class Review: Cardiotonics Regional Pharmacy & Therapeutics Committee July 2013 Formulary Decisions Submitted by: Paulette E. Crawford, PharmD, CGP Commercial and Medicare Part D (MPD) Formulary Decisions (cont’d)
DRUG AND STRENGTH
RESTRICTION/COMMENT
Reductase Inhibitors Class Review: Miscellaneous Class Review: Hypotensive Agents  No changes recommended. Adrenergic Inhibitors Class Review: Vasodilating Agents  No changes recommended. Class Review: Nitrates and Nitrites  No changes recommended.  See decisions above for Adcirca and generic Revatio. Type-5 Inhibitors Class Review: Miscellaneous Vasodilating Agents Class Review: Sclerosing Agents Blocking Agents Class Review: β-Adrenergic Blocking Agents Class Review: Calcium-Channel Blocking Agent Class Review: Dihydropyridines Calcium-Channel Blockers Class Review: Renin-Angiotensin- Aldosterone System Inhibitors Class Review: Angiotensin- Converting Enzyme Inhibitors Class Review: Angiotensin II Receptor Antagonists Class Review: Aldosterone Receptor Antagonists Class Review: Renin Inhibitors Regional Pharmacy & Therapeutics Committee July 2013 Formulary Decisions Submitted by: Paulette E. Crawford, PharmD, CGP Commercial and Medicare Part D (MPD) Formulary Decisions (cont’d)
DRUG AND STRENGTH
RESTRICTION/COMMENT
Inhibitors Class Review: Amylinomimetics REMOVE Lantus OptiClik SC 100 unit/mL
solution from the commercial formulary; effective 8/5/13. Product has been discontinued. REMOVE Lantus Solostar SC 100 unit/mL
solution from the commercial formulary, effective 8/5/13. REMOVE Humalog KwikPen SC 100 unit/mL
solution from the commercial formulary; effective 8/5/13. REMOVE Humalog Pen SC 100 unit/mL
solution from the commercial formulary, effective 8/5/13.  Insulin pens are non-formulary items under the commercial formulary; insulin vials are available Commercial and Medicare Part D (MPD) Formulary Decisions (cont’d)
DRUG AND STRENGTH
RESTRICTION/COMMENT
Regional Pharmacy & Therapeutics Committee July 2013 Formulary Decisions Submitted by: Paulette E. Crawford, PharmD, CGP Class Review: Somatropin Agonists  Omnitrope 5 mg/ 1.5 mL and 10 mg/1.5 mL SC solution are the preferred formulary somatropin agonists. REMOVE the following products from the
Norditropin FlexPro SC 5 mg/1.5 mL solution Norditropin FlexPro SC 10 mg/1.5 mL solution Norditropin NordiFlex Pen SC 5 mg/1.5 mL solution Norditropin NordiFlex Pen SC 10 mg/1.5 mL solution Norditropin SC 5 mg/1.5 mL solution (discontinued) Luteum Hormones Class Review: Thyroid Agents Therapeutic Agents Class Review: Disease-modifying Inter-regional MPD Pharmacy and Therapeutics (iM-PacT) Committee Decisions
(Recently launched and approved products)
DRUG AND STRENGTH
RESTRICTION/COMMENT
 Placed on Specialty Tier 5 of MPD formulary; effective  Placed on Specialty Tier 5 of MPD formulary; effective  Treatment of chronic idiopathic constipation and irritable bowel syndrome with constipation (IBS-C) in adults.  Specialist review in progress, remains on Non-  For the Reduction of Triglyceride Levels in Adult Patients With Severe Hypertriglyceridemia  Specialist review in progress, remains on Non- Apixaban (Eliquis) tab 2.5 mg and 5  To prevent stroke and systemic embolism in patients  Specialist review in progress, remains on Non- Anakinra (Kineret) injection 100 mg  For the treatment of children and adults with neonatal- onset multisystem inflammatory disease (NOMID)  New indication for Specialty Tier 5, review not Effective dates reflect implementation into the systems.
Regional Pharmacy & Therapeutics Committee July 2013 Formulary Decisions Submitted by: Paulette E. Crawford, PharmD, CGP KAISER PERMANENTE
Mid-Atlantic States Region
Pharmacy & Therapeutics Committee

On the Kaiser Permanente Intranet
1. Where can I find the drug formulary online?

Click on “Formulary” link on KPHealthConnect home page (bottom right), or
MAPMG Providers via intranet:
 Go to http://pithelp.co.kp.org/MAS/phcy_therpeutics.html
Network Providers:
 Go
http://providers.kp.org/mas/formulary.html 2. How can I find out if something is on the drug formulary and view the drug monograph
for a drug on the formulary?
MAPMG Providers
 To view the criteria for use, contraindications, adverse reactions, drug interactions, and
dosing information, click on the Lexi-comp® Interactive Version under Full MAS Drug Formulary. When you enter the site, a search screen appears in the upper left hand corner of your screen. Type in the first few letters or the entire drug name and select SEARCH. All drugs containing that information are listed in the SEARCH RESULTS box. If a drug is not on formulary or it is spelled incorrectly, "No occurrences found" will appear in the SEARCH RESULTS box.  Formulary status of a particular drug can be found in HealthConnect™ in the “Pharmacy” column in the drug listing. “Yes” in this column means that particular product is formulary. Remember, there are sometimes many duplicative products for a single drug entity. In that event, scroll down the list to look for the product that is formulary. http://providers.kp.org/mas/formulary.html  Click on comprehensive listing of formulary drugs  Press (ctrl+F) and search for the particular drug of interest on the “Find” field appearing on  If the drug is spelled incorrectly or is not on the formulary the following message will appear
3. How can I receive a copy of the formulary?

MAPMG Providers
http://pithelp.co.kp.org/MAS/formulary.html  You may print a copy of the formulary document Network Providers  Go http://providers.kp.org/mas/formulary.html  Click on comprehensive listing of formulary drugs  You may print a copy of the formulary document Regional Pharmacy & Therapeutics Committee July 2013 Formulary Decisions Submitted by: Paulette E. Crawford, PharmD, CGP You may also contact our Provider Relations Department at 1-877-806-7470 for a paper copy of our formularies. 4. How can I request an addition or deletion from the formulary?
 New drug entities remain Non-formulary until reviewed by the Regional P&T Committee. We will review any drug upon written request with supporting evidence to make an evidence-based decision. The Drug Formulary Addition and Deletion Request Form can be obtained via the internet for both MAPMG and Network Providers: http://pithelp.co.kp.org/MAS/documents/phcy_therpeutics/formulary_addition_deletion_request.pdf http://providers.kp.org/mas/formulary.html  Under section “Request to review medications for addition/deletion to the formulary”, 1. Faxed at 301-816-6372, attention: P&T Committee co-chairs 2. Mailed to: Kaiser Permanente Regional Office, Pharmacy 3-West Attention: P&T Committee Co-Chairs, Drug Review 2101 East Jefferson Street Rockville, MD 20852 3. Emailed by contacting any of the P&T Committee Co Chairs: Regional Pharmacy & Therapeutics Committee July 2013 Formulary Decisions Submitted by: Paulette E. Crawford, PharmD, CGP FORMULARY REVIEW PROCESS
Applying evidence-based medicine, the Regional P&T Committee and its Consultants determine
whether a medicine should be added to the drug formulary. The key points of this evidence-based
review are highlighted; a full description of the formulary review process is available on
www.mapmgonline.com, within the Pharmacy Group.
EFFICACY
Lack of compelling evidence
High ETY
probability of
EFFICACY
medication error
“Me-Too” Drugs
Potential Need for
Therapeutic Monitoring FORMULARY
Limited
Indication
Counters KP’s Mission
Strong Potential for Misuse
THERAPEUTIC
STEWARDSHIP
Non-formulary Considerations
Drug accepted on basis of sound clinical evidence that supports it’s:  1st line therapy; standard of care  Bioequivalent to existing drugs, most cost-effective  Status encourages use over NF agents Drug not accepted due to concerns in 1 or more of the following:  Duplicate Bioequivalent Agents, not cost-effective IN ADDITION TO FORMULARY OR NON-FORMULARY STATUS, DRUGS MAY BE RESTRICTED TO PRESCRIBING CRITERIA OR TO PRESCRIBER SPECIALTY DUE TO ISSUES REGARDING:  Limited indications/uses of drug endorsed *Stewardship: We ensure our stewardship using and managing our resources appropriately - KP-MAS Regional Pharmacy & Therapeutics Committee July 2013 Formulary Decisions Submitted by: Paulette E. Crawford, PharmD, CGP

Source: http://providers.kaiserpermanente.org/info_assets/cpp_mas/mas_formulary%20decisions_july%202013%20updated.pdf