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Non-Steroidal Anti-Inflammatories PDL Drug Class Review Announcement October 5, 2021 Drug Classes to be reviewed: Non-Steroidal Anti-Inflammatories (NSAIDs) (Oral & Non-Oral); Antibiotics, Inhaled; Anti-Herpetic Agents (Oral & Topical); Fluoroquinolones, Oral; Hepatitis C Virus Treatments (Direct Acting Antivirals & Ribavirin Products); Human Immunodeficiency Virus (HIV) Agents, Oral; Pulmonary Arterial Hypertension Therapies (Phosphodiesterase Inhibitors, Endothelin Antagonists, Prostanoids, Guanylate Cyclase Stimulator); Newer Generation Antidepressants; Monoamine Oxidase Inhibitors (MAOIs); Tricyclic Antidepressants (TCAs); Triptans and Other Migraine Agents (Oral & Non-Oral); Anti-Psoriatics (Oral & Topical); Topical Immunomodulators; Topical Steroids (Low, Medium, High, & Very High Potency); Antiemetics (Oral & Non-Oral); H. Pylori Treatments; Pancreatic Enzymes; Proton Pump Inhibitors; Non- Biologic Ulcerative Colitis Agents (Oral & Rectal); Immune Globulins; Newer Generation Antihistamines; Antihistamine/Decongestant Combinations; Intranasal Rhinitis Agents; Leukotriene Modifiers; Methotrexate Products; Targeted Immune Modulators; Epinephrine Products; Newer Hereditary Angioedema Agents; Antihyperuricemics; Respiratory Agents [Anticholinergics & Combinations, Beta-2 Agonists (Short & Long), Corticosteroids & Combinations, Phosphodiesterase Inhibitors]. These drug classes will be reviewed at the October 5th, 2021 P&T Committee meeting from 1-5pm. The meeting will be held virtually. Dossiers and Supplemental Rebate offers are due to Magellan by September 7, 2021. Interested parties who want to present at the meeting shall give advanced notice and provide a one-page summary of the clinical information no later than September 28, 2021 by 5pm MT. Please direct requests to Jessica Czechowski, Pharmacist Account Executive, [email protected] and carbon copy Brittany Schock, PDL & Clinical Strategy Pharmacist, at 303-866-6371 or by email at [email protected] to present at the meeting. Advance notice requests to present and/or written public comments can be submitted to and will be distributed to P&T Committee Members, once approved. Policies surrounding stakeholder comment can be found at: https://www.colorado.gov/pacific/hcpf/pharmacy-and-therapeutics-committee NON-STEROIDAL ANTI-INFLAMMATORIES (NSAIDS) Brand Name Generic Name Oral Diclofenac sodium DR/EC tablet, ER tablet Diclofenac potassium tablet Diflunisal tablet Etodolac capsule, tablet, ER tablet Flurbiprofen tablet Ibuprofen tablet (Rx), suspension Indomethacin capsule, ER capsule Ketoprofen capsule, ER capsule Ketorolac tablet Meclofenamate capsule Mefenamic acid capsule Nabumetone tablet Naproxen tablet, DR tablet, suspension Naproxen sodium ER tablet, IR tablet Sulindac tablet Tolmetin tablet, capsule Arthrotec Diclofenac/misoprostol tablet Diclofenac/misoprostol tablet Celebrex Celecoxib capsule Celecoxib capsule Daypro Oxaprozin tablet Oxaprozin tablet Duexis Ibuprofen/famotidine tablet Ibuprofen/famotidine tablet Feldene Piroxicam capsule Piroxicam capsule Indocin Indomethacin suspension Mobic Meloxicam tablet Meloxicam tablet, suspension Nalfon Fenoprofen capsule, tablet Fenoprofen capsule, tablet Naprelan CR Naproxen sodium CR tablet Naproxen sodium CR tablet Qmiiz Meloxicam ODT Relafen DS Nabumetone tablet Vimovo Naproxen/esomeprazole DR tablet Naproxen/esomeprazole DR tablet Vivlodex Meloxicam, submicronized capsule Meloxicam, submicronized capsule Zipsor Diclofenac potassium capsule Zorvolex Diclofenac, submicronized capsule Non-Oral Diclofenac topical solution Flector Diclofenac patch Diclofenac patch Licart Diclofenac patch Pennsaid Diclofenac solution pump Sprix Ketorolac nasal solution Ketorolac nasal solution Voltaren (Rx) Diclofenac gel (Rx) Diclofenac gel (Rx) ANTIBIOTICS, INHALED Brand Name Generic Name Arikayce Amikacin liposomal vial Bethkis Tobramycin ampule Tobramycin ampule Cayston Aztreonam inhalation solution Kitabis Tobramycin nebulizer Pak Tobramycin nebulizer Pak Tobi Tobramycin inhalation solution Tobramycin inhalation solution Tobi Podhaler Tobramycin inhalation capsule ANTIHERPETIC AGENTS Brand Name Generic Name Oral Famciclovir tablet Sitavig Acyclovir buccal tablet Valtrex Valacyclovir tablet Valacyclovir tablet Zovirax Acyclovir suspension Acyclovir tablet, capsule, suspension Topical Denavir Penciclovir cream Xerese Acyclovir/hydrocortisone cream Zovirax Acyclovir ointment, cream Acyclovir ointment, cream FLUOROQUINOLONES, ORAL Brand Name Generic Name Levofloxacin tablet, solution Moxifloxacin tablet Ofloxacin tablet Baxdela Delafloxacin tablet Cipro Ciprofloxacin tablet, suspension Ciprofloxacin tablet, suspension HEPATITIS C VIRUS TREATMENTS Brand Name Generic Name Direct Acting Antivirals (DAAs) Epclusa Velpatasvir/Sofosbuvir tablet Velpatasvir/Sofosbuvir tablet Harvoni Ledipasvir/Sofosbuvir tablet, pellet packet Ledipasvir/Sofosbuvir tablet Mavyret Glecaprevir/Pibrentasvir tablet Sovaldi Sofosbuvir tablet, pellet packet Viekira Pak Ombitasvir/Paritaprevir/Ritonavir/Dasabuvir tablet Vosevi Velpatasvir/Sofosbuvir/Voxilaprevir tablet Zepatier Elbasvir/Grazoprevir tablet Ribavirin Products Ribavirin capsule, tablet Ribasphere Ribavirin tablet Ribasphere Ribapak Ribavirin dosepack HUMAN IMMUNODEFICIENCY VIRUS (HIV) AGENTS, Oral Brand Name Generic Name Didanosine DR capsule Stavudine capsule Aptivus Tipranavir capsule Atripla Efavirenz/Emtricitabine/Tenofovir (TDF) tablet Efavirenz/Emtricitabine/Tenofovir (TDF) tablet Biktarvy Bictegravir/Emtricitabine/Tenofovir alafenamide (TAF) tablet Cimduo Lamivudine/Tenofovir (TDF) tablet Combivir Lamivudine/Zidovudine tablet Lamivudine/Zidovudine tablet Complera Emtricitabine/Rilpivirine/Tenofovir (TDF) tablet Crixivan Indinavir sulfate capsule Delstrigo Doravirine/Lamivudine/Tenofovir (TDF) tablet Descovy Emtricitabine/Tenofovir alafenamide (TAF) tablet Dovato Dolutegravir sodium/Lamivudine tablet Edurant Rilpivirine HCl tablet Emtriva Emtricitabine capsule, solution Emtricitabine capsule Epivir Lamivudine solution, tablet Lamivudine solution, tablet Epzicom Abacavir sulfate/Lamivudine tablet Abacavir sulfate/Lamivudine tablet Evotaz Atazanavir/Cobicistat tablet Genvoya Elvitegravir/Cobicistat/Emtricitabine/Tenofovir alafenamide (TAF) tablet Intelence Etravirine tablet Etravirine tablet Invirase Saquinavir mesylate tablet Isentress, Isentress HD Raltegravir potassium chewable, powder pack, tablet Juluca Dolutegravir/Rilpivirine tablet Kaletra Lopinavir/Ritonavir solution, tablet Lopinavir/Ritonavir solution, tablet Lexiva Fosamprenavir suspension, tablet Fosamprenavir tablet Norvir Ritonavir powder packet, solution, tablet Ritonavir tablet Odefsey Emtricitabine/Rilpivirine/Tenofovir alafenamide (TAF) tablet Pifeltro Doravirine tablet Prezcobix Darunavir/Cobicistat tablet Prezista Darunavir ethanolate suspension, tablet Retrovir Zidovudine capsule, syrup Zidovudine capsule, syrup, tablet Reyataz Atazanavir capsule, powder packet Atazanavir capsule Rukobia Fostemsavir tromethamine ER tablet Selzentry Maraviroc solution, tablet Stribild Elvitegravir/Cobicistat/Emtricitabine/Tenofovir (TDF) tablet Sustiva Efavirenz capsule, tablet Efavirenz capsule, tablet Symfi, Symfi Lo Efavirenz/Lamivudine/Tenofovir (TDF) tablet Efavirenz/Lamivudine/Tenofovir (TDF) tablet Symtuza Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (TAF) tablet Temixys Lamivudine/Tenofovir (TDF) tablet Tivicay Dolutegravir sodium tablet, tablet for suspension Triumeq Abacavir/Dolutegravir/Lamivudine tablet Trizivir Abacavir/Lamivudine/Zidovudine tablet Abacavir/Lamivudine/Zidovudine tablet Truvada Emtricitabine/Tenofovir (TDF) tablet Emtricitabine/Tenofovir (TDF) tablet Tybost Cobicistat tablet Viracept Nelfinavir mesylate tablet Viramune, Viramune XR Nevirapine suspension, ER tablet Nevirapine suspension, ER tablet, IR tablet Viread Tenofovir disoproxil fumarate (TDF) powder, tablet Tenofovir disoproxil fumarate (TDF) tablet Vocabria Cabotegravir sodium tablet Ziagen Abacavir sulfate solution, tablet Abacavir sulfate solution, tablet PULMONARY ARTERIAL HYPERTENSION, Phosphodiesterase Inhibitors Brand Name Generic Name Adcirca Tadalafil tablet Tadalafil tablet Alyq Tadalafil tablet Revatio Sildenafil tablet, oral suspension Sildenafil tablet, oral suspension PULMONARY ARTERIAL HYPERTENSION, Endothelin Antagonists Brand Name Generic Name Letairis Ambrisentan tablet Ambrisentan tablet Opsumit Macitentan tablet Tracleer Bosentan tablet, tablet for suspension Bosentan tablet PULMONARY ARTERIAL HYPERTENSION, Prostanoids Brand Name Generic Name Flolan Epoprostenol vial Epoprostenol vial Orenitram Treprostinil ER tablet Remodulin Treprostinil vial Treprostinil vial Tyvaso Treprostinil inhalation solution Uptravi Selexipag tablet, dosage pack Veletri Epoprostenol vial Epoprostenol vial Ventavis Iloprost inhalation solution PULMONARY ARTERIAL HYPERTENSION, Guanylate Cyclase Stimulator Brand Name Generic Name Adempas Riociguat tablet NEWER GENERATION ANTIDEPRESSANTS Brand Name Generic Name Bupropion IR Tablet Desvenlafaxine fumarate ER tablet Duloxetine 40mg capsule (generic Irenka) Fluoxetine tablet Fluvoxamine IR tablet, ER capsule Nefazodone tablet Trazodone tablet Venlafaxine IR tablet, ER tablet Aplenzin Bupropion ER tablet Celexa Citalopram tablet Citalopram solution, tablet Cymbalta Duloxetine DR capsule Duloxetine DR capsule Drizalma Duloxetine sprinkle capsule Effexor XR Venlafaxine ER capsule Venlafaxine ER capsule Fetzima ER Levomilnacipran ER capsule, titration pak Forfivo XL Bupropion XL tablet Bupropion XL tablet Lexapro Escitalopram
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