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Department of Health and Human Services Division Of BRIAN SANDOVAL RICHARD WHITLEY, MS Governor Director MARTA JENSEN Administrator DEPARTMENT OF HEALTH AND HUMAN SERVICES DIVISION OF HEALTH CARE FINANCING AND POLICY 1100 East William Street, Suite 101 Carson City, Nevada 89701 Telephone (775) 684-3676 • Fax (775) 687-3893 http://dhcfp.nv.gov PHARMACY AND THERAPEUTICS COMMITTEE Draft Meeting Minutes Date and Time of Meeting: Thursday, June 28, 2018 at 1:00 PM Name of Organization: The State of Nevada, Department of Health and Human Services (DHHS), Division of Health Care Financing and Policy (DHCFP) Place of Meeting: North Nevada Location: Division of Public & Behavioral Health 4150 Technology Way, Room 303 Carson City, NV 89706 South Nevada Location: Springs Preserve 333 S Valley View Blvd Las Vegas, NV 89107 Attendees Board Members (Present Las Vegas) Board Members (Absent) Shamim Nagy, MD, Chair Michael Hautekeet, RPh Mark Decerbo, Pharm.D. Joseph Adashek, MD Adam Zold, Pharm.D. Chris Highley, DO Evelyn Chu, Pharm.D. Sapandeep Khurana, MD Board Members (Present Carson City) Kate Ward, Pharm.D. Nevada Department of Health and Human Services Helping People -- It's Who We Are And What We Do December 20, 2018 Page 2 DHCFP (Las Vegas): Holly Long, Social Services Program Specialist III Gabe Lither, DAG DHCFP (Carson City): Jack Zenteno, DHCFP DXC (Carson City): Beth Slamowitz, Pharm.D. OptumRx (Las Vegas): Carl Jeffery, Pharm.D. Kevin Whittington, RPh Public (Las Vegas): Nate Bailey, Pfizer Alice Swett, Alexion Danny McNatty, Janssen Mark Schwartz, GSK William Crawford, DSI Cynthia Albert, Merck, Bryan Rodriguez, DSI Charissa Anne, J&J Michael Sans, Otsuka Allen Quan, DSI Samantha Sweeney, Otsuka Keri Smith, VIIV Mike Stroud, Novo Nordisk Christy Lemons, Orexo Pauline Whelan, Orexo Nana Numapay, BI William Lam, Boehringer Ingelheim Todd Gavin, Indivior Phil Walsh, Sunovian Georgette C., Indivior Leon Ravin, DPBH Public (Carson City): Lea Cartwright, JK Belz Paige Barnes, Crowley & Ferrato Public (Teleconference): Stephanie Ferrell, DXC Gary Okano, BMS Bruce Smith, GSK Brad Fuller, Aerie Melissa Wagenbrenner, Aerie AGENDA 1. Call to Order and Roll Call Meeting called to order at 1:00 PM. Holly Long Carl Jeffery Kevin Whittington Sapandeep Khurana Adam Zold Mark Decerbo 2 December 20, 2018 Page 3 Gabe Lither Evelyn Chu Shamim Nagy Beth Slamowitz Kate Ward 2. Public Comment 3. Administrative a. For Possible Action: Review and Approve Meeting Minutes from December 7, 2017 b. Status Update by DHCFP Holly Long: The Nevada Medicaid Drug Use Review Board has voted to adopt prior authorization changes at the October 19 meeting with the public hearing on April 26, 2018. These changes include revised prior authorization criteria for Xolair for pediatric patients, new prior authorization criteria for Austedo, Brineura, Ingrezza, Emflaza and Xadago. The DUR Board also recommended new prior authorization criteria for codeine and Tramadol for pediatric patients. For provider type 33, which is durable medical equipment, they added a HCPCS code with a zero rate, which will require prior authorization. This is effective for claims with a date of service on or after April 1, 2018. I have a list of the codes available if anyone is interested. All this information is also on the website on June 20, 2018. That concludes the update. i. Public Comment (indiscernible speakers) Shamim Nagy: Motion for approval of the meeting minutes. We need a motion of approval. Evelyn Chu: I move to accept the minutes from the last meeting. Adam Zold: Second Motion approved. 4. Proposed New Drug Classes a. Monoclonal Antibodies for the Treatment of Respiratory Conditions No public comment. Carl Jeffery: This is a new proposed class we have for the Board. It’s kind of a confusing class because all of these need to be administered in the doctor’s office so they’re all have to be administered that way, but we’re seeing a lot of claims coming through the pharmacy system so we thought we would introduce you, put these on the preferred drug list and have the benefits with having them listed on the preferred drug list. There’s three medications currently in this class. We have these that the DUR Board added criteria so there’s all clinical criteria on these but it’s very limited to just what the labeled indication is. There’s no crazy criteria on it. You’ll see the Xolair is a little bit different. It’s an IGE so it’s binds up the IGE. The other one’s kind of the same way. They’re IL-5 modulated so they’re a little bit different but they all have the same effect on reducing the antibodies that cause some of the reactive asthma disease. The comparative study, there’s not a whole lot out there. There’s a few that I looked at that Nevada Department of Health and Human Services Helping People -- It's Who We Are And What We Do December 20, 2018 Page 4 compared the Nucala and the Xolair. Statistically not really different. There’s a trend towards the benefit of the Nucala and in another review, with all of them, and they’re all very effective for patients that qualify to receive them, but there’s really no huge difference between them. I broke down kind of the different indications. You can see Xolair has more indications. We’re recommending Nucala be preferred anyway so this doesn’t really apply as with other eosinophilic granulomatosis added on there, too. The other ones have similar indications. The dosing is on here. I don’t know how familiar the Board is with these medications. I know it’s something we see too much, but most of them are every 4 weeks. The newest one on the market here is the Fasenra. It’s dosage is every 8 weeks after the first 3 doses so there’s a slight advantage and then the Cinqair which I’ll show you in a second, we don’t have any utilization of that one as that one has to be infused over 15 minutes so we don’t see that one in the pharmacy claims. So here’s our first quarter 2018 utilization. We have 71 claims for the Xolair and then 10 claims for Nucala. Xolair has by far been out much longer than the other one so it kind of makes sense, the Cinqair, we may never see claims for this because those are the ones that IV infusion they may only be billed through the doctor’s office so we may never see those but the Fasenra, I would expect to see a few claims once it gets more established in the marketplace. So, Optum makes the recommendation that this class be considered clinically and therapeutically equivalent. A motion and second to accept as clinically and therapeutically equivalent. The board voted unanimously, the motion carries. Carl Jeffery: Optum makes the recommendation since again it’s a new class, we don’t have any of these drugs that apparently are on the preferred drug list, but we would recommend the Nucala and Xolair be added to preferred and the Cinqair and Fasenra as non-preferred, and this just because the breadth of the indications and the current utilization trends, I think it kind of makes sense. Mark Decerbo: Since the proposed PDL, is there any functional difference from Medicaid whether it’s still preferred at home or a certain physician’s office or is that not (indiscernible). Carl Jeffery: My understanding is these aren’t allowed to be administered at home. I think there’s still a period of observation even after a dose that is needed so I think potentially they could be done through Home Health, but I think what we’re mostly seeing is they’re administered at the doctor’s office. Mark Decerbo: But unlike the IV product, there’s a different mechanism or would fall under to be consider for PDL? Carl Jeffery: There’s a lot of different ways doctors’ offices bill and so one they can just order the product in themselves and they’d have the stock on hand. I think what’s happening with these and why we’re seeing a utilization come through the pharmacy program is the doctors are ordering from the pharmacy, the pharmacy is filling it and billing it and then shipping it to the doctor’s office for administration and I think that’s where we’re seeing the benefits of having the preferred drug list on here. Kevin Whittington: We did see some Cinqair come through in 2017. Motion to accept PDL as presented and second. The Board votes unanimously, the motion carries. 5. Established Drug Classes Nevada Department of Health and Human Services Helping People -- It's Who We Are And What We Do December 20, 2018 Page 5 a. Cardiovascular Agents - Antihypertensive Agents - Direct Renin Inhibitors No public comment. Carl Jeffery: Optum recommends that the Board remove this class of medications from the PDL. This is a class that’s not frequently used. We’re not seeing any benefit from having it on here. What removal does for this class is essentially just open up access. So potentially makes it all preferred because there’s no restriction as when we have something in a class, it essentially makes it non-preferred. But what this will do is it makes everything where the rules don’t apply anymore. Here’s the utilization up here. We have a total of 4 claims over the quarter, so I think we’ve got one member is on the Tekturna still. They’re pretty good about getting their prescription filled every 3 months and then there’s one Tekturna HCT.
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