List of Off-Patent, Off-Exclusivity Drugs Without an Approved Generic
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Hyperinflation Management Medications Requiring Prior Authorization for Medical Necessity
July 2021 Effective 07/01/2021 Hyperinflation Management Medications Requiring Prior Authorization for Medical Necessity Below is a list of medicines by drug class that will not be covered without a prior authorization for medical necessity. If you continue using one of these drugs without prior approval for medical necessity, you may be required to pay the full cost. If you are currently using one of the drugs requiring prior authorization for medical necessity, ask your d octor to choose one of the generic or brand formulary options listed below. Category * Drugs Requiring Prior Formulary Options Drug Class Authorization for Medical Necessity 1 Allergies Dexchlorpheniramine levocetirizine Antihistamines Diphen Elixir (NDC^ 69067009204 only) RyClora CARBINOXAMINE TABLET 6 MG Anti-convulsants topiramate ext-rel capsule carbamazepine, carbamazepine ext-rel, (generics for QUDEXY XR only) clobazam, divalproex sodium, divalproex sodium ext-rel, gabapentin, lamotrigine, lamotrigine ext-rel, levetiracetam, levetiracetam ext-rel, oxcarbazepine, phenobarbital, phenytoin, phenytoin sodium extended, primidone, rufinamide, tiagabine, topiramate, valproic acid, zonisamide, FYCOMPA, OXTELLAR XR, TROKENDI XR, VIMPAT, XCOPRI ZONEGRAN carbamazepine, carbamazepine ext-rel, divalproex sodium, divalproex sodium ext-rel, gabapentin, lamotrigine, lamotrigine ext-rel, levetiracetam, levetiracetam ext-rel, oxcarbazepine, phenobarbital, phenytoin, phenytoin sodium extended, primidone, tiagabine, topiramate, valproic acid, zonisamide, FYCOMPA, OXTELLAR XR, TROKENDI -
30 Day Change Notice Effective Date
30 Day Change Notice Effective Date: January 1st, 2021 NEW PREFERRED DRUGS THERAPEUTIC CLASS NO PA REQUIRED PREFERRED Central Nervous System (CNS) Agents: Anticonvulsants Clobazam (Generic of Onfi) Central Nervous System (CNS) Agents: Multiple Aubagio EndocrineSclerosis Agents: Osteoporosis-Bone Ossification Forteo Enhancers Gastrointestinal Agents: Anti-Emetics Bonjesta Genitourinary Agents: Benign Prostatic Hyperplasia Alfuzosin (Generic of Uroxatral) Dutasteride (Generic of Avodart) Genitourinary Agents: Electrolyte Depleter Agents Sevelamer (Generic of Renagel and Renvela) Infectious Disease Agents: Antibiotics-Macrolides Eryped Infectious Disease Agents: Antivirals-HIV Atazanavir Sulfate Oral Powder (Generic of Reyataz) Tivicay PD Infectious Disease Agents: Antibiotics-Tetracyclines Vibramycin Suspension (no PA Required for age 12 or under) Ophthalmic Agents: Antibiotics and Antibiotic -Steroid Neomycin/Polymyxin/Bacitracin/Hydrocortisone Ointment Combination Drops and Ointments Ophthalmic Agents: Glaucoma Agents Dorzolamide/Timolol (Generic of Cosopt PF) NEW CLINICAL PA REQUIRED “PREFERRED” DRUGS THERAPEUTIC CLASS CLINICAL PA REQUIRED PREFERRED Blood Formation, Coagulation, and Thrombosis Agents: Corifact Hemophilia Factors Immunomodulator Agents for Systemic Inflammatory Taltz Disease Immunomodulator Agents for Systemic Inflammatory Xeljanz 5mg Disease NEW STEP THERAPY REQUIRED “PREFERRED” THERAPEUTIC CLASS STEP THERAPY REQUIRED “PREFERRED” Central nervous System (CNS) Agents: Anti-Migraine, Aimovig Prophylaxis Treatment Ajovy -
Antifungals, Topical
Therapeutic Class Overview Antifungals, Topical INTRODUCTION The topical antifungals are available in multiple dosage forms and are indicated for a number of fungal infections and related conditions. In general, these agents are Food and Drug Administration (FDA)-approved for the treatment of cutaneous candidiasis, onychomycosis, seborrheic dermatitis, tinea corporis, tinea cruris, tinea pedis, and tinea versicolor (Clinical Pharmacology 2018). The antifungals may be further classified into the following categories based upon their chemical structures: allylamines (naftifine, terbinafine [only available over the counter (OTC)]), azoles (clotrimazole, econazole, efinaconazole, ketoconazole, luliconazole, miconazole, oxiconazole, sertaconazole, sulconazole), benzylamines (butenafine), hydroxypyridones (ciclopirox), oxaborole (tavaborole), polyenes (nystatin), thiocarbamates (tolnaftate [no FDA-approved formulations]), and miscellaneous (undecylenic acid [no FDA-approved formulations]) (Micromedex 2018). The topical antifungals are available as single entity and/or combination products. Two combination products, nystatin/triamcinolone and Lotrisone (clotrimazole/betamethasone), contain an antifungal and a corticosteroid preparation. The corticosteroid helps to decrease inflammation and indirectly hasten healing time. The other combination product, Vusion (miconazole/zinc oxide/white petrolatum), contains an antifungal and zinc oxide. Zinc oxide acts as a skin protectant and mild astringent with weak antiseptic properties and helps to -
Active Pharmaceutical Ingredients
Active Pharmaceutical Ingredients Catalog HPD-5E ® CREATING A HEALTHY WORLDTM Active Pharmaceutical Ingredients (APIs) Available for International Markets Human Pharmaceutical Department www.Pharmapex.net Catalog HPD-5E *Not all products referred to on this site are available in all countries and our products are subject to different regulatory requirements depending on the country of use. Consequently, certain sections of this site may be indicated as being intended only for users in specic countries. Some of the products may also be marketed under different trade names. You should not construe anything on this site as a promotion or solicitation for any product or for the use of any product that is not authorized by the laws and regulations of your country of residence. For inquiries about the availability of any specic product in your country, you may simply contact us at [email protected]. **Products currently covered by valid US Patents may be offered for R&D use in accordance with 35 USC 271(e)+A13(1). Any patent infringement and resulting liability is solely at buyer risk. ©2016, Pharmapex USA, A member of Apex Group of Companies, All Rights Reserved. Toll-Free: 1.844.PHARMAPEX Fax: + 1.619.881.0035 ACTIVE PHARMACEUTICAL [email protected] CREATING A HEALTHY WORLD™ www.Pharmapex.net INGREDIENTS About Pharmapex’s Human Pharmaceuticals Department: Pharmapex’s Human Pharmaceuticals Department (HPD) is a leading source for high-quality Active Pharmaceutical Ingredients (APIs) and Finished Pharmaceutical Products (FPPs) in various markets across the globe. With an extensive product portfolio, our consortium of companies is dedicated to addressing and solving the most important medical needs of our time, including oncology (e.g., multiple myeloma and prostate cancer), neuroscience (e.g., schizophrenia, dementia and pain), infectious disease (e.g., HIV/AIDS, Hepatitis C and tuberculosis), and cardiovascular and metabolic diseases (e.g., diabetes). -
Ep 1931310 B1
(19) & (11) EP 1 931 310 B1 (12) EUROPEAN PATENT SPECIFICATION (45) Date of publication and mention (51) Int Cl.: of the grant of the patent: A61K 9/12 (2006.01) A61K 9/06 (2006.01) 06.06.2012 Bulletin 2012/23 A61K 9/70 (2006.01) A61K 47/32 (2006.01) A61K 47/24 (2006.01) A61K 47/10 (2006.01) (21) Application number: 06779420.6 (86) International application number: (22) Date of filing: 14.09.2006 PCT/GB2006/003408 (87) International publication number: WO 2007/031753 (22.03.2007 Gazette 2007/12) (54) Monophasic film-forming composition for topical administration Monophasische filmbildende Zusammensetzung zum topischen Auftrag Composition monophase formant un film pour l’administration à voie topique (84) Designated Contracting States: • JONES, Stuart, Allen AT BE BG CH CY CZ DE DK EE ES FI FR GB GR London SE3 0XA (GB) HU IE IS IT LI LT LU LV MC NL PL PT RO SE SI SK TR (74) Representative: Lord, Hilton David Marks & Clerk LLP (30) Priority: 14.09.2005 GB 0518769 90 Long Acre London (43) Date of publication of application: WC2E 9RA (GB) 18.06.2008 Bulletin 2008/25 (56) References cited: (73) Proprietor: Medpharm Limited WO-A2-01/43722 US-A- 4 752 466 Charlbury, US-A- 4 863 721 US-A1- 2004 184 994 Oxfordshire OX7 3RR (GB) US-A1- 2004 213 744 (72) Inventors: • BROWN, Marc, Barry Hertfordshire WD19 4QQ (GB) Note: Within nine months of the publication of the mention of the grant of the European patent in the European Patent Bulletin, any person may give notice to the European Patent Office of opposition to that patent, in accordance with the Implementing Regulations. -
INTEGRIS Formulary July 2017
INTEGRIS Formulary July 2017 Foreword FORMULARY EXCLUDED THERAPEUTIC DRUG This document represents the efforts of the MedImpact Healthcare Systems THERAPEUTIC DRUGS CLASS Pharmacy and Therapeutics (P & T) and Formulary Committees to provide ALTERNATIVES physicians and pharmacists with a method to evaluate the safety, efficacy and cost- clindamycin/tretinoin, ACNE AGENTS, effectiveness of commercially available drug products. A structured approach to the VELTIN drug selection process is essential in ensuring continuing patient access to rational ZIANA TOPICAL drug therapies. The ultimate goal of the MedPerform Formulary is to provide a morphine sulfate ER process and framework to support the dynamic evolution of this document to guide tablets, oxycodone ANALGESICS, KADIAN prescribing decisions that reflect the most current clinical consensus associated ER, NUCYNTA, NARCOTICS with drug therapy decisions. NUCYNTA ER ANALGESICS, This is accomplished through the auspices of the MedImpact P & T and Formulary BELBUCA BUTRANS PATCH Committees. These committees meet quarterly and more often as warranted to NARCOTICS ensure clinical relevancy of the Formulary. To accommodate changes to this ABSTRAL, document, updates are made accessible as necessary. FENTORA, fentanyl citrate ANALGESICS, LAZANDA, lozenge NARCOTICS As you use this Formulary, you are encouraged to review the information and ONSOLIS, provide your input and comments to the MedImpact P & T and Formulary SUBSYS Committees. immediate-release GRALISE ANTICONVULSANTS The MedImpact P & T -
Therapeutic Class Overview Antifungals, Topical
Therapeutic Class Overview Antifungals, Topical INTRODUCTION The topical antifungals are available in multiple dosage forms and are indicated for a number of fungal infections and related conditions. In general, these agents are Food and Drug Administration (FDA)-approved for the treatment of cutaneous candidiasis, onychomycosis, seborrheic dermatitis, tinea corporis, tinea cruris, tinea pedis, and tinea versicolor (Clinical Pharmacology 2018). The antifungals may be further classified into the following categories based upon their chemical structures: allylamines (naftifine, terbinafine [only available over the counter (OTC)]), azoles (clotrimazole, econazole, efinaconazole, ketoconazole, luliconazole, miconazole, oxiconazole, sertaconazole, sulconazole), benzylamines (butenafine), hydroxypyridones (ciclopirox), oxaborole (tavaborole), polyenes (nystatin), thiocarbamates (tolnaftate [no FDA-approved formulations]), and miscellaneous (undecylenic acid [no FDA-approved formulations]) (Micromedex 2018). The topical antifungals are available as single entity and/or combination products. Two combination products, nystatin/triamcinolone and Lotrisone (clotrimazole/betamethasone), contain an antifungal and a corticosteroid preparation. The corticosteroid helps to decrease inflammation and indirectly hasten healing time. The other combination product, Vusion (miconazole/zinc oxide/white petrolatum), contains an antifungal and zinc oxide. Zinc oxide acts as a skin protectant and mild astringent with weak antiseptic properties and helps to -
Meta-Xylene: Identification of a New Antigenic Entity in Hypersensitivity
Clinical Communications Meta-xylene: identification of a new Our patient is a 53-year-old male who presented in 2003 with antigenic entity in hypersensitivity contact dermatitis after the use of lidocaine and disinfection with reactions to local anesthetics chlorhexidine. In 2006, an extensive skin testing by patch, prick, Kuntheavy Ing Lorenzini, PhDa, intradermal sampling, and graded challenge was performed as b c followed. The patch tests were performed with the thin layer Fabienne Gay-Crosier Chabry, MD , Claude Piguet, PhD , rapid use epicutaneous test, using the caine mix (benzocaine, a and Jules Desmeules, MD tetracaine, and cinchocaine), the paraben mix (methyl, ethyl, propyl, butyl, and benzylparaben), and the Balsam of Peru. The Clinical Implications caine and paraben mix were positive, and the patch test was possibly positive for Balsam of Peru. The prick test performed The authors report a patient who presented delayed with preservative-free lidocaine 20 mg/mL (Lidocaïne HCl hypersensitivity reactions to several local anesthetics, all “Bichsel” 2%, Grosse Apotheke Dr. G. Bichsel, Switzerland) was containing a meta-xylene entity, but not to articaine, negative. The intradermal test, performed with lidocaine 20 mg/ which is a thiophene derivative. Meta-xylene could be the mL containing methylparaben (Xylocain 2%, AstraZeneca, immunogenic epitope. Switzerland) with 1/10 and 1/100 dilutions, was negative. The subcutaneous challenge test was performed with 10 mg of preservative-free lidocaine 20 mg/mL (Lidocaïne HCl “Bichsel” TO THE EDITOR: 2%, Grosse Apotheke Dr. G. Bichsel) and lidocaine 20 mg/mL containing methylparaben (Lidocaïne Streuli 2%, Streuli, Hypersensitivity reactions to local anesthetics (LAs) are rare and Switzerland), both of which were positive and had the appear- represent less than 1% of all adverse reactions to LAs. -
Local Anesthetics
Local Anesthetics Introduction and History Cocaine is a naturally occurring compound indigenous to the Andes Mountains, West Indies, and Java. It was the first anesthetic to be discovered and is the only naturally occurring local anesthetic; all others are synthetically derived. Cocaine was introduced into Europe in the 1800s following its isolation from coca beans. Sigmund Freud, the noted Austrian psychoanalyst, used cocaine on his patients and became addicted through self-experimentation. In the latter half of the 1800s, interest in the drug became widespread, and many of cocaine's pharmacologic actions and adverse effects were elucidated during this time. In the 1880s, Koller introduced cocaine to the field of ophthalmology, and Hall introduced it to dentistry Overwiev Local anesthetics (LAs) are drugs that block the sensation of pain in the region where they are administered. LAs act by reversibly blocking the sodium channels of nerve fibers, thereby inhibiting the conduction of nerve impulses. Nerve fibers which carry pain sensation have the smallest diameter and are the first to be blocked by LAs. Loss of motor function and sensation of touch and pressure follow, depending on the duration of action and dose of the LA used. LAs can be infiltrated into skin/subcutaneous tissues to achieve local anesthesia or into the epidural/subarachnoid space to achieve regional anesthesia (e.g., spinal anesthesia, epidural anesthesia, etc.). Some LAs (lidocaine, prilocaine, tetracaine) are effective on topical application and are used before minor invasive procedures (venipuncture, bladder catheterization, endoscopy/laryngoscopy). LAs are divided into two groups based on their chemical structure. The amide group (lidocaine, prilocaine, mepivacaine, etc.) is safer and, hence, more commonly used in clinical practice. -
Printed Formulary Catalog Basic
Scripps Health Formulary July 2016 Foreword Pharmacy and Therapeutics Committee. MedImpact approves such multi- This document represents the efforts of the MedImpact Healthcare Systems source drugs for addition to the MAC list based on the following criteria: Pharmacy and Therapeutics (P & T) and Formulary Committees to provide physicians A multi-source drug product manufactured by at least one (1) nationally and pharmacists with a method to evaluate the safety, efficacy and cost-effectiveness marketed company. of commercially available drug products. A structured approach to the drug selection At least one (1) of the generic manufacturer’s products must have an “A” process is essential in ensuring continuing patient access to rational drug therapies. rating or the generic product has been determined to be unassociated with The ultimate goal of the Portfolio Formulary is to provide a process and framework to efficacy, safety or bioequivalency concerns by the MedImpact P & T support the dynamic evolution of this document to guide prescribing decisions that Committee. reflect the most current clinical consensus associated with drug therapy decisions. Drug product will be approved for generic substitution by the MedImpact P & T Committee. This is accomplished through the auspices of the MedImpact P & T and Formulary Committees. These committees meet quarterly and more often as warranted to ensure This list is reviewed and updated periodically based on the clinical literature and clinical relevancy of the Formulary. To accommodate changes to this document, pharmacokinetic characteristics of currently available versions of these drug updates are made accessible as necessary. products. As you use this Formulary, you are encouraged to review the information and provide If a member or physician requests a brand name product in lieu of an approved your input and comments to the MedImpact P & T and Formulary Committees. -
Malta Medicines List April 08
Defined Daily Doses Pharmacological Dispensing Active Ingredients Trade Name Dosage strength Dosage form ATC Code Comments (WHO) Classification Class Glucobay 50 50mg Alpha Glucosidase Inhibitor - Blood Acarbose Tablet 300mg A10BF01 PoM Glucose Lowering Glucobay 100 100mg Medicine Rantudil® Forte 60mg Capsule hard Anti-inflammatory and Acemetacine 0.12g anti rheumatic, non M01AB11 PoM steroidal Rantudil® Retard 90mg Slow release capsule Carbonic Anhydrase Inhibitor - Acetazolamide Diamox 250mg Tablet 750mg S01EC01 PoM Antiglaucoma Preparation Parasympatho- Powder and solvent for solution for mimetic - Acetylcholine Chloride Miovisin® 10mg/ml Refer to PIL S01EB09 PoM eye irrigation Antiglaucoma Preparation Acetylcysteine 200mg/ml Concentrate for solution for Acetylcysteine 200mg/ml Refer to PIL Antidote PoM Injection injection V03AB23 Zovirax™ Suspension 200mg/5ml Oral suspension Aciclovir Medovir 200 200mg Tablet Virucid 200 Zovirax® 200mg Dispersible film-coated tablets 4g Antiviral J05AB01 PoM Zovirax® 800mg Aciclovir Medovir 800 800mg Tablet Aciclovir Virucid 800 Virucid 400 400mg Tablet Aciclovir Merck 250mg Powder for solution for inj Immunovir® Zovirax® Cream PoM PoM Numark Cold Sore Cream 5% w/w (5g/100g)Cream Refer to PIL Antiviral D06BB03 Vitasorb Cold Sore OTC Cream Medovir PoM Neotigason® 10mg Acitretin Capsule 35mg Retinoid - Antipsoriatic D05BB02 PoM Neotigason® 25mg Acrivastine Benadryl® Allergy Relief 8mg Capsule 24mg Antihistamine R06AX18 OTC Carbomix 81.3%w/w Granules for oral suspension Antidiarrhoeal and Activated Charcoal -
Index B Alphabetical List of Pharmaceutical Product Names
INDEX B ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCT NAMES PRODUCT NAME Page PRODUCT NAME Page 292 97 ACYCLOVIR 17 3TC (EDS) 14 ACYCLOVIR 17 5-AMINOSALICYLIC ACID (MESALAMINE) 170 " 18 ABACAVIR SO4 13 ADALAT XL 57 ABACAVIR SO4/LAMIVUDINE 13 ADALIMUMAB 220 ABACAVIR SO4/LAMIVUDINE/ZIDOVUDINE 13 ADAPALENE 206 ABATACEPT 220 ADCIRCA (EDS) 89 ABILIFY (EDS) 123 ADEFOVIR DIPIVOXIL 18 ACARBOSE 187 ADHESIVE WIPES (EDS) 239 ACCEL PIOGLITAZONE (EDS) 190 ADVAGRAF (EDS) 231 ACCEL TOPIRAMATE 112 ADVAIR (EDS) 33 ACCEL-CITALOPRAM 114 ADVAIR DISKUS (EDS) 33 ACCOLATE (EDS) 232 AGGRENOX (EDS) 87 ACCU-CHEK 1 MINI (EDS) 238 AGRYLIN 221 ACCU-CHEK 2 MINI (EDS) 238 AIROMIR 32 ACCU-CHEK ADVANTAGE 142 ALCOHOL PREP 234 ACCU-CHEK AVIVA 142 ALCOHOL SWAB 234 ACCU-CHEK COMPACT 142 ALDACTAZIDE-25 82 ACCU-CHEK FASTCLIX MOBILE 234 ALDACTAZIDE-50 82 ACCU-CHEK LINKASSIST (EDS) 239 ALDACTONE 148 ACCU-CHEK MOBILE 142 ALDARA (EDS) 209 ACCU-CHEK MULTICLIX 234 ALENDRONATE (EDS) 220 ACCU-CHEK RAPID D (EDS) 236 ALENDRONATE SODIUM 220 " 237 ALENDRONATE SODIUM (EDS) 220 " 238 ALENDRONATE SODIUM/VITAMIN D3 ACCU-CHEK SPIRIT (EDS) 236 (CHOLECALCIFEROL) 220 ACCU-CHEK TENDER 1 (EDS) 238 ALERTEC (EDS) 133 " 239 ALESSE 181 ACCU-CHEK TENDER 2 (EDS) 238 ALFACALCIDOL 217 " 239 ALFUZOSIN 220 ACCU-CHEK ULTRAFLEX 1 (EDS) 237 ALGLUCOSIDASE ALFA 221 " 238 ALLOPURINOL 221 ACCU-CHEK ULTRAFLEX 2 (EDS) 237 ALMOTRIPTAN MALATE 33 " 238 ALOMIDE 158 ACCUPRIL 79 ALPHAGAN 157 ACCURETIC 80 ALPHAGAN P 157 ACCUTANE 209 ALPRAZOLAM 134 ACCUTREND 142 ALPRAZOLAM 134 ACEBUTOLOL 48 ALTACE 80 ACEBUTOLOL HCL 48 " 81