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Preferred Drug List Drug Class Review Announcement

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PDL Drug Class Review Announcement January 12, 2021 Drug Classes to be reviewed: Anti-Parkinson’s Agents; Calcitonin-Gene Receptor Protein (CGRP) Inhibitors; Atypical Antipsychotics – Oral; Anxiolytics; Bile salts; Cardiovascular – Alpha-Blockers, Beta-Blockers & Combinations, Calcium Channel Blockers; Diabetes Management – Insulins; Glucagon, Self-Administered; Growth Hormones; Hemorrhoidal, Anorectal and Related Topical Anesthetic Agents; Immune Globulins; Intranasal Rhinitis Agents; Leukotriene Modifiers; Lipotropics – Statins, Statin Combinations, Other; Lithium Agents; Multiple Sclerosis Agents; Neurocognitive Disorder Agents; Ophthalmics - Allergy Agents, Anti-Inflammatory Agents, Glaucoma Agents; Sedative/Hypnotics - Non-Benzodiazepine, Benzodiazepine; and Topical Steroids – Low, Medium, High, Very High Potency. These drug classes will be reviewed at the January 12, 2021 P&T Committee meeting from 1-5pm. The meeting will be held virtually. Dossiers and Supplemental Rebate offers are due to Magellan by December 8, 2020. Please provide your public comments to Jessica Czechowski, Clinical Account Manager ([email protected]) no later than January 5, 2021 to ensure they are included in the information supplied to the P&T Committee members. Please carbon copy Brittany Schock, PDL Pharmacist ([email protected]) on all clinical information and public comment submissions. Anti-Parkinson’s Agents Brand Name Generic Name Dopa Decarboxylase Inhibitors Carbidopa/Levodopa ER tablet, ODT Duopa Carbidopa/Levodopa enteral suspension Inbrija Levodopa capsule for inhalation Lodosyn Carbidopa tablet Carbidopa tablet Rytary ER Carbidopa/Levodopa ER capsule Sinemet Carbidopa/Levodopa tablet Carbidopa/Levodopa tablet Stalevo Carbidopa/Levodopa/Entacapone tablet Carbidopa/Levodopa/Entacapone tablet Dopamine Agonists Pramipexole tablet Ropinirole tablet Apokyn Apomorphine cartridge Kynmobi Apomorphine sublingual film Mirapex ER Pramipexole ER tablet Pramipexole ER tablet Neupro Rotigotine patch Parlodel Bromocriptine capsule, tablet Bromocriptine capsule, tablet Requip XL Ropinirole ER tablet Ropinirole ER tablet MAO-B Inhibitors Selegiline capsule, tablet Azilect Rasagiline tablet Rasagiline tablet Zelapar Selegiline ODT tablet Xadago Safinamide tablet Other Agents Amantadine capsule, solution, tablet Benztropine Mesylate tablet Trihexyphenidyl elixir, tablet Comtan Entacapone tablet Entacapone tablet Gocovri ER Amantadine ER capsule Nourianz Istradefylline tablet Ongentys Opicapone capsule Osmolex ER Amantadine ER tablet Tasmar Tolcapone tablet Tolcapone tablet Atypical Antipsychotics, Oral Brand Name Generic Name Abilify/Abilify Mycite Aripiprazole tablet, Mycite Kit Aripiprazole tablet, ODT tablet, oral solution Caplyta Lumateperone capsule Clozaril Clozapine tabs, ODT Clozapine tabs, ODT Fanapt Iloperidone tablet, pack Fazaclo Clozapine ODT Geodon Ziprasidone capsule Ziprasidone capsule Invega ER Paliperidone ER tablet Paliperidone ER tablet Latuda Lurasidone tablet Nuplazid Pimavanserin capsule, tablet Rexulti Brexpiprazole tablet Risperdal Risperidone tablet, oral solution Risperidone tablet, ODT, oral solution Saphris Asenapine SL tablet Secuado Asenapine patch Seroquel/Seroquel XR Quetiapine tablet, ER tablet Quetiapine tablet, ER tablet Symbyax Olanzapine/fluoxetine capsule Olanzapine/fluoxetine capsule Versacloz Clozapine oral suspension Vraylar Cariprazine capsule Zyprexa/Zyprexa Zydis Olanzapine ODT, tablet Olanzapine ODT, tablet Anxiolytics Brand Name Generic Name Buspirone tablet Chlordiazepoxide capsule Clorazepate tablet Diazepam oral concentrate, solution, tablet Oxazepam capsule Ativan Lorazepam tablet, Intensol concentrate Lorazepam tablet, oral concentrate Lorazepam tablet Tranxene T-Tab Clorazepate tablet Clorazepate tablet Xanax/Xanax XR Alprazolam tablet/ER tablet Alprazolam tablet/ER tablet, ODT tablet Bile Salts Brand Name Generic Name Actigall Ursodiol capsule Ursodiol capsule Chenodal Chenodiol tablet Cholbam Cholic acid capsule Ocaliva Obeticholic acid tablet Urso/Urso Forte Ursodiol tablet Ursodiol tablet Calcitonin-Gene Receptor Protein (CGRP) Inhibitors Brand Name Generic Name Aimovig Erenumab-aooe auto-injector Ajovy Fremanezumab-vfrm auto-injector, syringe Emgality Galcanezumab-gnlm pen, syringe Nurtec ODT Rimegepant ODT tablet Ubrelvy Ubrogepant tablet Cardiovascular – Alpha-Blockers Brand Name Generic Name Minipress Prazosin capsule Prazosin capsule Cardiovascular – Beta-Blockers Brand Name Generic Name Single Agent Acebutolol capsule Betaxolol tablet Bisoprolol tablet Labetalol tablet Pindolol tablet Propranolol solution, tablet Timolol tablet Betapace Sotalol tablet Sotalol tablet Bystolic Nevibolol tablet Corgard Nadolol tablet Nadolol tablet Coreg Carvedilol tablet Carvedilol tablet Coreg CR Carvedilol ER capsule Carvedilol ER capsule Hemangeol Propranolol solution Inderal LA Propranolol ER capsule Propranolol ER capsule Inderal XL Propranolol ER capsule Innopran XL Propranolol ER capsule Kaspargo Metoprolol succinate sprinkle capsule Metoprolol tartrate tablet Lopressor Metoprolol tartrate tablet Metoprolol tartrate tablet Sotylize Sotalol solution Tenormin Atenolol tablet Atenolol tablet Toprol XL Metoprolol succinate tablet Metoprolol succinate tablet Combinations Metoprolol-HCTZ tablet Nadolol-Bendroflumethiazide tablet Propranolol-HCTZ tablet Tenoretic Atenolol-Chorthalidone tablet Atenolol-Chorthalidone tablet Ziac Bisoprolol-HCTZ tablet Bisoprolol-HCTZ tablet Cardiovascular – Calcium Channel Blockers Brand Name Generic Name Diltiazem ER capsule Felodipine ER tablet Isradipine capsule Nicardipine capsule Nimodipine capsule Verapamil tablet Adalat CC Nifedipine ER tablet Nifedipine ER tablet Calan SR Verapamil ER tablet Verapamil ER tablet Cardizem Diltiazem tablet Diltiazem tablet Cardizem CD Diltiazem ER capsule Diltiazem CD/ER capsule Cardizem LA Diltiazem ER/LA tablet Diltiazem ER/LA tablet Katerzia Amlodipine suspension Norvasc Amlodipine tablet Amlodipine tablet Nymalize Nimodipine solution, oral syringe Procardia Nifedipine capsule Nifedipine capsule Procardia XL Nifedipine ER tablet Nifedipine ER tablet Sular Nisoldipine ER tablet Nisoldipine ER tablet Tiazac ER Diltiazem ER capsule Diltiazem ER capsule Verelan/Verelan PM Verapamil ER pellet capsule Verapamil ER/ER PM capsule Diabetes Management - Insulins Brand Name Generic Name Rapid-acting Admelog Insulin lispro Solostar, vial Afrezza Insulin regular cartridge, unit Apidra Insulin glulisine Solostar, vial Fiasp Insulin aspart FlexTouch, penfill, vial Humalog/Humalog Jr. Insulin lispro cartridge, Kwikpen, vial Insulin lispro pen/Jr. pen, vial Lyumjev Insulin lispro-aabc Novolog Insulin aspart cartridge, Flexpen, vial Insulin aspart cartridge, pen, vial Short-acting Humulin R Regular insulin Kwikpen, vial Novolin R Regular insulin Kwikpen, vial Intermediate-acting Humulin N Insulin NPH Kiwkpen, vial Novolin N Insulin NPH Flexpen, vial Long-acting Basaglar Insulin glargine Kwikpen Lantus Insulin glargine Solostar, vial Levemir Insulin detemir Flextouch, vial Semglee Insulin glargine pen, vial Toujeo/Toujeo Max Insulin glargine Solostar Tresiba Insulin degludec Flextouch, vial Insulin Mixtures Humalog Mix 50/50 50% insulin lispro protamine/50% insulin lispro Kwikpen, vial Humalog Mix 75/25 75% insulin lispro protamine/25% insulin lispro Kwikpen, vial 75% insulin lispro protamine/25% insulin lispro Kwikpen, vial Humulin 70/30 70% insulin NPH/30% insulin regular Kwikpen, vial Novolin 70/30 70% insulin NPH/30% insulin regular Flexpen, vial Novolog Mix 70/30 70% insulin aspart protamine/30% insulin aspart Flexpen, vial 70% insulin aspart protamine/30% insulin aspart Flexpen, vial Glucagon, Self-Administered Brand Name Generic Name Baqsimi Glucagon spray Glucagen Hypokit Glucagon kit Glucagon Emergency Kit Glucagon kit Gvoke Glucagon Hypopen, syringe Growth Hormones Brand Name Generic Name Genotropin Somatropin cartridge, Miniquick pen Humatrope Somatropin cartridge, vial Norditropin Somatropin Flexpro pen Nutropin AQ Somatropin Nuspin injector Omnitrope Somatropin cartridge, vial Saizen Somatropin cartridge, vial Serostim Somatropin vial Zomacton Somatropin vial Zorbtive Somatropin vial Hemorrhoidal, Anorectal and Related Topical Anesthetic Agents Brand Name Generic Name Hydrocortisone-Pramoxine 1%-1% cream Lidocaine cream, ointment, topical solution Lidocaine-Hydrocortisone 3%-0.5% cream/cream kit (also), 3%-1% cream kit, 2%-2% cream kit Lidocaine-Hydrocortisone 3%-2.5% gel/gel kit, 2.8- 0.55% gel Lidocaine-Prilocaine cream Anusol-HC Hydrocortisone 2.5% cream Proctosol-HC Proctozone-HC Procto-Med HC Hydrocortisone 2.5% cream Colocort Hydrocortisone 100 mg/60 mL enema Cortenema Hydrocortisone 100 mg/60 mL enema Cortifoam Hydrocortisone acetate 10% aerosol Epifoam Hydrocortisone-Pramoxine foam Pliaglis Lidocaine-Tetracaine cream Proctofoam-HC Hydrocortisone-Pramoxine 1%-1% foam Procto-Pak Hydrocortisone 1% cream Hydrocortisone 1% cream Rectiv Nitroglycerin 0.4% ointment Synera Lidocaine-Tetracaine patch Immune Globulins Brand Name Generic Name Bivigam Immune Globulin IV solution Cutaquig Immune Globulin-hipp SC solution Cuvitru Immune Globulin SC solution Flebogamma Dif Immune Globulin IV solution Gammagard Immune Globulin SC solution Gammagard S/D Immune Globulin IV powder vial Gammaked Immune Globulin IV/SC solution Gammaplex Immune Globulin IV solution Gamunex-C Immune Globulin IV/SC solution Hizentra Immune Globulin SC solution syringe, vial Hyqvia Immune Globulin-Hyaluronidase SC kit/pack Octagam Immune Globulin
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  • Teva Pharmaceutical Industries Ltd

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    m n a d v s g o PRODUCT v1 2015 CATALOGUE h p b e q f i t w c l r z www.tapi.com PRODUCT CATALOGUE v1 2015 US CEP EU Japan Korea DMF DMF DMF DMF ABIRATERONE a ACYCLOVIR x x x AFATINIB ALCLOMETASONE DIPROPIONATE x x ALENDRONATE SODIUM x x x ALLOPURINOL x x x x AMCINONIDE x x x AMITRIPTYLINE HCL x x x x x AMLODIPINE BESYLATE x x x ANASTROZOLE x x x ANIDULAFUNGIN APIXABAN APREMILAST ARIPIPRAZOLE x x ARIPIPRAZOLE LAUROXIL ATORVASTATIN CALCIUM* x x x x ATOSIBAN ACETATE ATRACURIUM BESYLATE x x x AZACITIDINE x x AZITHROMYCIN x x x x AZTREONAM x BECLOMETHASONE DIPROPIONATE x x x x b BETAMETHASONE ACETATE x x x BETAMETHASONE BASE x x x BETAMETHASONE DIPROPIONATE x x x x BETAMETHASONE VALERATE x x x x BICALUTAMIDE x x BIMATOPROST x x BIVALIRUDIN x x BLEOMYCIN SULFATE x x BORTEZOMIB x x x * TAPI can provide several different polymorphs or processes of this product. To obtain complete DMF files of a specific product's polymorph or process, please contact your account manager. For the most updated product list please go to "Products" at www.tapi.com Additional DMFs or Tech Files are available upon request All subject to the disclaimer on page 15 PRODUCT CATALOGUE v1 2015 US CEP EU Japan Korea DMF DMF DMF DMF BROMOCRIPTINE MESYLATE x x b BUDESONIDE x x x x BUPRENORPHINE BASE x x BUPRENORPHINE HCL x x x BUTORPHANOL TARTRATE x x CABAZITAXEL x CABERGOLINE x x x x c CALCIPOTRIENE (CALCIPOTRIOL)* x x x CALCITRIOL x x x CANDESARTAN CILEXETIL x CAPECITABINE x x CARBIDOPA x x x x CARBOPLATIN x x x x CARFILZOMIB CARVEDILOL BASE x x x x x CARVEDILOL PHOSPHATE x CASPOFUNGIN ACETATE x x CERITINIB CHLORMADINONE ACETATE x x CICLOSPORIN x x x x x CILOSTAZOL x x x x CINACALCET HCL x x CISATRACURIUM BESYLATE x x CISPLATIN x x x CLARITHROMYCIN x x x x x CLOBETASOL PROPIONATE x x x x x CLONAZEPAM x CLOPIDOGREL BISULFATE x x x x CYPROTERONE ACETATE x x d DABIGATRAN ETEXILATE x DARIFENACIN HBR x x * TAPI can provide several different polymorphs or processes of this product.