PDL Drug Class Review Announcement October 6, 2020
Drug Classes to be reviewed: Antibiotics, Inhaled; Antiemetics, Non-Oral; Antiemetics, Oral; Antiherpetic Agents, Oral; Antiherpetic Agents, Topical; Antihyperuricemics; Anti-Platelets; Antipsoriatics, Oral; Antipsoriatics, Topical; Epinephrine (Self-Injected) Products; Fluoroquinolones, Oral; H. Pylori Treatments; Hepatitis C Virus Treatments, Direct Acting Antivirals (DAAs); Hepatitis C Virus Treatments, Ribavirin Products; Methotrexate; Monoamine Oxidase Inhibitors (MAOIs); Newer Generation Antidepressants; NSAIDs, Non-Oral; NSAIDs, Oral; Pancreatic Enzymes; Proton Pump Inhibitors; Pulmonary Arterial Hypertension (PAH) Therapies, Endothelin Antagonists; PAH Therapies, Guanylate Cyclase Stimulator (sGC); PAH Therapies, Phosphodiesterase Inhibitors; PAH Therapies, Prostanoids; Targeted Immune Modulators; Tricyclic Antidepressants; Triptans and Other Migraine Treatments, Non-Oral; Triptans and Other Migraine Treatments, Oral; Ulcerative Colitis Agents, Oral; Ulcerative Colitis Agents, Rectal.
These drug classes will be reviewed at the October 6, 2020 P&T Committee meeting from 1‐5pm. The meeting will be held virtually. Dossiers and Supplemental Rebate offers are due to Magellan by September 8, 2020.
Please provide your public comments to Jessica Czechowski, Pharmacist Account Executive ([email protected]) no later than September 25, 2020 to ensure they may be 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.
ANTIBIOTICS, INHALED Brand Name Generic Name
Arikayce Amikacin liposomal vial
Bethkis 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 ANTIEMETICS Brand Name Generic Name
Oral
Doxylamine 25 mg tablet OTC
Granisetron tablet
Meclizine tablet
Prochlorperazine tablet
Promethazine syrup, tablet
Pyridoxine 50mg, 100 mg tablet OTC
Akynzeo Netupitant/Palonosetron capsule
Bonjesta ER Doxylamine/pyridoxine tablet
Diclegis Doxylamine/pyridoxine tablet
Doxylamine/pyridoxine tablet
Emend Aprepitant capsule, powder pack, tripack
Aprepitant capsule, tripack
Marinol Dronabinol capsule
Dronabinol capsule
Reglan Metoclopramide tablet
Metoclopramide ODT, solution, tablet
Tigan Trimethobenzamide capsule
Trimethobenzamide capsule
Varubi Rolapitant tablet
Zofran Ondansetron tablet
Ondansetron tablet, ODT, oral solution/suspension
Zuplenz Ondansetron film
Non-Oral Compro Prochlorperazine suppository
Prochlorperazine suppository
Phenadoz Promethazine suppository
Promethazine suppository
Sancuso Granisetron patch
Sustol Granisetron syringe
Transderm-Scop Scopolamine patch
Scopolamine patch
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
ANTIHYPERURICEMICS Brand Name Generic Name
Probenecid tablet
Probenecid-Colchicine tablet
Colcrys Colchicine tablet
Colchicine tablet
Gloperba Colchicine solution
Mitigare Colchicine capsule
Colchicine capsule
Uloric Febuxostat tablet
Febuxostat tablet
Zyloprim Allopurinol tablet
Allopurinol tablet
ANTI-PLATELETS Brand Name Generic Name
Cilostazol tablet
Dipyridamole tablet
Pentoxifylline ER tablet
Aggrenox Aspirin/dipyridamole capsule
Aspirin/dipyridamole capsule
Brilinta Tigacrelor tablet
Effient Prasugrel tablet
Prasugrel tablet
Plavix Clopidogrel tablet
Clopidogrel tablet Zontivity Vorapaxar tablet
ANTIPSORIATICS Brand Name Generic Name
Oral
Oxsoralen-Ultra Methoxsalen capsule
Methoxsalen capsule
Soriatane Acitretin capsule
Acitretin capsule
Topical
Dovonex Calcipotriene cream
Calcipotriene cream, ointment, solution
Duobrii Halobetasol/Tazarotene lotion
Enstilar Calcipotriene/Betamethasone DP foam
Sorilux Calcipotriene foam
Taclonex Calcipotriene/Betamethasone DP ointment, suspension
Calcipotriene/Betamethasone DP ointment, suspension
Vectical Calcitriol ointment
Calcitriol ointment
EPINEPHRINE PRODUCTS, SELF-ADMINISTERED Brand Name Generic Name
Epinephrine auto-injector (generic Adrenaclick)
Epipen, Epipen Jr. Epinephrine auto-injector
Epinephrine auto-injector
Symjepi Epinephrine syringe Epinephrine syringe
FLUOROQUINOLONES (ORAL) Brand Name Generic Name
Ciprofloxacin ER tablet
Levofloxacin tablet, solution
Ofloxacin tablet
Avelox Moxifloxacin tablet
Moxifloxacin tablet
Baxdela Delafloxacin tablet
Cipro Ciprofloxacin tablet, suspension
Ciprofloxacin tablet, suspension
H. PYLORI TREATMENTS Brand Name Generic Name
Amoxicillin / lansoprazole / clarithromycin
HELIDAC Bismuth subsalicylate / metronidazole / tetracycline
OMECLAMOX-PAK Amoxicillin / omeprazole / clarithromycin
PYLERA Bismuth subcitrate / metronidazole / tetracycline
TALICIA Omeprazole / amoxicillin / rifabutin
HEPATITIS C VIRUS TREATMENTS Brand Name Generic Name
Direct Acting Antivirals (DAAs)
Epclusa Velpatasvir/Sofosbuvir tablet
Velpatasvir/Sofosbuvir tablet Harvoni Ledipasvir/ Sofosbuvir tablet
Ledipasvir/ Sofosbuvir tablet
Mavyret Glecaprevir/Pibrentasvir tablet
Sovaldi Sofosbuvir tablet
Viekira Pak Ombitasvir/Paritaprevir/Ritonavir/Dasabuvir tablet
Vosevi Velpatasvir/Sofosbuvir/Voxilaprevir tablet
Zepatier Elbasvir/Grazoprevir tablet
Ribavirin Agents
Ribasphere Ribavirin capsule, dosepack, tablet
Ribavirin capsule, dosepack, tablet
METHOTREXATE Brand Name Generic Name
Oral
Trexall Methotrexate tablet
Methotrexate tablet
Xatmep Methotrexate oral solution
Non-Oral
Methotrexate Vial
Otrexup Methotrexate auto-injector
Rasuvo Methotrexate auto-injector
MONOAMINE OXIDASE INHIBITORS (MAOIS) Brand Name Generic Name
Emsam Selegiline patch
Marplan Isocarboxazid tablet Nardil Phenelzine tablet
Phenelzine tablet
Parnate Tranylcypromine tablet
Tranylcypromine tablet
NEWER GENERATION ANTIDEPRESSANTS Brand Name Generic Name
Bupropion IR Tablet
Desvenlafaxine fumarate ER tablet
Duloxetine 40mg capsule (generic Irenka)
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 tablet Escitalopram tablet, oral solution
Paxil Paroxetine tablet, oral suspension
Paroxetine tablet
Paxil CR Paroxetine CR tablet
Paroxetine CR/ER tablet
Pexeva Paroxetine mesylate tablet
Pristiq Desvenlafaxine succinate ER tablet
Desvenlafaxine succinate ER tablet
Prozac Fluoxetine pulvule
Fluoxetine capsule, DR capsule, oral solution
Remeron Mirtazapine tablet, ODT Soltab
Mirtazapine tablet, ODT
Sarafem Fluoxetine tablet
Fluoxetine tablet
Trintellix Vortioxetine tablet
Viibryd Vilazodone tablet, Starter Pack
Wellbutrin SR, XL Bupropion ER/SR, XL tablets
Bupropion ER/SR, XL tablets
Zoloft Sertraline tablet, oral concentrate
Sertraline tablet, oral concentrate
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 RX tablet, suspension
Indomethacin capsule, ER capsule
Ketoprofen capsule, ER capsule
Ketorolac tablet
Meclofenamate capsule
Mefenamic acid capsule
Nabumetone tablet
Naproxen tablet, DR tablet, EC tablet, ER tablet, suspension Sulindac tablet
Tolmetin tablet, capsule
Anaprox DS Naproxen sodium tablet
Naproxen sodium tablet
Arthrotec Diclofenac/misoprostol tablet
Diclofenac/misoprostol tablet
Celebrex Celecoxib capsule
Celecoxib capsule
Daypro Oxaprozin tablet
Oxaprozin tablet
Duexis 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
Tivorbex Indomethacin capsule
Vimovo Naproxen/esomeprazole DR tablet
Naproxen/esomeprazole DR tablet
Vivlodex Meloxicam capsule
Zipsor Diclofenac capsule
Zorvolex Diclofenac capsule
Non-Oral
Diclofenac topical solution
Flector Diclofenac patch
Diclofenac patch
Licart Diclofenac patch
Pennsaid Diclofenac solution packet, pump
Sprix Ketorolac nasal solution
Ketorolac nasal solution
Voltaren Diclofenac gel
Diclofenac gel
PANCREATIC ENZYMES Brand Name Generic Name
Creon Lipase/Protease/Amylase
Pancreaze Lipase/Protease/Amylase
Pertzye Lipase/Protease/Amylase
Viokace Lipase/Protease/Amylase
Zenpep Lipase/Protease/Amylase
PROTON PUMP INHIBITORS Brand Name Generic Name
Esomeprazole DR 49.3mg capsule
Omeprazole DR capsule
Omeprazole DR tablet (OTC), ODT (OTC)
Aciphex Rabeprazole tablet, sprinkles
Rabeprazole tablet
Dexilant Dexlansoprazole capsule
Nexium Esomeprazole DR capsule, oral suspension packet
Esomeprazole DR capsule, oral suspension packet
Nexium 24HR (OTC) Esomeprazole DR capsule (OTC)
Esomeprazole DR capsule (OTC)
Prilosec DR Omeprazole suspension
Prevacid Lansoprazole DR capsule, ODT solutab, suspension
Lansoprazole DR capsule, ODT
Prevacid 24HR DR (OTC) Lansoprazole DR capsule (OTC)
Lansoprazole DR capsule (OTC)
Protonix DR Pantoprazole DR tablet, oral suspension packet Pantoprazole DR tablet
Zegerid Omeprazole/Na Bicarb capsule, oral suspension packet
Omeprazole/Na Bicarb capsule, oral suspension packet
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 (Guanylate Cyclase Stimulator) Brand Name Generic Name
Adempas Riociguat tablet
PULMONARY ARTERIAL HYPERTENSION (Phosphodiesterase Inhibitors) Brand Name Generic Name
Adcirca Tadalafil tablet
Alyq Tadalafil 20mg tablet
Tadalafil 20 mg tablet
Revatio Sildenafil tablet, oral suspension
Sildenafil tablet, oral suspension
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
Ventavis Iloprost inhalation solution
TARGETED IMMUNE MODULATORS Brand Name Generic Name
Actemra Tocilizumab SC syringe, Actpen
Arcalyst Rilonacept SC vial
Cimzia Certolizumab SC kit
Cosentyx Secukinumab SC pen, syringe
Enbrel Etanercept SC kit, mini cartridge, sureclick, syringe, vial
Humira Adalimumab SC syringe, pen, kit
Ilaris Canakinumab SC vial
Kevzara Sarilumab SC pen, syringe
Kineret Anakinra SC syringe
Olumiant Baricitinib oral tablet
Orencia Abatacept SC clickject, syringe
Otezla Apremilast oral tablet Rinvoq Upadacitinib ER oral tablet
Siliq Brodalumab SC syringe
Simponi Golimumab SC pen injector, syringe
Skyrizi Risankizumab-rzaa SC syringe
Stelara Ustekinumab SC syringe
Taltz Ixekizumab SC autoinjector, syringe
Tremfya Guselkumab SC injector, syringe
Xeljanz Tofacitinib oral tablet
Xeljanz XR Tofacitinib ER oral tablet
TRICYCLIC ANTIDEPRESSANTS Brand Name Generic Name
Amitriptyline tablet
Amoxapine tablet
Doxepin capsule 10mg, 25mg, 50mg, 75mg, 100mg, 150mg, solution Imipramine pamoate capsule
Maprotiline tablet
Protriptyline tablet
Anafranil Clomipramine capsule
Clomipramine capsule
Norpramin Desipramine tablet
Desipramine tablet
Pamelor Nortriptyline capsule
Nortriptyline capsule, solution
Surmontil Trimipramine capsule
Trimipramine capsule Tofranil Imipramine tablet
Imipramine tablet
TRIPTANS AND OTHER MIGRAINE AGENTS Brand Name Generic Name
Oral
Almotriptan tablet
Amerge Naratriptan tablet
Naratriptan tablet
Frova Frovatriptan tablet
Frovatriptan tablet
Imitrex Sumatriptan tablet
Sumatriptan tablet
Maxalt, Maxalt MLT Rizatriptan tablets, ODT
Rizatriptan tablets, ODT
Relpax Eletriptan tablet
Eletriptan tablet
Reyvow Lasmitidan tablet
Treximet Sumatriptan/naproxen tablet
Sumatriptan/naproxen tablet
Zomig, Zomig ZMT Zolmitriptan tablet, ODT
Zolmitriptan tablet, ODT
Non-Oral
Imitrex Sumatriptan nasal spray, cartridge, pen injector, syringe, vial, kit Sumatriptan nasal spray, cartridge, pen injector, syringe, vial, kit Onzentra Xsail Sumatriptan nasal powder
Tosymra Sumatriptan nasal spray
Zembrace Symtouch Sumatriptan SC auto-injector
Zomig Zolmitriptan nasal spray
ULCERATIVE COLITIS AGENTS Brand Name Generic Name
Oral
Apriso Mesalamine ER capsule
Mesalamine ER capsule
Asacol HD Mesalamine DR tablet
Mesalamine DR tablet
Azulfidine, Azulfidine Entab Sulfasalazine tablet, DR tablet
Sulfasalazine tablet, DR tablet
Colazal Balsalazide capsule
Balsalazide capsule
Delzicol Mesalamine DR capsule
Mesalamine DR capsule
Dipentum Olsalazine capsule
Lialda Mesalamine DR tablet
Mesalamine DR tablet
Pentasa Mesalamine capsule
Uceris Budesonide tablet
Budesonide tablet
Non-Oral Canasa Mesalamine suppository
Mesalamine suppository
Rowasa, SFRowasa Mesalamine enema, kit
Mesalamine enema, kit
Uceris Budesonide rectal foam