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Preferred Drug List Drug Class Review Announcement

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Preferred Drug List Drug Class Review Announcement 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)
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