DOCSLIB.ORG

NEW--Npf-MASTER LIST.Xlsx

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
NEW--Npf-MASTER LIST.Xlsx National Performance Formulary Prior Approval List As of: 10/27/2020 Helpful Tip: To search for a specific drug, use the find feature (Ctrl + F) Trade Name Chemical/Biological Name Class Prior Authorization Program FUSILEV LEVOLEUCOVORIN CALCIUM ADJUNCTIVE AGENTS UNCLASSIFIED DRUG PRODUCTS KHAPZORY LEVOLEUCOVORIN ADJUNCTIVE AGENTS UNCLASSIFIED DRUG PRODUCTS LEVOLEUCOVORIN CALCIUM LEVOLEUCOVORIN CALCIUM ADJUNCTIVE AGENTS UNCLASSIFIED DRUG PRODUCTS VISTOGARD URIDINE TRIACETATE ADJUNCTIVE AGENTS UNCLASSIFIED DRUG PRODUCTS ACTHAR CORTICOTROPIN ADRENAL HORMONES HORMONES BELRAPZO BENDAMUSTINE HCL ALKYLATING AGENTS ANTINEOPLASTICS BENDAMUSTINE HCL BENDAMUSTINE HCL ALKYLATING AGENTS ANTINEOPLASTICS BENDEKA BENDAMUSTINE HCL ALKYLATING AGENTS ANTINEOPLASTICS TREANDA BENDAMUSTINE HCL ALKYLATING AGENTS ANTINEOPLASTICS DAW (DISPENSE AS WRITTEN) ALL CUSTOM BELVIQ LORCASERIN HCL ANOREXIANTS ANTI‐OBESITY DRUGS BELVIQ XR LORCASERIN HCL ANOREXIANTS ANTI‐OBESITY DRUGS CONTRAVE ER NALTREXONE HCL/BUPROPION HCL ANOREXIANTS ANTI‐OBESITY DRUGS DIETHYLPROPION HCL DIETHYLPROPION HCL ANOREXIANTS ANTI‐OBESITY DRUGS DIETHYLPROPION HCL ER DIETHYLPROPION HCL ANOREXIANTS ANTI‐OBESITY DRUGS LOMAIRA PHENTERMINE HCL ANOREXIANTS ANTI‐OBESITY DRUGS PHENDIMETRAZINE TARTRATE PHENDIMETRAZINE TARTRATE ANOREXIANTS ANTI‐OBESITY DRUGS QSYMIA PHENTERMINE/TOPIRAMATE ANOREXIANTS ANTI‐OBESITY DRUGS SAXENDA LIRAGLUTIDE ANOREXIANTS ANTI‐OBESITY DRUGS ABIRATERONE ACETATE ABIRATERONE ACETATE ANTIANDROGENS ANTINEOPLASTICS ERLEADA APALUTAMIDE ANTIANDROGENS ANTINEOPLASTICS NUBEQA DAROLUTAMIDE ANTIANDROGENS ANTINEOPLASTICS XTANDI ENZALUTAMIDE ANTIANDROGENS ANTINEOPLASTICS YONSA ABIRATERONE ACET,SUBMICRONIZED ANTIANDROGENS ANTINEOPLASTICS ZYTIGA ABIRATERONE ACETATE ANTIANDROGENS ANTINEOPLASTICS DIACOMIT STIRIPENTOL ANTICONVULSANTS CNS DRUGS EPIDIOLEX CANNABIDIOL (CBD) ANTICONVULSANTS CNS DRUGS LYRICA CR PREGABALIN ANTICONVULSANTS UNCLASSIFIED DRUG PRODUCTS BELLADONNA & OPIUM OPIUM/BELLADONNA ALKALOIDS ANTIDIARRHEALS ANALGESICS FASLODEX FULVESTRANT ANTIESTROGENS ANTINEOPLASTICS FULVESTRANT FULVESTRANT ANTIESTROGENS ANTINEOPLASTICS FOLOTYN PRALATREXATE ANTIMETABOLITES ANTINEOPLASTICS ONUREG AZACITADINE ANTIMETABOLITES ANTINEOPLASTICS VIDAZA AZACITIDINE ANTIMETABOLITES ANTINEOPLASTICS GOCOVRI AMANTADINE HCL ANTIPARKINSONISM AGENTS ANTIPARKINSON DRUGS INBRIJA LEVODOPA ANTIPARKINSONISM AGENTS ANTIPARKINSON DRUGS OSMOLEX ER AMANTADINE HCL ANTIPARKINSONISM AGENTS ANTIPARKINSON DRUGS COSENTYX 150MG SECUKINUMAB ANTIPSORIATIC / ANTISEBORRHEIC SKIN PREPS COSENTYX 300MG SECUKINUMAB ANTIPSORIATIC / ANTISEBORRHEIC SKIN PREPS ILUMYA TILDRAKIZUMAB‐ASMN ANTIPSORIATIC / ANTISEBORRHEIC SKIN PREPS ORENCIA ABATACEPT SC INJECTION ANTIPSORIATIC / ANTISEBORRHEIC SKIN PREPS OTEZLA APREMILAST TABLETS ANTIPSORIATIC / ANTISEBORRHEIC SKIN PREPS SILIQ BRODALUMAB ANTIPSORIATIC / ANTISEBORRHEIC SKIN PREPS SKYRIZI (2 SYRINGES) KIT RISANKIZUMAB‐RZAA ANTIPSORIATIC / ANTISEBORRHEIC SKIN PREPS STELARA USTEKINUMAB ANTIPSORIATIC / ANTISEBORRHEIC IMMUNOSUPPRESSANTS TALTZ AUTOINJECTOR IXEKIZUMAB ANTIPSORIATIC / ANTISEBORRHEIC SKIN PREPS TALTZ AUTOINJECTOR (2 PACK) IXEKIZUMAB ANTIPSORIATIC / ANTISEBORRHEIC SKIN PREPS TALTZ AUTOINJECTOR (3 PACK) IXEKIZUMAB ANTIPSORIATIC / ANTISEBORRHEIC SKIN PREPS TALTZ SYRINGE IXEKIZUMAB ANTIPSORIATIC / ANTISEBORRHEIC SKIN PREPS TREMFYA GUSELKUMAB ANTIPSORIATIC / ANTISEBORRHEIC SKIN PREPS LEMTRADA ALEMTUZUMAB INJECTION CD52‐DIRECTED CYTOLYTIC MONOCLONAL ANTIBODY MULTIPLE SCLEROSIS ACETAMINOPHEN W/CODEINE ACETAMINOPHEN WITH CODEINE COMBINATION NARCOTIC /ANALGESICS ANALGESICS APADAZ BENZHYDROCODONE/ACETAMINOPHEN COMBINATION NARCOTIC /ANALGESICS ANALGESICS ASCOMP WITH CODEINE CODEINE/BUTALBITAL/ASA/CAFFEIN COMBINATION NARCOTIC /ANALGESICS ANALGESICS ASPIRIN WITH CODEINE ASPIRIN/CODEINE PHOSPHATE COMBINATION NARCOTIC /ANALGESICS ANALGESICS BENZHYDROCODONE‐ACETAMINOPHEN BENZHYDROCODONE/ACETAMINOPHEN COMBINATION NARCOTIC /ANALGESICS ANALGESICS BUTALBITAL/CAFF/APAP/CODEINE BUTALBIT/ACETAMIN/CAFF/CODEINE COMBINATION NARCOTIC /ANALGESICS ANALGESICS DVORAH ACETAMINOPHEN/CAFF/DIHYDROCOD COMBINATION NARCOTIC /ANALGESICS ANALGESICS FIORICET WITH CODEINE BUTALBIT/ACETAMIN/CAFF/CODEINE COMBINATION NARCOTIC /ANALGESICS ANALGESICS HYDROCODONE BIT‐IBUPROFEN HYDROCODONE/IBUPROFEN COMBINATION NARCOTIC /ANALGESICS ANALGESICS HYDROCODONE W/ACETAMINOPHEN HYDROCODONE/ACETAMINOPHEN COMBINATION NARCOTIC /ANALGESICS ANALGESICS LORCET HYDROCODONE/ACETAMINOPHEN COMBINATION NARCOTIC /ANALGESICS ANALGESICS LORCET HD HYDROCODONE/ACETAMINOPHEN COMBINATION NARCOTIC /ANALGESICS ANALGESICS MARGESIC #3 ACETAMINOPHEN WITH CODEINE COMBINATION NARCOTIC /ANALGESICS ANALGESICS NALOCET OXYCODONE HCL/ACETAMINOPHEN COMBINATION NARCOTIC /ANALGESICS ANALGESICS OXYCODONE HCL‐IBUPROFEN IBUPROFEN/OXYCODONE HCL COMBINATION NARCOTIC /ANALGESICS ANALGESICS TYLENOL W/CODEINE ACETAMINOPHEN WITH CODEINE COMBINATION NARCOTIC /ANALGESICS ANALGESICS COPAXONE MISCELLANEOUS NEUROLOGICAL VUMERITY DIROXIMEL FUMARATE ORAL MULTIPLE SCLEROSIS THERAPY CNS DRUGS ARIPIPRAZOLE FOR EXTENDEDRELEASE INJECTABLE SUSPENSION FOR ABILIFY MAINTENA CUSTOM CUSTOM INTRAMUSCULAR USE APOKYN APOMORPHINE HYDROCHLORIDE INJCTION CUSTOM CUSTOM CIALIS FOR BENIGN PROSTATIC HYPERTROPHY ONLY TADALAFIL CUSTOM CUSTOM COMPOUNDED* MEDICATIONS CUSTOM CUSTOM DISPENSE AS WRITTEN ‐ DAW BRAND‐ NAME DRUGS WITH GENERICS AVAILABLE CUSTOM CUSTOM ENTERAL NUTRITION AND MEDICAL FOOD CUSTOM CUSTOM HIGH DOSE OPIOIDS CUSTOM CUSTOM INNOHEP TINZAPARIN CUSTOM CUSTOM KEYTRUDA PEMBROLIZUMAB CUSTOM CUSTOM LUTATHERA LUTETIUM LU 177 DOTATATE CUSTOM CUSTOM National Performance Formulary (NPF) *For compounds costing $300 or more Prior Approval List As of: 10/27/2020 | Rev: 10/27/2020 Trade Name Chemical/Biological Name Class Prior Authorization Program LUVERIS LUTROPIN ALFA CUSTOM CUSTOM OPIOID NAIVE IMMEDIATE RELEASE/ LONG ACTING IN OPIOID NAÏVE PERSON CUSTOM CUSTOM PEGASYS PEGYLATED INTERFERON ALFA 2A CUSTOM CUSTOM PEG‐INTRON PEGYLATED INTERFERON ALFA 2A CUSTOM CUSTOM PRALUENT ALICROCUMAB CUSTOM CUSTOM PROVENGE SIPULEUCEL‐T CUSTOM CUSTOM REBETOL ROBAVIRIN CUSTOM CUSTOM REPATHA EVOLOCUMAB CUSTOM CUSTOM SEROQUEL QUETIAPINE CUSTOM CUSTOM VIDAZA AZACITIDINE INJECTIONS CUSTOM CUSTOM VIMIZIM ELOSULFASE ALFA CUSTOM CUSTOM VPRIV VELAGLUCERASE ALFA CUSTOM CUSTOM YONDELIS TRABECTEDIN CUSTOM CUSTOM ZOMACTRA HIGH CUSTOM CUSTOM ARANESP DARBOEPOETIN ALFA ERYTHROID STIMULANTS COLONY STIMULATING FACTORS EPOGEN EPOETIN ALFA ERYTHROID STIMULANTS COLONY STIMULATING FACTORS MIRCERA EPOETIN BETA ERYTHROID STIMULANTS COLONY STIMULATING FACTORS REBLOZYL LUSPATERCEPT‐AAMT ERYTHROID STIMULANTS UNCLASSIFIED DRUG PRODUCTS RETACRIT EPOETIN ALFA‐EPBX ERYTHROID STIMULANTS COLONY STIMULATING FACTORS ORILISSA ELAGOLIX SODIUM GONADOTROPIN & RELATED AGENTS HORMONES GENOTROPIN SOMATROPIN GROWTH HORMONES HORMONES NORDITROPIN FLEXPRO SOMATROPIN GROWTH HORMONES HORMONES NUTROPIN AQ NUSPIN SOMATROPIN GROWTH HORMONES HORMONES OMNITROPE SOMATROPIN GROWTH HORMONES HORMONES SAIZEN SOMATROPIN GROWTH HORMONES HORMONES SAIZENPREP SOMATROPIN GROWTH HORMONES HORMONES SEROSTIM SOMATROPIN GROWTH HORMONES HORMONES ZOMACTON SOMATROPIN GROWTH HORMONES HORMONES ZORBTIVE SOMATROPIN GROWTH HORMONES HORMONES AIMOVIG AUTOINJECTOR ERENUMAB‐AOOE HEADACHE THERAPY ANALGESICS AJOVY FREMANEZUMAB‐VFRM HEADACHE THERAPY ANALGESICS EMGALITY GALCANEZUMAB‐GNLM HEADACHE THERAPY ANALGESICS EMGALITY SYRINGE GALCANEZUMAB‐GNLM HEADACHE THERAPY ANALGESICS DOPTELET AVATROMBOPAG MALEATE HEMOSTATICS COLONY STIMULATING FACTORS MULPLETA LUSUTROMBOPAG HEMOSTATICS COLONY STIMULATING FACTORS NPLATE ROMIPLOSTIM HEMOSTATICS COLONY STIMULATING FACTORS WILATE ANTIHEMOPHILIC FACTOR/VWF HEMOSTATICS BLOOD HETLIOZ TASIMELTEON HYPNOTIC AGENTS SEDATIVE/HYPNOTICS ZEPOSIA OZANIMOD IMMUNOMODULATOR MULTIPLE SCLEROSIS GAMIFANT EMAPALUMAB‐LZSG IMMUNOSUPPRESSANT DRUGS IMMUNOSUPPRESSANTS EXTAVIA INTERFERON BETA‐1B INTERFERONS CNS DRUGS PEGASYS PEGINTERFERON ALFA‐2A INTERFERONS ANTIVIRALS PLEGRIDY PEGINTERFERON BETA‐1A INTERFERONS CNS DRUGS REBIF INTERFERON BETA‐1A/ALBUMIN INTERFERONS CNS DRUGS REBIF REBIDOSE INTERFERON BETA‐1A/ALBUMIN INTERFERONS CNS DRUGS AYVAKIT AVAPRITINIB TABLET KINASE INHIBITOR ANTINEOPLASTICS JUXTAPID LOMITAPIDE MESYLATE LIPID LOWERING/CHOLESTEROL CARDIOVASCULAR NEXLETOL BEMPEDOIC ACID ORAL LIPID LOWERING/CHOLESTEROL HYPERLIPIDEMIA NEXLIZET BEMPEDOIC ACID/EZETIMIBE ORAL LIPID LOWERING/CHOLESTEROL HYPERLIPIDEMIA PRALUENT PEN ALIROCUMAB LIPID LOWERING/CHOLESTEROL CARDIOVASCULAR REPATHA PUSHTRONEX EVOLOCUMAB LIPID LOWERING/CHOLESTEROL CARDIOVASCULAR REPATHA SURECLICK EVOLOCUMAB LIPID LOWERING/CHOLESTEROL CARDIOVASCULAR REPATHA SYRINGE EVOLOCUMAB LIPID LOWERING/CHOLESTEROL CARDIOVASCULAR SARCLISA ISATUXIMAB INJECTION MISCELLAENOUS ANTINEOPLASTICS ADCETRIS BRENTUXIMAB INJECTION MISCELLANEOUS ANTINEOPLASTICS ARZERRA OFATUZUMAB INJECTION MISCELLANEOUS ANTINEOPLASTICS BLENREP BELANTAMAB MAFODOTIN‐BLMF MISCELLANEOUS ANTINEOPLASTICS DACOGEN DECITABIN INJECTION MISCELLANEOUS ANTINEOPLASTICS GIVLAARI GIVOSIRAN INJECTION MISCELLANEOUS HEPATOLOGY HALAVEN ERIBULIN MESYLATE INJECTION MISCELLANEOUS ANTINEOPLASTICS HERZUMA TRASTUZUMAB‐PKRB INJECTION FOR INTRAVENOUS INFUSION MISCELLANEOUS ANTINEOPLASTICS KANJINTI TRASTUZUMAB‐ANNS INJECTION MISCELLANEOUS ANTINEOPLASTICS KOSELUGO SELUMETINIB CAPSULES MISCELLANEOUS ANTINEOPLASTICS OGIVRI TRASTUZUMAB‐DKST INJECTION FOR INTRAVENOUS INFUSION MISCELLANEOUS ANTINEOPLASTICS ONTRUZANT TRASTUZUMAB‐DTTB INJECTION FOR INTRAVENOUS INFUSION MISCELLANEOUS ANTINEOPLASTICS PEMAZYRE PEMIGATINIB TABLETS MISCELLANEOUS ANTINEOPLASTICS TEPADINE THIOTEPA INJECTION FOR
Load more

Recommended publications
  • Keeping up with FDA Drug Approvals: 60 New Drugs in 60 Minutes Elizabeth A
    Keeping Up with FDA Drug Approvals: 60 New Drugs in 60 Minutes Elizabeth A. Shlom, PharmD, BCPS Senior Vice President & Director Clinical Pharmacy Program | Acurity, Inc. Privileged and Confidential April 10, 2019 Privileged and Confidential Program Objectives By the end of the presentation, the pharmacist or pharmacy technician participant will be able to: ▪ Identify orphan drugs and first-in-class medications approved by the FDA in 2018. ▪ List five new drugs and their indications. ▪ Identify the place in therapy for three novel monoclonal antibodies. ▪ Discuss at least two new medications that address public health concerns. Dr. Shlom does not have any conflicts of interest in regard to this presentation. Both trade names and generic names will be discussed throughout the presentation Privileged and Confidential 2018 NDA Approvals (NMEs/BLAs) ▪ Lutathera (lutetium Lu 177 dotatate) ▪ Braftovi (encorafenib) ▪ Vizimpro (dacomitinib) ▪ Biktarvy (bictegravir, emtricitabine, ▪ TPOXX (tecovirimat) ▪ Libtayo (cemiplimab-rwic) tenofovir, ▪ Tibsovo (ivosidenib) ▪ Seysara (sarecycline) alafenamide) ▪ Krintafel (tafenoquine) ▪ Nuzyra (omadacycline) ▪ Symdeko (tezacaftor, ivacaftor) ▪ Orilissa (elagolix sodium) ▪ Revcovi (elapegademase-lvir) ▪ Erleada (apalutamide) ▪ Omegaven (fish oil triglycerides) ▪ Tegsedi (inotersen) ▪ Trogarzo (ibalizumab-uiyk) ▪ Mulpleta (lusutrombopag) ▪ Talzenna (talazoparib) ▪ Ilumya (tildrakizumab-asmn) ▪ Poteligeo (mogamulizumab-kpkc) ▪ Xofluza (baloxavir marboxil) ▪ Tavalisse (fostamatinib disodium) ▪ Onpattro (patisiran)
    [Show full text]
  • CDER List of Licensed Biological Products With
    Center for Drug Evaluation and Research List of Licensed Biological Products with (1) Reference Product Exclusivity and (2) Biosimilarity or Interchangeability Evaluations to Date DATE OF FIRST REFERENCE PRODUCT DATE OF LICENSURE LICENSURE EXCLUSIVITY EXPIRY DATE INTERCHANGEABLE (I)/ BLA STN PRODUCT (PROPER) NAME PROPRIETARY NAME (mo/day/yr) (mo/day/yr) (mo/day/yr) BIOSIMILAR (B) WITHDRAWN 125118 abatacept Orencia 12/23/05 NA NA 103575 abciximab ReoPro 12/22/94 NA NA Yes 125274 abobotulinumtoxinA Dysport 04/29/09 125057 adalimumab Humira 12/31/02 NA NA 761071 adalimumab-adaz Hyrimoz 10/30/18 B 761058 adalimumab-adbm Cyltezo 08/25/17 B 761118 adalimumab-afzb Abrilada 11/15/19 B 761024 adalimumab-atto Amjevita 09/23/16 B 761059 adalimumab-bwwd Hadlima 07/23/19 B 125427 ado-trastuzumab emtansine Kadcyla 02/22/13 125387 aflibercept Eylea 11/18/11 103979 agalsidase beta Fabrazyme 04/24/03 NA NA 125431 albiglutide Tanzeum 04/15/14 017835 albumin chromated CR-51 serum Chromalbin 02/23/76 103293 aldesleukin Proleukin 05/05/92 NA NA 103948 alemtuzumab Campath, Lemtrada 05/07/01 NA NA 125141 alglucosidase alfa Myozyme 04/28/06 NA NA 125291 alglucosidase alfa Lumizyme 05/24/10 125559 alirocumab Praluent 07/24/15 103172 alteplase, cathflo activase Activase 11/13/87 NA NA 103950 anakinra Kineret 11/14/01 NA NA 020304 aprotinin Trasylol 12/29/93 125513 asfotase alfa Strensiq 10/23/15 101063 asparaginase Elspar 01/10/78 NA NA 125359 asparaginase erwinia chrysanthemi Erwinaze 11/18/11 761034 atezolizumab Tecentriq 05/18/16 761049 avelumab Bavencio 03/23/17
    [Show full text]
  • Prior Authorization and Step Therapy Criteria
    BCN AdvantageSM HMO-POS and HMO BCN Advantage Comprehensive Formulary Prior Authorization / Step Therapy Program 2020 Plan Year Updated 12/1/2020 BCN Advantage HMO-POS and HMO monitor the use of certain medications to ensure our members receive the most appropriate and cost-effective drug therapy. Prior authorization (PA) for these drugs means that either clinical and/or administrative criteria must be met before coverage is provided. Drugs subject to step therapy (ST) may require previous treatment with one or more formulary drugs prior to coverage. Drugs that must meet clinical/administrative criteria are identified in the formulary list with (PA) or (ST). If drugs listed below have a (g) noted, the PA or ST criteria may also apply to the generic version of the drug. In some cases, the brand name drug is listed for reference and the generic drug is covered. Please refer to the Formulary to verify if your drugs are covered. Your physician can contact our pharmacy help desk to request prior authorization or step therapy for these drugs. The clinical criteria for authorization are based on current medical information and the recommendations of the Blues’ Pharmacy and Therapeutics Committee, a group of physicians, pharmacists and other experts. Please call the customer service number on the back of your BCN Advantage member ID card if you have questions about your drug coverage or a drug claim. g = generic available 12/1/2020 Page 1 of 35 FORM ID# 20165 H5883_20IndPAST_C FVNR 1120 MEDICATION/ DRUG CLASS CRITERIA Abilify Maintena® Coverage requires trial of oral aripiprazole. (aripiprazole) Coverage duration: Lifetime.
    [Show full text]
  • Drug Code List
    Blue Cross Blue Shield Arizonia Specialty Drug Code List HCPCS Generic Name Product Name Therapeutic Category Code 90281 Immune Globulin Gamastan Immune deficiency 90283 Immune Globulin Gammagard Immune deficiency 90284 Immune Globulin Cuvitru Immune deficiency 90378 Palivizumab Synagis RSV Polyneuropathy of hereditary transthyretin-mediated C9036 Patisiran Onpattro amyloidosis in adults. C9257 Bevacizumab Avastin Ophthalmic disorder C9399 Defibrotide Defitelio Other C9399 Elapegademase-lvlr Revcovi ADA-SCID (PKU) with uncontrolled blood phenylalanine C9399 Pegvaliase-pqpz Palynziq concentrations greater than 600 micromol/L on existing management C9399 Pasireotide Signifor Other C9399 Ravulizumab-cwvz Ultomiris PNH C9399 Unclassified drug or biological (new drug) Unclassified drug or biological (new drug) J0178 Aflibercept Eylea Ophthalmic disorder J0180 Agalsidase Beta Fabrazyme Lysosomal storage disorders J0202 Alemtuzumab Lemtrada Multiple sclerosis J0221 Alglucosidase Alfa Lumizyme Lysosomal storage disorders J0256 Alpha1-proteinase inhibitors Aralast NP, Prolastin-C, Zemaira Alpha-1 antitrypsin deficiency J0257 Alpha1-proteinase inhibitors Glassia Alpha-1 antitrypsin deficiency J0364 Apomorphine Apokyn Other J0517 Benralizumab Fasenra Severe Asthma with an Eosinophilic phenotye J0565 Bezlotoxumab Zinplava C-Diff J0584 Burosumab-twza Crysvita X-linked hypophosphatemia (XLH) J0585 OnabotulinumtoxinA Botox Spacticity disorder Updated: 3/13/2019 V1.2019 Effective: 1/1/2019 HCPCS Generic Name Product Name Therapeutic Category Code J0586
    [Show full text]
  • Mrx CLINICAL ALERT
    MRx NOVEMBER 2018 CLINICAL ALERT YOUR MONTHLY SOURCE FOR DRUG INFORMATION HIGHLIGHTS HOT TOPIC: While yearly vaccination is the primary NEW FLU MED APPROVED means of preventing and controlling EDITORIAL flu outbreaks, treatment with antiviral Influenza places a considerable burden agents can lessen symptoms, shorten STAFF on the United States (US) healthcare duration of illness, and prevent serious system, with up to 35 million cases complications. reported each year. As the 2018- EDITOR IN CHIEF 2019 flu season gets underway, the UPDATED CONSENSUS ON Maryam Tabatabai Food and Drug Administration (FDA) DIABETES MANAGEMENT PharmD granted Priority Review and approval for Genentech/Shionogi’s baloxavir The American Diabetes Association marboxil (Xofluza™), the first new (ADA) and the European Association for EXECUTIVE EDITOR novel influenza antiviral in nearly 20 the Study of Diabetes (EASD) updated Carole Kerzic years. The new agent is indicated to their 2015 joint position statement on RPh treat acute uncomplicated influenza the management of type 2 diabetes in people ≥ 12 years of age with flu mellitus (T2DM). It includes a new DEPUTY EDITORS symptoms for ≤ 48 hours. Baloxavir decision cycle for patient-centered Stephanie Christofferson marboxil uses a unique mechanism glycemic management with a goal PharmD of action to block the replication of to prevent diabetes complications influenza A and B viruses, including and enhance quality of life (QOL). Jessica Czechowski Avian strains (H7N9, H5N1). In clinical Greater focus is placed on lifestyle PharmD studies, it was well tolerated and management and diabetes self- eased flu symptoms in about the management education and support. Lara Frick same amount of time as the market Weight loss strategies include lifestyle, PharmD, BCPS, BCPP leader, oral oseltamivir (Tamiflu®), and medical nutrition therapy (MNT), significantly less time compared to medication, and surgical interventions.
    [Show full text]
  • Formulary Drug List
    ABALOPARATIDE Products Affected • TYMLOS PA Criteria Criteria Details Exclusion PATIENT HAS RECEIVED A TOTAL OF 24 MONTHS Criteria CUMULATIVE TREATMENT WITH ANY PARATHYROID HORMONE THERAPY. Required Medical Information Age Restrictions Prescriber Restrictions Coverage 12 MONTHS Duration 1 PA Criteria Criteria Details Other Criteria ONE OF THE FOLLOWING: (1) HIGH RISK FOR FRACTURES DEFINED AS ONE OF THE FOLLOWING: (A) HISTORY OF OSTEOPOROTIC (I.E., FRAGILITY, LOW TRAUMA) FRACTURE(S), (B) 2 OR MORE RISK FACTORS FOR FRACTURE (E.G., HISTORY OF MULTIPLE RECENT LOW TRAUMA FRACTURES, BMD T-SCORE LESS THAN OR EQUAL TO -2.5, CORTICOSTEROID USE, OR USE OF GNRH ANALOGS), OR (C) NO PRIOR TREATMENT FOR OSTEOPOROSIS AND FRAX SCORE OF AT LEAST 20% FOR ANY MAJOR FRACTURE OR OF AT LEAST 3% FOR HIP FRACTURE. (2) UNABLE TO USE ORAL THERAPY (I.E., UPPER GASTROINTESTINAL PROBLEMS UNABLE TO TOLERATE ORAL MEDICATION, LOWER GASTROINTESTINAL PROBLEMS UNABLE TO ABSORB ORAL MEDICATIONS, TROUBLE REMEMBERING TO TAKE ORAL MEDICATIONS OR COORDINATING AN ORAL BISPHOSPHONATE WITH OTHER ORAL MEDICATIONS OR THEIR DAILY ROUTINE). (3) ADEQUATE TRIAL OF, INTOLERANCE TO, OR A CONTRAINDICATION TO ONE BISPHOSPHONATE. Indications All FDA-approved Indications. Off Label Uses 2 ABATACEPT IV Products Affected • ORENCIA (WITH MALTOSE) PA Criteria Criteria Details Exclusion Criteria Required Medical Information Age Restrictions Prescriber RHEUMATOID ARTHRITIS AND POLYARTICULAR Restrictions JUVENILE IDIOPATHIC ARTHRITIS: PRESCRIBED BY OR GIVEN IN CONSULTATION WITH A RHEUMATOLOGIST. PSORIATIC ARTHRITIS: PRESCRIBED BY OR GIVEN IN CONSULTATION WITH A DERMATOLOGIST OR RHEUMATOLOGIST. Coverage INITIAL: 6 MONTHS. RENEWAL: 12 MONTHS. Duration Other Criteria INITIAL: RHEUMATOID ARTHRITIS (RA): PREVIOUS TRIAL OF OR CONTRAINDICATION TO ANY TWO OF THE FOLLOWING PREFERRED AGENTS: HUMIRA, ENBREL, XELJANZ, RINVOQ.
    [Show full text]
  • Stembook 2018.Pdf
    The use of stems in the selection of International Nonproprietary Names (INN) for pharmaceutical substances FORMER DOCUMENT NUMBER: WHO/PHARM S/NOM 15 WHO/EMP/RHT/TSN/2018.1 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. The use of stems in the selection of International Nonproprietary Names (INN) for pharmaceutical substances. Geneva: World Health Organization; 2018 (WHO/EMP/RHT/TSN/2018.1). Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data.
    [Show full text]
  • Blue Cross and Blue Shield October 2020 Multi-Tier Basic Annual Drug List I How to Use This List Generic Drugs Are Shown in Lower-Case Boldface Type
    Multi-Tier Basic Annual Drug List October 2020 Please consider talking to your doctor about prescribing preferred medications, which may help reduce your out- of-pocket costs. This list may help guide you and your doctor in selecting an appropriate medication for you. The drug list is regularly updated. You can view the most up-to-date list, or the specialty drug list, at MyPrime.com. Contents Therapeutic Class Drug List Introduction ....................................................... I Anti-Infective Agents ........................................ 1 How drugs are selected .................................... I Antineoplastic Agents ...................................... 3 How member payment is determined ............... I Endocrine and Metabolic Drugs ...................... 6 How to use this list ........................................... II Cardiovascular Agents ................................... 11 Drugs used to treat multiple conditions ........... II Respiratory Agents ........................................ 16 Generic drugs ................................................. III Gastrointestinal Agents .................................. 18 Consider talking to your doctor about generic Genitourinary Agents ..................................... 20 drugs ........................................................... III Central Nervous System Drugs ..................... 20 Coverage considerations ............................... IV Analgesics and Anesthetics ........................... 24 Specialty drugs ..............................................
    [Show full text]
  • Potential and Applications of Nanocarriers for Efficient Delivery Of
    pharmaceutics Review Potential and Applications of Nanocarriers for Efficient Delivery of Biopharmaceuticals 1,2, 2, 1 1 1 Alam Zeb y , Isra Rana y, Ho-Ik Choi , Cheol-Ho Lee , Seong-Woong Baek , Chang-Wan Lim 1, Namrah Khan 2, Sadia Tabassam Arif 2, Najam us Sahar 2, Arooj Mohsin Alvi 2 , Fawad Ali Shah 2 , Fakhar ud Din 3, Ok-Nam Bae 1 , Jeong-Sook Park 4,* and Jin-Ki Kim 1,* 1 Institute of Pharmaceutical Science and Technology, College of Pharmacy, Hanyang University, 55 Hanyangdaehak-ro, Sangnok-gu, Ansan, Gyeonggi-do 15588, Korea; [email protected] (A.Z.); [email protected] (H.-I.C.); [email protected] (C.-H.L.); [email protected] (S.-W.B.); [email protected] (C.-W.L.); [email protected] (O.-N.B.) 2 Riphah Institute of Pharmaceutical Science, Riphah International University, Islamabad 44000, Pakistan; [email protected] (I.R.); [email protected] (N.K.); [email protected] (S.T.A.); [email protected] (N.u.S.); [email protected] (A.M.A.); [email protected] (F.A.S.) 3 Department of Pharmacy, Quaid-i-Azam University, Islamabad 45320, Pakistan; [email protected] 4 Institute of Drug Research and Development, College of Pharmacy, Chungnam National University, 99 Daehak-ro, Yuseong-gu, Daejeon 34134, Korea * Correspondence: [email protected] (J.-S.P.); [email protected] (J.-K.K.); Tel.: +82-42-821-5932 (J.-S.P.); +82-31-400-5808 (J.-K.K.) These authors contributed equally to this work.
    [Show full text]
  • North Carolina Division of Health Benefits Physician Administered Drug Program Catalog
    North Carolina Division of Health Benefits Physician Administered Drug Program Catalog North Carolina Division of Health Benefits Physician Administered Drug Program Catalog •Unless otherwise indicated, the catalog contains procedure codes representing drugs, biologics, devices and vaccines which are only covered for FDA approved indications. Covered indications that are not FDA approved are identified with **. •11 digit National Drug Codes (NDCs) are required to be billed along with their corresponding procedure code. Drugs and biologics must be classified as CMS covered outpatient drugs from a labeler/manufacturer participating in the Medicaid Drug Rebate Program (MDRP). •The Max Daily Units for radiopharmaceuticals represents one therapeutic dose or diagnostic dose. •The HCPCS Code effective date represents the date the HCPCS code was established •Procedure codes for covered devices and vaccines are not required to be from a rebating labeler/manufacturer as they are not classified as covered outpatient drugs. HCPCS HCPCS HCPCS Code Billing FDA Approved Indications Max Monthly Gender NDC Rebating Labeler Last Modified Category HCPCS Description Effective Brand Name Generic Name Max Daily Units Minimum Age Maximum Age Comments Code Unit (See Package Insert for full FDA approved indication descriptions) Units Restrictions Required Required Date Date Injection, amphotericin B lipid amphotericin B lipid complex Drugs J0287 10 mg 1/1/2003 Abelcet® Indicated for the treatment of invasive fungal infections in patients who are refractory to or intolerant of conventional amphotericin B therapy. 70 2,170 N/A N/A N/A Y Y 5/6/2019 complex, 10 mg injection aripiprazole extended-release Injection, aripiprazole, Indicated for the treatment of schizophrenia in adults.
    [Show full text]
  • Perioperative Medication Management - Adult/Pediatric - Inpatient/Ambulatory Clinical Practice Guideline
    Effective 6/11/2020. Contact [email protected] for previous versions. Perioperative Medication Management - Adult/Pediatric - Inpatient/Ambulatory Clinical Practice Guideline Note: Active Table of Contents – Click to follow link INTRODUCTION........................................................................................................................... 3 SCOPE....................................................................................................................................... 3 DEFINITIONS .............................................................................................................................. 3 RECOMMENDATIONS ................................................................................................................... 4 METHODOLOGY .........................................................................................................................28 COLLATERAL TOOLS & RESOURCES..................................................................................................31 APPENDIX A: PERIOPERATIVE MEDICATION MANAGEMENT .................................................................32 APPENDIX B: TREATMENT ALGORITHM FOR THE TIMING OF ELECTIVE NONCARDIAC SURGERY IN PATIENTS WITH CORONARY STENTS .....................................................................................................................58 APPENDIX C: METHYLENE BLUE AND SEROTONIN SYNDROME ...............................................................59 APPENDIX D: AMINOLEVULINIC ACID AND PHOTOTOXICITY
    [Show full text]
  • CDER List of Licensed Biological Products With
    Center for Drug Evaluation and Research List of Licensed Biological Products with (1) Reference Product Exclusivity and (2) Biosimilarity or Interchangeability Evaluations to Date DATE OF FIRST REFERENCE PRODUCT DATE OF LICENSURE LICENSURE EXCLUSIVITY EXPIRY DATE INTERCHANGEABLE (I)/ BLA STN PRODUCT (PROPER) NAME PROPRIETARY NAME (mo/day/yr) (mo/day/yr) (mo/day/yr) BIOSIMILAR (B) WITHDRAWN 125118 abatacept Orencia 12/23/05 NA NA 103575 abciximab ReoPro 12/22/94 NA NA 125274 abobotulinumtoxinA Dysport 04/29/09 125057 adalimumab Humira 12/31/02 NA NA 761071 adalimumab-adaz Hyrimoz 10/30/18 B 761058 adalimumab-adbm Cyltezo 08/25/17 B 761024 adalimumab-atto Amjevita 09/23/16 B 125427 ado-trastuzumab emtansine Kadcyla 02/22/13 125387 aflibercept Eylea 11/18/11 103979 agalsidase beta Fabrazyme 04/24/03 NA NA 125431 albiglutide Tanzeum 04/15/14 103293 aldesleukin Proleukin 05/05/92 NA NA 103948 alemtuzumab Campath, Lemtrada 05/07/01 NA NA 125141 alglucosidase alfa Myozyme 04/28/06 NA NA 125291 alglucosidase alfa Lumizyme 05/24/10 125559 alirocumab Praluent 07/24/15 103172 alteplase, cathflo activase Activase 11/13/87 NA NA 103950 anakinra Kineret 11/14/01 NA NA 125513 asfotase alfa Strensiq 10/23/15 101063 asparaginase Elspar 01/10/78 NA NA 125359 asparaginase erwinia chrysanthemi Erwinaze 11/18/11 761034 atezolizumab Tecentriq 05/18/16 761049 avelumab Bavencio 03/23/17 103764 basiliximab Simulect 05/12/98 NA NA 103691 becaplermin Regranex 12/16/97 NA NA 125288 belatacept Nulojix 06/15/11 125370 belimumab Benlysta 03/09/11 761043 belimumab Benlysta
    [Show full text]