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Pharmacy and Therapeutics (P&T) Committee Meeting May MAY 22, 2018 PHARMACY AND THERAPEUTICS (P&T) COMMITTEE MEETING NORTH CAROLINA STATE HEALTH PLAN 3200 ATLANTIC AVENUE, RALEIGH, NC 27604 Pharmacy and Therapeutics (P&T) Committee Meeting Tuesday, May 22nd 2018, 6:30 p.m. to 8:00 p.m. Agenda Topic: Presenter: 1. Welcome Carl Antolick III, Chair • Call to Order • Roll Call 2. Conflict of Interest Statement Carl Antolick III, Chair 3. Minutes from February 20, 2018 Meeting* Carl Antolick III, Chair 4. Old Business Carl Antolick III, Chair • Formulary Development and Management at CVS Caremark • Plan Formulary Decisions o New Policies o Policy Removals 5. Formulary Updates* Carl Antolick III, Chair • Hyperinflation Exclusions Heather Renee Jarnigan, CVS • Tier Changes Heather Renee Jarnigan, CVS o Uptier o Downtier • Formulary Additions • New Drug Reviews ® o Calquence Michael Spiritos, MD o Verzenio™ Michael Spiritos, MD o Xermelo™ Michael Spiritos, MD ® o Imfinzi Michael Spiritos, MD ® o Ozempic Jennifer Burch, PharmD o Trogarzo™ John Engemann, MD o Odactra™ Joseph Shanahan, MD o Symdeko™ David Konanc, MD 6. Utilization Management Policy Review* Carl Antolick III, Chair • New Policies Under Consideration Heather Renee Jarnigan, CVS ® o Dupixent Enhanced SGM ® o Eucrisa o Topical Corticosteroids *Requires a recommendation from the P&T Committee North Carolina State Health Plan • Existing Policies Heather Renee Jarnigan, CVS ® o Praluent ® o Repatha o Omega-3 Fatty Acids ® o Prolia ® o Xgeva 7. Adjourn Carl Antolick III, Chair • Next Meeting: Tuesday August 21, 2018 from 6:30 to 8:00 PM via webinar *Requires a recommendation from the P&T Committee North Carolina State Health Plan PHARMACY AND THERAPEUTICS (P&T) COMMITTEE February 20, 2018 The meeting of the Pharmacy and Therapeutics (P&T) Committee of the North Carolina State Health Plan for Teachers and State Employees (The Plan) was called to order at 6:30 P.M. (EST) on Tuesday, February 20, 2018, via webinar, accessible to the public through the Plan’s website. Quorum was present. MEMBERS PRESENT: Carl Antolick III, PharmD, Clinical Pharmacist, NCSHP (Chair) David Konanc, MD, Neurologist, Raleigh Neurology Associates Matthew K. Flynn, MD, Founder, Family Dermatology Joseph Shanahan, MD, Owner, Shanahan Rheumatology & Immunotherapy Jennifer Burch, PharmD, Owner, Central Compounding Center Peter Robie, MD, General Internist, Wake Forest Baptist Community Physicians Tony Gurley, RPh, JD, Owner/Pharmacy Manager, Glenwood South Pharmacy + Market Heather Renee Jarnigan, RPh, Clinical Advisor, CVS Health (non-voting member) MEMBERS ABSENT: John Anderson, MD, MPH, Chief Medical Officer, Duke Primary Care John J. Engemann, MD, Infectious Disease Specialist, Raleigh Infectious Disease Associates, PA Michael D. Spiritos, MD, Chief Medical Officer, Duke Raleigh Hospital W. Randolph Grigg, MD, Psychiatrist, Psychiatric Associates of North Carolina, PA STATE HEALTH PLAN STAFF: Tracy Linton, Sr. Director, Plan Benefits Dee Jones, Executive Administrator Caroline Smart, Sr. Director, Plan Integration Lucy Barreto, DDS, MHA, Healthcare Product Manager Welcome: The Chairperson welcomed the Committee members and guests to the webinar and performed roll call. Dee Jones introduced and welcomed new P&T Committee members, Peter Robie & Tony Gurley. Conflict of Interest In compliance with the requirements of Chapter 138A-15(e) of the State Government Ethics Act the Chairperson read the NCSHP’s Ethics Awareness & Conflict of Interest Reminder to the P&T Committee members and requested that members who have either an actual or perceived conflict of interest identify the conflict and refrain from discussion and voting in those matters as appropriate. No conflicts of interest were noted. Minutes from August P&T Meeting: The Chairperson asked the P&T Committee members to review the November 2017 P&T meeting minutes, which were distributed prior to the meeting. There were no additions or corrections to the minutes so they were approved as is. P&T Bylaws: The Chairperson informed the participants that the P&T Committee Bylaws had been finalized by the Plan’s legal team and were available for review. These bylaws set up the basic rules, operating standards and procedures the Committee will follow and to maintain consistency they mirror the established NCSHP Board of Trustee bylaws. After a brief summary, no edits were suggested by the Committee members and the bylaws were unanimously approved. Old Business: The Chairperson summarized the Plan’s 2018 Formulary Strategy which was voted on and approved during the last P&T Committee meeting held in November of 2017. One notable change that was not discussed during the last meeting was the removal of the buprenorphine, buprenorphine/naloxone, and Dificid prior authorizations. The Dificid prior authorization was not producing a return on investment while the other prior authorizations were removed to allow for increased access of medication assisted therapies in the treatment of opioid dependence. Formulary Updates: Heather Renee Jarnigan presented CVS Caremark’s Quarterly Formulary Updates which will be effective May 1, 2018. This included drug removals and additions to the formulary as well as tier changes. Dr. Jarnigan reviewed the following branded products that will be removed from the formulary: Alevicyn, Buphenyl, and Ravicti. All products being removed have comparable preferred generic formulary options available as alternative therapies. There were no comments or opposition from the Committee members so the changes were approved as presented. Dr. Jarnigan outlined products that would be changing their specialty classification. Products that will no longer be considered specialty include: Oralair, Botox, Dysport, Myobloc, Xeomin, Monovisc, Genvisc 850, Hymovis, Euflexxa, Gel One, Gelsyn-3, Hyalgan, Orthovisc, Supartz, Synvisc, Synvisc One, Implanon, Kyleena, Liletta, Mirena, Nexplanon, and Skyla. Products that will now be considered specialty are Xyrem. There were no comments or opposition from the Committee members so the changes were approved as presented. Dr. Jarnigan identified all of the branded products that will be moving to a non-preferred status, or uptiered. They include: Brisdelle, Juxtapid, Renvela, and Tamiflu. All of these products have formulary alternatives that are preferred. There were no comments or opposition from the Committee members so the changes were approved as presented. Dr. Jarnigan identified all of the branded products that will be moving to a preferred status, or downtiered. They include: Austedo, Kyleena, Mirena, Skyla, Odomzo, Cystagon, Estring, Omnipod and Tolak. The members of the P&T Committee were not asked to vote on this change as it was a positive benefit change for the Plan membership. Dr. Jarnigan identified all of the medications that were being removed from CVS’s New-to-Market block and would be available as covered products effective May 1, 2018. All of the products were new formulations or strengths of medications that were already on the formulary and include: Varubi, Qtern, Tracleer, Zenpep, Retin-A Micro Gel, Odomzo, Trisenox, Stelara, Tolak, Fibryga, Trelegy Ellipta, Opdivo, Prolastin-C, Xigduo, Actimmune, Jadenu, Adzenys ER, Fiasp, Romidepsin, methylphenidate ER and gemcitabine. The Committee members also reviewed the following new molecular entities: Hemlibra and Verzenio. Calquence and Fasenra were tabled due to the absence of the Committee’s oncologist, Dr. Spiritos, although they still will be added to the formulary starting May 1, 2018. The members of the P&T Committee were not asked to vote on this change as it was a positive benefit change for the Plan membership. The Committee reviewed new utilization management criteria which included: Proton Pump Inhibitors Quantity Limit; Post Limit Prior Authorization, ZEGERID® Initial Prior Authorization, ULORIC® Initial Step Therapy; Post Step Therapy Prior Authorization, and ACTICLATE® Initial Step Therapy; Post Step Therapy Prior Authorization. Dr. Burch commented that the adoption of the Proton Pump Inhibitors Quantity Limit; Post Limit Prior Authorization may cause undue member disruption as there is a large population of Plan members that may be taking the medications affected. The Chairperson responded by ensuring the Committee that additional utilization studies will be done before the Plan decides incorporate the criteria. No other revisions were recommended by the Committee. The Plan will determine implementation of these policies for a future date. The Committee also reviewed current utilization management criteria which included: 5-HT1 Agonist Quantity Limit; Post Limit Prior Authorization, MIGRANAL Quantity Limit, Butorphanol Quantity Limit; Post Limit Prior Authorization, and Lidocaine Quantity Limit; Post Limit Prior Authorization. Dr. Konanc had some questions about the quantity limits for the 5-HT1 Agonists and Dr. Jarnigan was able to provide a satisfactory explanation. No other revisions were recommended by the Committee. Adjourn The meeting was adjourned at approximately 7:45 P.M. (EST), with the next meeting scheduled for May 22, 2018 at 6:30 PM EST via webinar. Carl Antolick III, Chair Recent Plan Formulary Decisions 1. New Policies Enacted: • ZEGERID® Initial Prior Authorization • ACTICLATE® Initial Step Therapy & Post Step Therapy Prior Authorization 2. New Policies Not Enacted: • Proton Pump Inhibitors Quantity Limit & Post Limit Prior Authorization • ULORIC® Initial Step Therapy & Post Step Therapy Prior Authorization 3. Criteria Removed: • All prior authorization requirements
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