Number 135, October 10, 2019

MHDL Update c. Effective October 7, 2019, the following urinary dysfunction agent will no longer Below are certain updates to the MassHealth require prior authorization for exceeding Drug List (MHDL). See the MHDL for a complete quantity limits. listing of updates. • Detrol LA # (tolterodine extended-release 2 mg) Additions d. Effective October 7, 2019, the following urinary dysfunction agent will require prior a. Effective October 1, 2019, the following authorization. newly marketed drug has been added to the MassHealth Drug List. • trospium extended-release – PA PD e. Effective October 7, 2019, the following • Dovato (dolutegravir/lamivudine) antihistamine agent will no longer require b. Effective October 7, 2019, the following prior authorization for use above quantity newly marketed drugs have been added to limits. the MassHealth Drug List. • azelastine 137 mcg nasal spray • dexchlorpheniramine solution – PA f. Effective October 7, 2019, the following • Evenity (romosozumab-aqqg) – PA antihistamine agent will no longer require • Ezallor (rosuvastatin sprinkle capsule) – PA prior authorization. • Gamifant (emapalumab-lzsg) – PA • carbinoxamine 4 mg/5mL solution, 4 mg tablet • Mavenclad (cladribine tablet) – PA • Clarinex # (desloratadine syrup, tablet) • Piqray (alpelisib) – PA • Dymista (azelastine/fluticasone propionate) • pyridostigmine bromide 30 mg tablet – PA • Skyrizi (risankizumab-rzaa) – PA Updated MassHealth Brand Name • Vyndaqel (tafamidis) – PA Preferred Over Generic Drug List a. Effective October 1, 2019, the following Change in Prior Authorization Status agents will be removed from the MassHealth Brand Name Preferred Over Generic Drug a. Effective October 1, 2019, the following antiretroviral agent will no longer require List. prior authorization. • Epclusa (sofosbuvir/velpatasvir) – PA • Juluca (dolutegravir/rilpivirine) PD • Harvoni (ledipasvir/sofosbuvir) – PA b. Effective October 7, 2019, the following b. Effective October 7, 2019, the following agent will be added to the MassHealth Brand urinary dysfunction agents will no longer require prior authorization. Name Preferred Over Generic Drug List. • Copaxone (glatiramer 40 mg) BP • Gelnique (oxybutynin gel)

• Myrbetriq (mirabegron extended-release) • Oxytrol (oxybutynin transdermal system) • Toviaz (fesoterodine) BP • Vesicare # (solifenacin)

Pharmacy Facts, Number 135 Page 2 of 2

c. Effective October 7, 2019, the following Updated MassHealth ACPP/MCO Uniform agents will be removed from the Preferred Drug List MassHealth Brand Name Preferred Over a. Effective January 1, 2020. the following Generic Drug List. antiretroviral agents will be added to the • Delzicol DR # (mesalamine capsule) MassHealth ACPP/MCO Uniform Preferred • Flector (diclofenac topical patch) – PA Drug List. • Letairis (ambrisentan) – PA • Dovato (dolutegravir/lamivudine) • Tamiflu # (oseltamivir 30mg) – PA all • Juluca (dolutegravir/rilpivirine) quantities (June 1st to September 30th); • Triumeq (abacavir/dolutegravir/lamivudine) PA > 20 capsules/season (October 1st to May 31st) b. Effective January 1. 2020, the following • Tamiflu # (oseltamivir 45 mg and 75 mg) – hepatitis antiviral agents will be added to the PA all quantities (June 1st to September MassHealth ACPP/MCO Uniform Preferred 30th); PA > 10 capsules/season (October 1st to May 31st) Drug List. • Vesicare # (solifenacin) • ledipasvir/sofosbuvir • Xeloda # (capecitabine) • sofosbuvir/velpatasvir c. Effective January 1, 2020, the following Updated MassHealth Supplemental hepatitis antiviral agents will be removed Rebate/Preferred Drug List from the MassHealth ACPP/MCO Uniform Preferred Drug List. a. Effective October 1, 2019, the following • Epclusa (sofosbuvir/velpatasvir) antiretroviral agents will be added to the • Harvoni (ledipasvir/sofosbuvir) MassHealth Supplemental • Sovaldi (sofosbuvir) Rebate/Preferred Drug List. ______• Dovato (dolutegravir/lamivudine) PD PD Legend • Juluca (dolutegravir/rilpivirine) PD PA • Triumeq (abacavir/dolutegravir/lamivudine) Prior authorization is required. The prescriber must obtain b. Effective October 1, 2019, the following prior authorization for the drug in order for the pharmacy to receive payment. Note: PA applies to both the brand- hepatitis antiviral agents will be added to name and the FDA “A”-rated generic equivalent of listed the MassHealth Supplemental product.

Rebate/Preferred Drug List. # PD Designates a brand-name drug with FDA “A”-rated • ledipasvir/sofosbuvir – PA PD generic equivalents. Prior authorization is required for the • sofosbuvir/velpatasvir – PA brand, unless a particular form of that drug (for example, c. Effective October 1, 2019, the following tablet, capsule, or liquid) does not have an FDA “A”-rated generic equivalent. hepatitis antiviral agents will be removed

from the MassHealth Supplemental BP Brand preferred over generic equivalents. In general, Rebate/Preferred Drug List. MassHealth requires a trial of the preferred drug or • Epclusa (sofosbuvir/velpatasvir) – PA clinical rationale for prescribing the nonpreferred drug generic equivalent. • Harvoni (ledipasvir/sofosbuvir) – PA • Sovaldi (sofosbuvir) – PA PD In general, MassHealth requires a trial of the preferred drug (PD) or a clinical rationale for prescribing a nonpreferred drug within a therapeutic class.

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