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Wednesday, February 10, 2016 4 P.M Wednesday, February 10, 2016 4 p.m. Oklahoma Health Care Authority 4345 N. Lincoln Blvd. Oklahoma City, OK 73105 The University of Oklahoma Health Sciences Center COLLEGE OF PHARMACY PHARMACY MANAGEMENT CONSULTANTS MEMORANDUM TO: Drug Utilization Review (DUR) Board Members FROM: Bethany Holderread, Pharm.D. SUBJECT: Packet Contents for DUR Board Meeting – February 10, 2016 DATE: February 1, 2016 Note: The DUR Board will meet at 4:00p.m. The meeting will be held at 4345 N Lincoln Blvd. Enclosed are the following items related to the February meeting. Material is arranged in order of the agenda. Call to Order Public Comment Forum Action Item – Approval of DUR Board Meeting Minutes – Appendix A Update on Medication Coverage Authorization Unit/Oral Viscous Lidocaine Claims Analysis Update – Appendix B Action Item – Vote to Prior Authorize Duopa™ (Carbidopa/Levodopa Enteral Suspension) and Rytary™ (Carbidopa/Levodopa Extended-Release Capsules) – Appendix C Action Item – Vote to Prior Authorize Cortisporin® and Pediotic® (Neomycin/Polymyxin B/Hydrocortisone Otic) – Appendix D Action Item – Vote to Prior Authorize Migranal® (Dihydroergotamine Nasal Spray) – Appendix E Action Item – Vote to Prior Authorize Strensiq™ (Asfotase Alfa) – Appendix F Action Item – Vote to Prior Authorize Varubi™ (Rolapitant) – Appendix G Action Item – Vote to Prior Authorize Xuriden™ (Uridine Triacetate) – Appendix H Annual Review of Gout Medications and 30-Day Notice to Prior Authorize Mitigare™ (Colchicine Capsules) and Zurampic® (Lesinurad) – Appendix I Annual Review of Seizure Medications and 30-Day Notice to Prior Authorize Spritam® (Levetiracetam) – Appendix J 30-Day Notice to Prior Authorize Solaraze® (Diclofenac Gel) – Appendix K Annual Review of Ulcerative Colitis Medications and 30-Day Notice to Prior Authorize Uceris® (Budesonide Extended-Release Tablets), Uceris® (Budesonide Rectal Foam), and Miscellaneous Mesalamine Products – Appendix L Annual Review of Ocular Allergy Medications and 30-Day Notice to Prior Authorize Pazeo® (Olopatadine Ophthalmic) – Appendix M ORI-4403 • P.O. BOX 26901 • OKLAHOMA CITY, OKLAHOMA 73126-0901 • (405) 271-9039 • FAX: (405) 271-2615 Annual Review of Gonadotropin Releasing Hormones – Appendix N Annual Review of Northera™ (Droxidopa) – Appendix O FDA and DEA Updates – Appendix P Future Business (Upcoming Product and Class Reviews) Adjournment ORI-4403 • P.O. BOX 26901 • OKLAHOMA CITY, OKLAHOMA 73126-0901 • (405) 271-9039 • FAX: (405) 271-2615 Oklahoma Health Care Authority Drug Utilization Review Board (DUR Board) Meeting – February 10, 2016 @ 4:00 p.m. Oklahoma Health Care Authority 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105 AGENDA Discussion and Action on the Following Items: Items to be presented by Dr. Muchmore, Chairman: 1. Call to Order A. Roll Call – Dr. Cothran Items to be presented by Dr. Muchmore, Chairman: 2. Public Comment Forum A. Acknowledgment of Speakers and Agenda Items Items to be presented by Dr. Muchmore, Chairman: 3. Action Item – Approval of DUR Board Meeting Minutes – See Appendix A A. January 13, 2016 DUR Minutes – Vote B. January 13, 2016 DUR Recommendations Memorandum Items to be presented by Dr. Holderread, Dr. Muchmore, Chairman: 4. Update on Medication Coverage Authorization Unit/Oral Viscous Lidocaine Claims Analysis Update – See Appendix B A. Medication Coverage Activity for January 2016 B. Pharmacy Help Desk Activity for January 2016 C. Oral Viscous Lidocaine Claims Analysis Update Items to be presented by Dr. Holderread, Dr. Muchmore, Chairman: 5. Action Item – Vote to Prior Authorize Duopa™ (Carbidopa/Levodopa Enteral Suspension) and Rytary™ (Carbidopa/Levodopa Extended-Release Capsules) – See Appendix C A. Introduction B. College of Pharmacy Recommendations Items to be presented by Dr. Holderread, Dr. Muchmore, Chairman: 6. Action Item – Vote to Prior Authorize Cortisporin® and Pediotic® (Neomycin/Polymyxin B/ Hydrocortisone Otic) – See Appendix D A. Introduction B. College of Pharmacy Recommendations Items to be presented by Dr. Nawaz, Dr. Muchmore, Chairman: 7. Action Item – Vote to Prior Authorize Migranal® (Dihydroergotamine Nasal Spray) – See Appendix E A. Indication(s) B. College of Pharmacy Recommendations Items to be presented by Dr. Nawaz, Dr. Muchmore, Chairman: 8. Action Item – Vote to Prior Authorize Strensiq™ (Asfotase Alfa) – See Appendix F A. Introduction B. College of Pharmacy Recommendations Items to be presented by Dr. Adams, Dr. Muchmore, Chairman: 9. Action Item – Vote to Prior Authorize Varubi™ (Rolapitant) – See Appendix G A. Introduction B. College of Pharmacy Recommendations Items to be presented by Dr. Chandler, Dr. Muchmore, Chairman: 10. Action Item – Vote to Prior Authorize Xuriden™ (Uridine Triacetate) – See Appendix H A. Introduction B. College of Pharmacy Recommendations Items to be presented by Dr. Chandler, Dr. Muchmore, Chairman: 11. Annual Review of Gout Medications and 30-Day Notice to Prior Authorize Mitigare™ (Colchicine Capsules) and Zurampic® (Lesinurad) – See Appendix I A. Current Prior Authorization Criteria B. Utilization of Gout Medications C. Prior Authorization of Gout Medications D. Market News and Updates E. Mitigare™ (Colchicine Capsules) Product Summary F. Zurampic™ (Lesinurad) Product Summary G. College of Pharmacy Recommendations H. Utilization Details of Gout Medications Items to be presented by Dr. Adams, Dr. Muchmore, Chairman: 12. Annual Review of Seizure Medications and 30-Day Notice to Prior Authorize Spritam® (Levetiracetam) – See Appendix J A. Current Prior Authorization Criteria B. Utilization of Seizure Medications C. Prior Authorization of Seizure Medications D. Market News and Updates E. Spritam® (Levetiracetam) Product Summary F. Vimpat® (Lacosamide) Product Summary G. Banzel® (Rufinamide) Product Summary H. Fycompa® (Perampanel) Product Summary I. College of Pharmacy Recommendations J. Utilization Details of Seizure Medications Items to be presented by Dr. Adams, Dr. Muchmore, Chairman: 13. 30-Day Notice to Prior Authorize Solaraze® (Diclofenac Gel) – See Appendix K A. Actinic Keratosis Background Information B. Solaraze® (Diclofenac 3% Gel) Product Summary C. College of Pharmacy Recommendations Items to be presented by Dr. Nawaz, Dr. Muchmore, Chairman: 14. Annual Review of Ulcerative Colitis Medications and 30-Day Notice to Prior Authorize Uceris® (Budesonide Extended-Release Tablets), Uceris® (Budesonide Rectal Foam), and Miscellaneous Mesalamine Products – See Appendix L A. Ulcerative Colitis (UC) Background Information B. Current Prior Authorization Criteria C. Utilization of UC Medications D. Prior Authorization of UC Medications E. Market News and Updates F. Uceris® (Budesonide) Extended-Release Tablets Product Summary G. Uceris® (Budesonide) Rectal Foam Product Summary H. Asacol® HD (Mesalamine) Delayed-Release Tablets Product Summary I. Pentasa® (Mesalamine) Controlled-Release Capsules Product Summary J.Rowasa® (Mesalamine) Rectal Suspension Enema Product Summary K. Lialda® (Mesalamine) Delayed-Release Capsules Product Summary L. Colazal® (Balsalazide) Capsules Product Summary M.Dipentum® (Olsalazine) Capsules Product Summary N. Canasa® (Mesalamine) Suppositories Product Summary O. Apriso® (Mesalamine) Extended-Release Capsules Product Summary P. Delzicol® (Mesalamine) Delayed-Release Capsules Product Summary Q. Cost Comparison R. College of Pharmacy Recommendations S. Utilization Details of Ulcerative Colitis Medications Items to be presented by Dr. Holderread, Dr. Muchmore, Chairman: 15. Annual Review of Ocular Allergy Medications and 30-Day Notice to Prior Authorize Pazeo® (Olopatadine Ophthalmic) – See Appendix M A. Current Prior Authorization Criteria B. Utilization of Ocular Allergy Medications C. Prior Authorization of Ocular Allergy Medications D. Market News and Updates E. Pazeo® (Olopatadine Ophthalmic) Product Summary F. College of Pharmacy Recommendations G. Utilization Details of Ocular Allergy Medications Non-Presentation, Questions Only: 16. Annual Review of Gonadotropin Releasing Hormones (GnRH) – See Appendix N A. Introduction B. FDA Approved GnRH Options for Treatment of Central Precocious Puberty or Endometriosis C. Current Prior Authorization Criteria D. Utilization of GnRH Medications E. Prior Authorization of GnRH Medications F. Market News and Updates G. College of Pharmacy Recommendations H. Utilization Details of GnRH Medications Non-Presentation, Questions Only: 17. Annual Review of Northera™ (Droxidopa) – See Appendix O A. Introduction B. Current Prior Authorization Criteria C. Utilization of Northera™ (Droxidopa) D. Prior Authorization of Northera™ (Droxidopa) E. Market News and Updates F. College of Pharmacy Recommendations Items to be presented by Dr. Cothran, Dr. Muchmore, Chairman: 18. FDA and DEA Updates – See Appendix P Items to be presented by Dr. Holderread, Dr. Muchmore, Chairman: 19. Future Business* (Upcoming Product and Class Reviews) A. Makena® (Hydroxyprogesterone Caproate) B. Multiple Sclerosis Medications C. Growth Hormone D. Vasomotor Symptom Medications E. Idiopathic Pulmonary Fibrosis Medications F. Botulinum Toxins G.Pulmonary Arterial Hypertension Medications H. Cerdelga™ (Eliglustat) I. Hemophilia Medication Pharmacy Providers *Future business subject to change. 20. Adjournment Appendix A OKLAHOMA HEALTH CARE AUTHORITY DRUG UTILIZATION REVIEW BOARD MEETING MINUTES OF MEETING OF JANUARY 13, 2016 BOARD MEMBERS: PRESENT ABSENT Theresa Garton, M.D. x Carla Hardzog-Britt, M.D. x Anetta Harrell, Pharm.D. x Ashley Huddleston, Pharm.D. x John Muchmore,
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