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PDL Drug Class Review Announcement January 09, 2018

Drug Classes to be reviewed: Atypical , Growth Hormones, Insulins, Intranasal Corticosteroids, Modifiers, Multiple Sclerosis Agents, Neurocognitive Disorder Agents, Ophthalmic Allergy, Sedative Hypnotics (Non- & Benzodiazepine), and Statins/Statin Combinations

These drug classes will be reviewed at the January 09, 2018 P&T Committee meeting from 1‐5pm. The location is 303 East 17th Avenue, Denver, CO 80203 7th Floor Conference Rooms (7ABC). Dossiers and Supplemental Rebate offers are due to Magellan by November 21, 2017.

Please provide your public comments to Jessica Czechowski, Clinical Account Manager ([email protected]) no later than January 5, 2018 to ensure they are included in the information supplied to the P&T Committee members. Please see the P&T Policies and Procedures for public comment specifications. Please carbon copy Brittany Schock, PDL Pharmacist ([email protected]) on all clinical information and public comment submissions.

Atypical Antipsychotics Brand Name Generic Name

Abilify , ODT, oral solution

Aripiprazole tablet, ODT, oral solution

Clozaril tablet, ODT

Clozapine tablet, ODT

Fanapt tablet

Fazaclo Clozapine ODT

Clozapine ODT

Geodon capsule

Ziprasidone capsule

Invega ER tablet

Paliperidone ER tablet Latuda tablet

Nuplazid tablet

Rexulti tablet

Risperdal tablet, ODT, oral solution

Risperidone tablet, ODT, oral solution

Saphris sublingual tablet

Seroquel tablet

Quetiapine tablet

Seroquel XR Quetiapine XR tablet

Quetiapine XR tablet

Symbyax / capsule

Olanzapine/fluoxetine capsule

Versacloz Clozapine oral suspension

Vraylar capsule

Zyprexa Olanzapine tablet

Olanzapine tablet

Zyprexa Zydis Olanzapine ODT

Olanzapine ODT

Growth Hormones Brand Name Generic Name

Genotropin Somatropin

Humatrope Somatropin

Norditropin Somatropin

Nutropin Somatropin

Omnitrope Somatropin Saizen Somatropin

Serostim Somatropin

Zomacton Somatropin

Zorbtive Somatropin

Insulin

Rapid-acting Afrezza inhaled powder Insulin human

Apidra vial/pen Insulin glulisine

Fiasp vial/pen insulin aspart

Humalog vial/pens Insulin lispro

Humalog Junior pen Insulin lispro

Novolog vial/pen Insulin aspart

Short-acting Humulin R vial/pen Regular insulin

Novolin R vial/pen Regular insulin

Intermediate-acting Humulin N vial/pen Insulin NPH

Novolin N vial/pen Insulin NPH

Long-acting Basaglar pen Insulin glargine

Lantus vial/pen Insulin glargine Levemir vial/pen Insulin detemir

Toujeo pen Insulin glargine

Tresiba pen Insulin degludec

Insulin Mixtures Humalog Mix 50/50 vial/pen 50% insulin lispro protamine/50% insulin lispro

Humalog Mix 75/25 vial/pen 75% insulin lispro protamine/25% insulin lispro

Humulin 70/30 vial/pen 70% insulin NPH/30% insulin regular

Novolin 70/30 vial 70% insulin NPH/30% insulin regular

Novolog Mix 70/30 vial/pen 70% insulin aspart protamine/30% insulin aspart

Intranasal Corticosteroids Brand Name Generic Name

Triamcinolone acetonide (generic Nasacort AQ)

Flunisolide (generic Nasarel)

Budesonide (generic Rhinocort Aqua)

Beconase AQ Beclomethasone diproprionate

Dymista /fluticasone propionate

Flonase Fluticasone propionate

Fluticasone propionate

Nasonex Mometasone

Mometasone

Omnaris Ciclesonide

Qnasl Beclomethasone dipropionate

Ticanase Fluticasone propionate + sterile saline wash Zetonna Ciclesonide

Leukotriene Modifiers

Brand Name Generic Name

Accolate Zafirlukast (tablet)

Zafirlukast (tablet)

Singulair Montelukast (tablet, chewable tablet, granules)

Montelukast (tablet, chewable tablet, granules)

Zyflo, Zyflo CR Zileuton (IR tablet, ER tablet)

Zileuton (IR tablet, ER tablet)

Multiple Sclerosis Agents

Brand Name Generic Name

Ampyra Dalfampridine

Avonex Interferon Beta 1a

Betaseron Interferon Beta 1b

Extavia Interferon Beta 1b

Plegridy Peginterferon Beta 1a

Rebif Interferon Beta 1a

Copaxone 20 mg Glatiramer acetate

Glatiramer acetate

Copaxone 40 mg Glatiramer acetate

Glatiramer acetate Glatopa (20 mg) Glatiramer acetate

Aubagio Teriflunomide

Gilenya Fingolimod

Tecfidera Dimethyl Fumarate

Zinbryta daclizumab

Neurocognitive Disorder Agents Brand Name Generic Name

Aricept Donepezil (tablet, ODT)

Donepezil (tablet, ODT)

Exelon Rivastigmine (capsule, patch, oral solution)

Rivastigmine (capsule, patch, oral solution)

Namenda IR (tablet, oral solution)

Memantine (tablet, oral solution)

Namenda XR Memantine XR capsule

Namzaric Memantine/Donepezil ER capsule

Razadyne Galantamine (IR tabs, oral solution, ER caps)

Galantamine (IR tabs, oral solution, ER caps)

Ophthalmic Allergy

Brand Name Generic Name

Azelastine (generic Optivar) Cromolyn (generic Crolom, Opticrom)

Alaway Ketotifen furmarate

Ketotifen furmarate

Alocril Nedocromil sodium

Alomide Lodoxamide tromethamine

Alrex Loteprednol

Bepreve besilate

Elestat Epinatstine

Emadine difumarate

Lastacaft

Pataday 0.2%

Olopatadine 0.2%

Patanol Olopatadine 0.1%

Olopatadine 0.1%

Pazeo Olopatadine 0.7%

Zaditor Ketotifen fumarate

Ketotifen fumarate

Sedative Hypnotics (Non-Benzodiazepine & Benzodiazepine)

Brand Name Generic Name

Non-Benzodiazepine

Ambien Zolpidem IR tablet

Zolpidem IR tablet

Ambien CR Zolpidem ER tablet

Zolpidem ER tablet

Belsomra Suvorexant tablet Edluar Zolpidem sublingual tablet

Intermezzo Zolpidem sublingual tablet

Zolpidem sublingual tablet

Lunesta Eszopiclone tablet

Eszopiclone tablet

Rozerem Ramelteon tablet

Sonata Zaleplon capsule

Zaleplon capsule

Zolpimist Zolpidem oral solution

Benzodiazepine

Estazolam tablet (generic Prosom)

Flurazepam capsule (generic Dalmane)

Quazepam tablet (generic Doral)

Restoril Temazepam capsule

Temazepam capsule

Halcion Triazolam tablet

Triazolam tablet

Statins/ Statin Combinations

Brand Name Generic Name

Lovastatin (generic Mevacor)

Altoprev Lovastatin ER

Crestor Rosuvastatin

Rosuvastatin

Lescol Fluvastatin Fluvastatin

Lescol XL Fluvastatin ER

Fluvastatin ER

Lipitor Atorvastatin

Atorvastatin

Livalo Pitavastatin

Pravachol Pravastatin

Pravastatin

Zocor Simvastatin

Simvastatin

Advicor Niacin ER/lovastatin

Caduet Amlodipine/Atorvastatin

Amlodipine/Atorvastatin

Simcor Niacin/Simvastatin

Vytorin Ezetimibe/Simvastatin

Ezetimibe/Simvastatin