Wednesday, September 14, 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 – September 14, 2016 DATE: August 31, 2016 Note: The DUR Board will meet at 4:00 p.m. The meeting will be held at 4345 N Lincoln Blvd. Enclosed are the following items related to the September 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 Action Item – Update on Medication Coverage Authorization Unit/Concomitant Benzodiazepine and Opioid Utilization – Appendix B Action Item – Vote to Prior Authorize Dexilant™ SoluTab (Dexlansoprazole Delayed-Release Orally Disintegrating Tablets) – Appendix C Action Item – Vote to Prior Authorize AK-Tracin® (Bacitracin) and Bleph-10® (Sulfacetamide Sodium) Ophthalmic Ointment – Appendix D Action Item – Vote to Prior Authorize Betoptic® (Betaxolol Ophthalmic Solution), Timoptic-XE® (Timolol Maleate Ophthalmic Gel-Forming Solution), & Betimol® (Timolol Ophthalmic Solution) – Appendix E Action Item – Vote to Prior Authorize Nasarel® (Flunisolide Nasal Spray) – Appendix F Action Item – Vote to Prior Authorize Ocaliva™ (Obeticholic Acid) – Appendix G Action Item – Vote to Prior Authorize Belbuca™ (Buprenorphine Buccal Film), Dolophine® (Methadone), MorphaBond™ (Morphine Extended-Release), Xtampza™ ER (Oxycodone Extended-Release), & Probuphine® (Buprenorphine Implant) – Appendix H Action Item – Vote to Prior Authorize Vivlodex™ (Meloxicam Capsules) – Appendix I Annual Review of Prednisolone Special Formulations and 30-Day Notice to Prior Authorize Millipred™ (Prednisolone Sodium Phosphate Oral Solution 10mg/5mL) – Appendix J Annual Review of Synagis® (Palivizumab) – Appendix K Action Item – Annual Review of Antihyperlipidemics – Appendix L ORI-4403 • P.O. BOX 26901 • OKLAHOMA CITY, OKLAHOMA 73126-0901 • (405) 271-9039 • FAX: (405) 271-2615 Action Item – Annual Review of Anticoagulants and Platelet Aggregation Inhibitors – Appendix M Annual Review of Dry Eye Disease Products and 30-Day Notice to Prior Authorize Xiidra™ (Lifitegrast 5% Ophthalmic Solution) – Appendix N Annual Review of Butalbital Products and 30-Day Notice to Prior Authorize Allzital® (Butalbital/Acetaminophen 25mg/325mg) & Esgic® Capsules (Butalbital/Acetaminophen/Caffeine 50mg/325mg/40mg) – 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 – September 14, 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. Keast 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. July 13, 2016 DUR Minutes – Vote B. July 13, 2016 DUR Recommendations Memorandum C. August 10, 2016 DUR Recommendations Memorandum Items to be presented by Dr. Holderread, Dr. Muchmore, Chairman: 4. Action Item – Update on Medication Coverage Authorization Unit/Concomitant Benzodiazepine and Opioid Utilization – See Appendix B A. Medication Coverage Activity for August 2016 B. Pharmacy Help Desk Activity for August 2016 C. Concomitant Benzodiazepine and Opioid Utilization Items to be presented by Dr. Nawaz, Dr. Muchmore, Chairman: 5. Action Item – Vote to Prior Authorize Dexilant™ SoluTab (Dexlansoprazole Delayed-Release Orally Disintegrating Tablets) – See Appendix C A. Indication(s) and Dosing B. College of Pharmacy Recommendations Items to be presented by Dr. Nawaz, Dr. Muchmore, Chairman: 6. Action Item – Vote to Prior Authorize AK-Tracin® (Bacitracin) and Bleph-10® (Sulfacetamide Sodium) Ophthalmic Ointment – See Appendix D A. Indication(s) B. College of Pharmacy Recommendations Items to be presented by Dr. Adams, Dr. Muchmore, Chairman: 7. Action Item – Vote to Prior Authorize Betoptic® (Betaxolol Ophthalmic Solution), Timoptic-XE® (Timolol Maleate Ophthalmic Gel-Forming Solution), & Betimol® (Timolol Ophthalmic Solution) – See Appendix E A. Introduction B. College of Pharmacy Recommendations Items to be presented by Dr. Chandler, Dr. Muchmore, Chairman: 8. Action Item – Vote to Prior Authorize Nasarel® (Flunisolide Nasal Spray) – See Appendix F A. Introduction B. College of Pharmacy Recommendations Items to be presented by Dr. Chandler, Dr. Muchmore, Chairman: 9. Action Item – Vote to Prior Authorize Ocaliva™ (Obeticholic Acid) – See Appendix G A. Introduction B. College of Pharmacy Recommendations Items to be presented by Dr. Holderread, Dr. Muchmore, Chairman: 10. Action Item – Vote to Prior Authorize Belbuca™ (Buprenorphine Buccal Film), Dolophine® (Methadone), MorphaBond™ (Morphine Extended-Release), Xtampza™ ER (Oxycodone Extended- Release), & Probuphine® (Buprenorphine Implant) – See Appendix H A. Introduction B. College of Pharmacy Recommendations Items to be presented by Dr. Holderread, Dr. Muchmore, Chairman: 11. Action Item – Vote to Prior Authorize Vivlodex™ (Meloxicam Capsules) – See Appendix I A. Introduction B. College of Pharmacy Recommendations Items to be presented by Dr. Holderread, Dr. Muchmore, Chairman: 12. Annual Review of Prednisolone Special Formulations and 30-Day Notice to Prior Authorize Millipred™ (Prednisolone Sodium Phosphate Oral Solution 10mg/5mL) – See Appendix J A. Introduction B. Current Prior Authorization Criteria C. Utilization of Prednisolone Special Formulations D. Prior Authorization of Prednisolone Special Formulations E. Prednisolone Special Formulations Claims Analysis F. Millipred™ (Prednisolone Sodium Phosphate Oral Solution 10mg/5mL) Product Summary G. College of Pharmacy Recommendations H. Utilization Details of Prednisolone Special Formulations Items to be presented by Dr. Holderread, Dr. Muchmore, Chairman: 13. Annual Review of Synagis® (Palivizumab) – See Appendix K A. Current Prior Authorization Criteria B. Utilization of Palivizumab C. Prior Authorization of Palivizumab D. Season Comparison E. Market News and Updates F. College of Pharmacy Recommendations Items to be presented by Dr. Adams, Dr. Muchmore, Chairman: 14. Action Item – Annual Review of Antihyperlipidemics – See Appendix L A. Current Prior Authorization Criteria B. Utilization of Antihyperlipidemics C. Prior Authorization of Antihyperlipidemics D. Market News and Updates E. College of Pharmacy Recommendations F. Utilization Details of Statin Medications and Zetia® (Ezetimibe) G.Utilization Details of Omega-3 Fatty Acids H. Utilization Details of Juxtapid® (Lomitapide) and Kynamro® (Mipomersen) I. Utilization Details of PCSK9 Inhibitors Items to be presented by Dr. Nawaz, Dr. Muchmore, Chairman: 15. Action Item – Annual Review of Anticoagulants and Platelet Aggregation Inhibitors – See Appendix M A. Current Prior Authorization Criteria B. Utilization of Anticoagulants and Platelet Aggregation Inhibitors C. Prior Authorization of Anticoagulants and Platelet Aggregation Inhibitors D. Market News and Updates E. College of Pharmacy Recommendations F. Utilization Details of Anticoagulants G. Utilization Details of Platelet Aggregation Inhibitors Items to be presented by Dr. Chandler, Dr. Muchmore, Chairman: 16. Annual Review of Dry Eye Disease Products and 30-Day Notice to Prior Authorize Xiidra™ (Lifitegrast 5% Ophthalmic Solution) – See Appendix N A. Utilization of Dry Eye Disease Products B. Dry Eye Disease C. Xiidra™ (Lifitegrast Ophthalmic Solution) Product Summary D. College of Pharmacy Recommendations Items to be presented by Dr. Chandler, Dr. Muchmore, Chairman: 17. Annual Review of Butalbital Products and 30-Day Notice to Prior Authorize Allzital® (Butalbital/Acetaminophen 25mg/325mg) & Esgic® Capsules (Butalbital/Acetaminophen/Caffeine 50mg/325mg/40mg) – See Appendix O A. Current Prior Authorization Criteria B. Utilization of Butalbital Products C. Prior Authorization of Butalbital Products D. Pricing Trend(s) E. Allzital® (Butalbital/Acetaminophen 25mg/325mg) Product Summary F. College of Pharmacy Recommendations G. Utilization Details of Butalbital Products Items to be presented by Dr. Keast, 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. Heart Failure Medications B. Targeted Immunomodulator Agents C. Breast Cancer Medications D. Skin Cancer Medications E. Constipation and Diarrhea Medications F. Topical Corticosteroids G. Bladder Control Medications H. Topical Lidocaine Medications I. Growth Hormone *Future business subject to change. 20. Adjournment Appendix A OKLAHOMA HEALTH CARE AUTHORITY DRUG UTILIZATION REVIEW BOARD MEETING MINUTES OF MEETING OF JULY 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., BCOP x John Muchmore, M.D., Ph.D.; Chairman x James Osborne, Pharm.D. x Paul Louis Preslar, D.O., MBA; Vice Chairman x James Rhymer, D.Ph.