AHCCCS Pharmacy and Therapeutics Committee Recommendations May 23, 2023

The AHCCCS Pharmacy and Therapeutics Committee made recommendations on various drug classes, including Analgesics, Narcotics, Antibiotics, Inhaled, Anticoagulants, and Antimigraine Agents. The recommendations specify preferred products and changes in preferred status for certain medications. Brand preferences over generic drugs are highlighted in the report, providing comprehensive insights for healthcare professionals and stakeholders.

• AHCCCS
• Pharmacy
• Therapeutics
• Recommendations

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1. AHCCCS Pharmacy and Therapeutics Committee Recommendations May 23, 2023

2. Committee Recommendations PDL Recommendation Key: Products currently preferred and remaining preferred are listed in Black Products currently new, not previously reviewed or non-preferred and recommended to be preferred are listed in Blue Products currently new, not previously reviewed or preferred and recommended to be non- preferred are listed in Red Products currently included on the AHCCCS approved drug list are noted with an asterisk (*) Classes where grandfathering is recommended will have a notation on the preferred recommendations page 2

3. P&T Public Class Vote: Analgesics, Narcotics Long Acting 3

4. Analgesics, Narcotics Long Acting PDL Recommendations (preferred products): Butrans*^ fentanyl transdermal (not including the 37.5mg, 62.5mg & 87.5 strengths)* morphine ER tablet* tramadol ER (generic Ultram ER)* Xtampza ER*^ ^Brand is preferred over generic 4

5. P&T Public Class Vote: Antibiotics, Inhaled 5

6. Antibiotics, Inhaled PDL Recommendations (preferred products): Bethkis* Kitabis Pak* 6

7. P&T Public Class Vote: Anticoagulants 7

8. Anticoagulants PDL Recommendations (preferred products): Oral Agents PDL Recommendations (products moving to nonpreferred status): Pradaxa Pellet Pack o Eliquis*, Eliquis Dose Pack* o Pradaxa*^ o Xarelto*, Xarelto Dose Pack* Grandfathering - No o warfarin* Injectable Agents o enoxaparin syringe*, enoxaparin syringe* (AG) ^Brand is preferred over generic o enoxaparin vial* (AG) 8

9. P&T Public Class Vote: Antimigraine Agents, CGRP 9

10. Antimigraine Agents, CGRP PDL Recommendations (preferred products): Ajovy* Cafergot* Emgality Syringe 120mg* Emgality Pen* Ubrelvy* PDL Recommendations (products moving to nonpreferred status): Aimovig* Migergot rectal Grandfathering Aimovig Yes Migergot rectal - No 10

11. P&T Public Class Vote: Antipsychotics, Atypical Long-Acting Injectable 11

12. Antipsychotics, Atypical Long-Acting Injectable PDL Recommendations (preferred products): Long-Acting Injectable Agents o Abilify Maintena* o Aristada* o Aristada Initio* o Invega Hafyera o Invega Sustenna* o Invega Trinza* o Perseris* o Risperdal Consta* 12

13. P&T Public Class Vote: Antipsychotics, Oral Atypical 13

14. Antipsychotics, Oral Atypical PDL Recommendations (preferred products): Oral Agents o aripiprazole tablet* o clozapine ODT*, clozapine ODT*(AG), clozapine tablet* o lurasidone o olanzapine ODT*, olanzapine tablet* o quetiapine tablet* o risperdone ODT*, risperidone solution*, risperidone tablet* o ziprasidone capsule* PDL Recommendations (products moving to nonpreferred status): Latuda Grandfathering - No 14

15. P&T Public Class Vote: COPD Agents 15

16. COPD Agents PDL Recommendations (preferred products): Antimuscarinics - Short-Acting o Atrovent* o ipratropium nebulizer* Antimuscarinics - Long-Acting o Spiriva HandiHaler* o Spiriva Respimat o Tudorza Pressair* Beta Agonist/Antimuscarinic Combination - Short-Acting o ipratropium/albuterol nebulizer* o Combivent Respimat* Beta Agonist/Antimuscarinic Combination - Long-Acting o Anoro Ellipta* o Stiolto Respimat* 16

17. P&T Public Class Vote: Cytokine and CAM Antagonists 17

18. Cytokine and CAM Antagonists PDL Recommendations (preferred products): Enbrel Kit*, Enbrel Syringe*, Enbrel Pen*, Enbrel Mini Cartridge*, Enbrel Vial* with PA Humira Kit*, Humira Pen Kit* with PA infliximab Orencia Clickject, Orencia Syringe Otezla* with PA Xeljanz (immediate release) with PA PDL Recommendations (products moving to nonpreferred status): Avsola Grandfathering No grandfathering for Remicade, Inflectra, Renflexis, and Avsola 18

19. P&T Public Class Vote: Epinephrine, Self-Injected 19

20. Epinephrine, Self-Injected PDL Recommendations (preferred products): epinephrine 0.15mg (generic EpiPen Jr.)* epinephrine 0.3mg (generic EpiPen)* 20

21. P&T Public Class Vote: Glucagon Agents 21

22. Glucagon Agents PDL Recommendations (preferred products): glucagon injection* glucagon emergency kit (by Amphastar)* Gvoke Pen PA for greater QL of 1, Gvoke Syringe, Gvoke Vial Proglycem Suspension* Zegalogue Autoinjector PDL Recommendations (products moving to nonpreferred status): glucagon emergency kit (by Eli Lilly)* Grandfathering - Yes 22

23. P&T Public Class Vote: Glucocorticoids, Inhaled 23

24. Glucocorticoids, Inhaled PDL Recommendations (preferred products): Single Agent Products o Asmanex* o budesonide 1 mg respules* o budesonide 0.25 and 0.5 mg respules* o Flovent HFA*^ o Pulmicort Flexhaler* Combination Products o Advair Diskus*^ o Advair HFA* o Flovent Diskus* o Dulera* o Symbicort*^ ^Brand is preferred over generic 24

25. P&T Public Class Vote: Growth Hormone 25

26. Growth Hormone PDL Recommendations (preferred products): Genotropin Cartridge*, Genotropin Disp Syringe* Norditropin Pen* 26

27. P&T Public Class Vote: Hepatitis C Agents Direct Acting 27

28. Hepatitis C Agents (Direct Acting) PDL Recommendations (preferred products): Mavyret* sofosbuvir/velpatasvir (AG)* 28

29. P&T Public Class Vote: Hypoglycemics, Incretin Mimetics/Enhancers 29

30. Hypoglycemics, Incretin Mimetics/Enhancers PDL Recommendations (preferred products): Amylin Analogues o Symlin Pens* Dipeptidyl Peptidase-4 Enzyme Inhibitors (DPP-4s) o Janumet* o Janumet XR* o Januvia* o Jentadueto* o Jentadueto XR* o Kazano*^ o Kombiglyze XR* ^Brand is preferred over generic Dipeptidyl Peptidase-4 Enzyme Inhibitors (DPP-4s) Cont. o Nesina*^ o Onglyza* o Oseni*^ o Tradjenta* o Trijardy XR* Glucagon-Like Peptide-1 Receptor Agonists (GLP-1s) o Bydureon Pens* o Byetta Pens* o Trulicity* o Victoza* 30

31. P&T Public Class Vote: Hypoglycemics, Insulin and Related Agents 31

32. Hypoglycemics, Insulin and Related Agents (1 of 2) PDL Recommendations (preferred products): Rapid-Acting Insulins o Humalog Cartridge* o Insulin Aspart Cartridge (AG) o Insulin Aspart Pen (AG) o Insulin Aspart Vial (AG) o Insulin Lispro Junior Kwikpen (AG) o Insulin Lispro Pen (AG) o Insulin Lispro Vial (AG) Regular Insulins o Humulin 500 Pens*, Humulin 500 Vials* o Novolin Vial OTC* Long-Acting Insulins o Lantus Vial* o Lantus Solostar Pen* o Levemir Pens*, Levemir Vials* 32

33. Hypoglycemics, Insulin and Related Agents (2 of 2) PDL Recommendations (preferred products): Rapid/Intermediate-Acting Combination Insulins o Humalog Mix Vials* o Insulin Aspart/Insulin Aspart Protamine Vial (AG) o Insulin Aspart/Insulin Aspart Protamine Insulin Pen (AG) o Insulin Lispro Protamine Mix Kwikpen (AG) Regular/Intermediate-Acting Combination Insulins o Humulin Pen 70/30 Pen OTC, Humulin 70/30 Vials* o Novolin 70/30 Vial OTC* 33

34. P&T Public Class Vote: Opioid Dependence Treatments 34

35. Opioid Dependence Treatments PDL Recommendations (preferred products): Buprenorphine/Naloxone Products o buprenorphine/naloxone sublingual tablet o Suboxone Film*^ Buprenorphine Products o buprenorphine sublingual tablet PA required unless member is pregnant* o Sublocade subcutaneous with PA (Statewide PA criteria to be developed) Naloxone Products o naloxone syringe*, naloxone vials* o Kloxxado Spray o Narcan Nasal* Naltrexone Products o naltrexone tablets* o Vivitrol* Alpha Agonist Products o clonidine tablet* ^Brand is preferred over generic 35

36. P&T Public Class Vote: Pancreatic Enzymes 36

37. Pancreatic Enzymes PDL Recommendations (preferred products): Creon* Zenpep* 37

38. P&T Public Class Vote: Progestational Agents 38

39. Progestational Agents PDL Recommendations (preferred products): medroxyprogesterone acetate, medroxyprogesterone acetate (AG) norethindrone acetate progesterone Capsule Withdrawn from Market by FDA: Makena Auto Injector* Grandfathering No (all hydroxyprogesterone products have been withdrawn from market) 39

40. P&T Public Class Vote: Stimulants and Related Agents 40

41. Stimulants and Related Agents PDL Recommendations (preferred products): Adderall XR*^ amphetamine salt combination* atomoxetine, atomoxetine (AG)* clonidine ER* Concerta*^ Daytrana* dexmethylphenidate*, dexmethylphenidate (AG)* dexmethylphenidate ER dextroamphetamine tablet* guanfacine ER* Methylin Solution*^ methylphenidate* methylphenidate CD*, methylphenidate CD (AG)* Ritalin LA 10mg capsule* Vyvanse Capsule* ^Brand is preferred over generic 41

42. Stimulants and Related Agents PDL Recommendations (products moving to nonpreferred status): Focalin XR* Grandfathering No, dependent on shortages 42

43. New Drug Recommendations (Non-Supplemental) Joenja Nonpreferred 43

44. Public Therapeutic Class Votes 44

45. Meeting Adjournment Future Meeting Dates: October 25, 2023 January 24, 2024 45