Updates on New Drugs in MO Healthnet Pharmacy Program
This content provides information on new drugs added to the MO Healthnet Pharmacy Program, including Enspryng for NMOSD, Evrysdi for SMA, Tecartus for MCL, Viltepso for DMD, Xywav for narcolepsy, Airduo Digihaler and Armonair Digihaler for asthma, among others. It highlights the indications, trade names, and ingredients of these medications, along with specific clinical and PDL edits. The content also emphasizes the importance of reviewing and documenting clinical edits for patient care.
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http://www.nmcfamilyresourcecenter.com/images/dss.gif MO HEALTHNET PHARMACY PROGRAM NEW DRUGS AND EDITS WITH NO ANNUAL CHANGES MHD DUR BOARD JANUARY 20, 2021 JOSH MOORE, PHARM D-DIRECTOR OF PHARMACY
NEW DRUGS CLINICAL EDITS Common Trade Name Ingredient Name Indications Enspryng 120mg/ml Syringe Satralizumab-Mwge Indicated for the treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive. NMOSD Clinical Edit to be reviewed today Evrysdi 0.75mg/ml Solution Risdiplam Indicated for the treatment of spinal muscular atrophy (SMA) in patients 2 months of age and older. SMA Clinical Edit to be reviewed today Tecartus 2X10EXP8 Infusion Bag & Cassette Brexucabtagene Autoleucel Indicated for the treatment of adult patients with relapsed or refractory mantle cell lymphoma (MCL). Car T Cell Clinical Edit to be reviewed today Viltepso 250mg/5ml Vial Viltolarsen Indicated for the treatment of Duchenne muscular dystrophy (DMD) in patients who have a confirmed mutation of the DMD gene that is amenable to exon 53 skipping. DMD Clinical Edit to be reviewed today 2
NEW DRUGS CLINICAL EDITS Common Trade Name Ingredient Name Indications Xywav 0.5gm/ml Solution Sodium,Calcium,Mag,Pot Oxybate Indicated for the treatment of cataplexy or excessive daytime sleepiness (EDS) in patients 7 years of age and older with narcolepsy. Narcolepsy Inhibitors Clinical Edit Must be approved by MHD Clinical Pharmacist Documentation of why participant cannot use Xyrem 3
NEW DRUGS PDL EDITS Common Trade Name Ingredient Name Indications Airduo Digihaler 55-14mcg Inhaler Airduo Digihaler 113-14mcg Inhaler Airduo Digihaler 232-14mcg Inhaler Akynzeo 235-0.25mg/20ml Vial Fosnetupitant/Palonosetro Fluticasone Propion/Salmeterol Indicated for treatment of asthma in patients aged 12 years and older. Corticosteroids Oral Inhaled PDL - Non-preferred Indicated in combination with dexamethasone in adults for the prevention of acute and delayed nausea and vomiting associated with initial and repeat courses of highly emetogenic cancer chemotherapy. Antiemetic 5-HT3, NK1 and Other Select Agents PDL - Non-Preferred n Armonair Digihaler 55mcg Inhaler Armonair Digihaler 113mcg Inhaler Armonair Digihaler 232mcg Inhaler Fluticasone Propionate Indicated for the maintenance treatment of asthma as prophylactic therapy in patients 12 years of age and older. Corticosteroids Oral Inhaled PDL - Non-Preferred 4
NEW DRUGS PDL EDITS Common Trade Name Ingredient Name Indications Bafiertam 95mg Capsule Monomethyl Fumarate Indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease in adults. Multiple Sclerosis Agents PDL - Non-Preferred Approval criteria: Must follow PDL guideline AND t/f of Tecfidera first. Breztri Aerosphere 160-9- 4.8mcg Inhaler Budesonide/Glycopyr/Form oterol Indicated for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD). COPD Anticholinergic Agents PDL - Non-Preferred Dupixent 300mg/2ml Pen Dupilumab Indications include: for the treatment of patients aged 6 years and older with moderate-to-severe atopic dermatitis whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. DUPIXENT can be used with or without topical corticosteroids. as an add-on maintenance treatment in patients with moderate-to-severe asthma aged 12 years and older with an eosinophilic phenotype or with oral corticosteroid dependent asthma. as an add-on maintenance treatment in adult patients with inadequately controlled chronic rhinosinusitis with nasal polyposis (CRSwNP). Respiratory Monoclonal Antibodies PDL - Non-Preferred Indicated for the treatment of: Rheumatoid Arthritis (RA) Polyarticular Juvenile Idiopathic Arthritis (JIA) in patients aged 2 years or older Psoriatic Arthritis (PsA) Ankylosing Spondylitis (AS) Plaque Psoriasis (PsO) in patients 4 years or older TIMS PDL - Preferred Enbrel 25mg/0.5ml Vial Etanercept 5
NEW DRUGS PDL EDITS Common Trade Name Ingredient Name Indications Fintepla 2.2mg/ml Solution Fenfluramine Hcl Indicated for the treatment of seizures associated with Dravet syndrome in patients 2 years of age and older. Anticonvulsants, Dravet Syndrome PDL Edit to be discussed today Kesimpta 20mg/0.4ml Pen Ofatumumab Indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults. Multiple Sclerosis PDL - Non-Preferred Natesto 5.5mg/0.122gm Nasal Spray Testosterone Indicated for replacement therapy in males for conditions associated with a deficiency or absence of endogenous testosterone: Primary hypogonadism (congenital or acquired) Hypogonadotropic hypogonadism (congenital or acquired) Androgenic Agents PDL - Non-Preferred Ortikos ER 6mg Capsule Ortikos ER 9mg Capsule Budesonide Indicated for: Treatment of mild to moderate active Crohn s disease involving the ileum and/or the ascending colon, in patients 8 years and older. Maintenance of clinical remission of mild to moderate Crohn s disease involving the ileum and/or the ascending colon for up to 3 months in adults. Ulcerative Colitis Agents, Oral PDL - Non-Preferred 6
NEW DRUGS PDL EDITS Common Trade Name Ingredient Name Indications Trulicity 3mg/0.5ml Pen Trulicity 4.5mg/0.5ml Pen Dulaglutide Indicated: as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus. to reduce the risk of major adverse cardiovascular events in adults with type 2 diabetes mellitus who have established cardiovascular disease or multiple cardiovascular risk factors. GLP-1 Receptor Agonists PDL - Non-Preferred 7
NEW DRUGS OPEN ACCESS Common Trade Name Ingredient Name Indications Cystadrops 0.37% Drops Cysteamine HCl Indicated for the treatment of corneal cystine crystal deposits in adults and children with cystinosis. Dojolvi 8.3KCAL/ml Liquid Triheptanoin Indicated as a source of calories and fatty acids for the treatment of pediatric and adult patientswith molecularly confirmed long-chain fatty acid oxidation disorders (LC-FAOD). Indicated in pediatric patients (birth to less than 18 years of age and weighing at least 2.5 kg) for the treatment of Chagas disease (American Trypanosomiasis), caused by Trypanosoma cruzi. Indicated for long-term maintenance treatment in acromegaly patients who have responded to and tolerated treatment with octreotide or lanreotide. Indicated as adjunctive treatment to levodopa/carbidopa in patients with Parkinson s disease (PD) experiencing off episodes. Lampit 30mg Tablet Lampit 120mg Tablet Nifurtimox Mycapssa DR 20mg Capsule Octreotide Acetate Ongentys 50mg Capsule Opicapone Phexxi 1.8-1-0.4% Vaginal Gel Lactic Acid/Citric/Potassium Indicated for the prevention of pregnancy in females of reproductive potential for use as an on-demand method of contraception. Sirturo 20mg Tablet Bedaquiline Fumarate Indicated as part of combination therapy in adult and pediatric patients (5 years and older and weighing at least 15 kg) with pulmonary multi-drug resistant tuberculosis (MDR-TB). Reserve SIRTURO for use when an effective treatment regimen cannot otherwise be provided. Vancomycin 750mg/150ml Bag Vancomycin 1.25gm/250ml Bag Vancomycin 1.75gm/350ml Bag Vancomycin/Water for Inj (PEG) Indicated for the treatment of serious or severe infections caused by susceptible strains of methicillin-resistant (beta-lactam-resistant) staphylococci. 8
NEW DRUGS PA CONTINUED Common Trade Name Ingredient Name Indications Hemady 20mg Tablet Dexamethasone Indicated in combination with other antimyeloma products for the treatment of adults with multiple myeloma. Must provide a reason why the participant is unable to utilize the lower strengths of dexamethasone. 9
CLINICAL & FISCAL EDITS WITH NO ANNUAL CHANGES 15 Day Supply Oral Oncology Fiscal Edit Acetaminophen Cumulative Dose Clinical Edit BiDil Clinical Edit Butalbital Combinations Excessive Therapy Edit Butalbital Combinations without Codeine Clinical Edit Corlanor Clinical Edit Entresto Clinical Edit Selzentry Clinical Edit 10
PREFERRED DRUG LIST EDITS WITH NO ANNUAL CHANGES Alzheimer s Agents Antiandrogenic Agents Antiemetic 5-HT3, NK1 and Other Select Agents, Non-Injectable Antiemetic, THC Derivatives Anti-Parkinsonism MAO-B Inhibitor Agents Hereditary Angioedema Agents Opiate Emergency Reversal Agents 11
