AHCCCS Pharmacy and Therapeutics Committee Recommendations - Oct. 2019

AHCCCS Pharmacy and Therapeutics Committee Recommendations for October 2019 include preferred products for oral and topical antifungals in Arizona, with details on current preferred medications and voting outcomes. The recommendations aim to provide quality healthcare through a comprehensive approach.

• AHCCCS
• Pharmacy
• Therapeutics
• Recommendations
• Antifungals

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1. AHCCCS Pharmacy and Therapeutics Committee Recommendations 16 October 2019

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

3. P&T Public Class Vote: Antifungals, Oral 3 Reaching across Arizona to provide comprehensive quality health care for those in need

4. Antifungals, Oral Current PDL (preferred products): CLOTRIMAZOLE (MUCOUS MEM) FLUCONAZOLE SUSPENSION (ORAL)* FLUCONAZOLE TABLET (ORAL)* GRISEOFULVIN SUSPENSION (ORAL)* GRISEOFULVIN TABLETS (ORAL)* NYSTATIN SUSPENSION (ORAL)* NYSTATIN TABLET (ORAL)* TERBINAFINE (ORAL)* Reaching across Arizona to provide comprehensive quality health care for those in need 4

5. P&T Public Class Vote: Antifungals, Topical 5 Reaching across Arizona to provide comprehensive quality health care for those in need

6. Antifungals, Topical Current PDL (preferred products): MICONAZOLE CREAM OTC (TOPICAL)* MICONAZOLE OINT OTC (TOPICAL)* CICLOPIROX CREAM (TOPICAL) CICLOPIROX SOLUTION (TOPICAL) MICONAZOLE POWDER OTC (TOPICAL)* CICLOPIROX SUSPENSION (TOPICAL) MICONAZOLE SPRAY OTC (TOPICAL) CLOTRIMAZOLE-BETAMETHASONE CREAM (TOPICAL)* NYSTATIN CREAM (TOPICAL)* CLOTRIMAZOLE CREAM OTC (TOPICAL)* NYSTATIN OINT (TOPICAL)* CLOTRIMAZOLE CREAM RX (TOPICAL)* NYSTATIN POWDER (TOPICAL)* CLOTRIMAZOLE SOLUTION OTC (TOPICAL)* TERBINAFINE CREAM OTC (TOPICAL) CLOTRIMAZOLE SOLUTION RX (TOPICAL)* TOLNAFTATE CREAM OTC (TOPICAL) KETOCONAZOLE CREAM (TOPICAL)* TOLNAFTATE POWDER OTC (TOPICAL) KETOCONAZOLE SHAMPOO (TOPICAL)* TOLNAFTATE SPRAY OTC (TOPICAL) LOTRIMIN ULTRA OTC (TOPICAL) TOLNAFTATE AERO POWDER OTC (TOPICAL) 6

7. P&T Public Class Vote: Antimigraine Agents, Triptans 7 Reaching across Arizona to provide comprehensive quality health care for those in need

8. Antimigraine Agents, Triptans PDL Recommendations (preferred products): SUMATRIPTAN (NASAL) SUMATRIPTAN (ORAL) SUMATRIPTAN VIAL (SUBCUTANE.) IMITREX (NASAL) ZOLMITRIPTAN ODT (AG) (ORAL) NARATRIPTAN (ORAL) ZOLMITRIPTAN ODT (ORAL) RIZATRIPTAN ODT (ORAL) ZOLMITRIPTAN TABLET (AG) (ORAL) RIZATRIPTAN TABLET (ORAL) ZOLMITRIPTAN TABLET (ORAL) SUMATRIPTAN KIT (SUBCUTANE.) ZOMIG (NASAL) SUMATRIPTAN KIT (SUN) (SUBCUTANE.) GRANDPARENTING - NO Reaching across Arizona to provide comprehensive quality health care for those in need 8

9. P&T Public Class Vote: Beta Blockers 9 Reaching across Arizona to provide comprehensive quality health care for those in need

10. Beta Blockers METOPROLOL / HCTZ (ORAL) PDL Recommendations (preferred products): METOPROLOL (ORAL)* METOPROLOL XL (ORAL)* ATENOLOL (ORAL)* NADOLOL / BENDROFLUMETHIAZIDE (ORAL) ATENOLOL / CHLORTHALIDONE (ORAL)* NADOLOL (ORAL)* BISOPROLOL HCTZ (ORAL) PROPRANOLOL ER (ORAL)* BISOPROLOL (ORAL) PROPRANOLOL / HCTZ (ORAL) CARVEDILOL (ORAL)* PROPRANOLOL SOLUTION (ORAL)* LABETALOL (ORAL)* PROPRANOLOL TABLET (ORAL)* SOTALOL (ORAL)* 10 GRANDPARENTING - YES

11. P&T Public Class Vote: BPH Treatments 11 Reaching across Arizona to provide comprehensive quality health care for those in need

12. BPH Treatments PDL Recommendations (preferred products): ALFUZOSIN (ORAL) DOXAZOSIN (ORAL)* DUTASTERIDE (ORAL) FINASTERIDE (ORAL)* TAMSULOSIN (ORAL)* TERAZOSIN (ORAL)* Reaching across Arizona to provide comprehensive quality health care for those in need 12

13. P&T Public Class Vote: Calcium Channel Blockers 13 Reaching across Arizona to provide comprehensive quality health care for those in need

14. Calcium Channel Blockers PDL Recommendations (preferred products): AMLODIPINE (ORAL)* DILTIAZEM CAPSULE ER (ORAL)* DILTIAZEM TABLET (ORAL)* FELODIPINE ER (ORAL)* KATERZIA (ORAL) NIFEDIPINE IR (ORAL)* NIFEDIPINE ER (ORAL)* VERAPAMIL CAPSULE ER (ORAL)* VERAPAMIL TABLET ER (ORAL)* VERAPAMIL ER PM (ORAL)* VERAPAMIL TABLET (ORAL)* Reaching across Arizona to provide comprehensive quality health care for those in need 14

15. P&T Public Class Vote: Leukotriene Modifiers 15 Reaching across Arizona to provide comprehensive quality health care for those in need

16. Leukotriene Modifiers PDL Recommendations (preferred products): MONTELUKAST TABLET (ORAL) MONTELUKAST CHEWABLE TABLET (ORAL) MONTELUKAST GRANULES (ORAL) No PA required for children less than 4 years old Reaching across Arizona to provide comprehensive quality health care for those in need 16

17. P&T Public Class Vote: Phosphate Binders 17 Reaching across Arizona to provide comprehensive quality health care for those in need

18. Phosphate Binders PDL Recommendations (preferred products): CALCIUM ACETATE CAPSULE (ORAL) CALCIUM ACETATE TABLET (ORAL) RENAGEL (ORAL) RENVELA TABLET (ORAL) SEVELAMER CARBONATE TABLET (AG) (ORAL) SEVELAMER CARBONATE TABLET (ORAL) GRANDPARENTING - NO Reaching across Arizona to provide comprehensive quality health care for those in need 18

19. P&T Public Class Vote: Sedative Hypnotics 19 Reaching across Arizona to provide comprehensive quality health care for those in need

20. Sedative Hypnotics PDL Recommendations (preferred products): ESZOPICLONE (ORAL) RAMELTEON (ORAL) ROZEREM (ORAL) TEMAZEPAM (ORAL) 15 mg and 30 mg capsules ZOLPIDEM (ORAL) GRANDPARENTING NO Reaching across Arizona to provide comprehensive quality health care for those in need 20

21. P&T Public Class Vote: Steroids, Topical 21 Reaching across Arizona to provide comprehensive quality health care for those in need

22. Steroids, Topical PDL Recommendations (preferred products): Low Potency Topical Steroid Agents DERMA-SMOOTHE-FS (TOPICAL) FLUOCINOLONE 0.01% OIL (TOPICAL)* HYDROCORTISONE ACETATE CREAM OTC (TOPICAL)* HYDROCORTISONE ACETATE OINTMENT OTC (TOPICAL)* HYDROCORTISONE-ALOE CREAM OTC (TOPICAL) HYDROCORTISONE CREAM OTC (TOPICAL)* HYDROCORTISONE CREAM (TOPICAL)* HYDROCORTISONE LOTION OTC (TOPICAL)* HYDROCORTISONE OINTMENT OTC (TOPICAL)* HYDROCORTISONE OINTMENT (TOPICAL)* o o o o o o o o o o 22

23. Steroids, Topical PDL Recommendations (preferred products): Medium Potency Topical Steroid Agents o FLUTICASONE PROPIONATE CREAM (TOPICAL)* o FLUTICASONE PROPIONATE OINTMENT (TOPICAL)* o MOMETASONE FUROATE CREAM (TOPICAL)* o MOMETASONE FUROATE OINTMENT (TOPICAL)* o MOMETASONE FUROATE SOLUTION (TOPICAL)* Reaching across Arizona to provide comprehensive quality health care for those in need 23

24. Steroids, Topical PDL Recommendations (preferred products): High Potency Topical Steroid Agents BETAMETHASONE DIPROPIONATE LOTION (TOPICAL) BETAMET DIPROP / PROP GLY CREAM (TOPICAL)* BETAMETHASONE VALERATE CREAM (TOPICAL)* BETAMETHASONE VALERATE LOTION (TOPICAL)* BETAMETHASONE VALERATE OINTMENT (TOPICAL)* FLUOCINONIDE CREAM (TOPICAL)* FLUOCINONIDE OINTMENT (TOPICAL)* FLUOCINONIDE SOLUTION (TOPICAL)* TRIAMCINOLONE ACETONIDE CREAM (TOPICAL)* TRIAMCINOLONE ACETONIDE LOTION (TOPICAL)* TRIAMCINOLONE ACETONIDE OINTMENT (TOPICAL)* o o o o o o o o o o o Reaching across Arizona to provide comprehensive quality health care for those in need 24

25. Steroids, Topical PDL Recommendations (preferred products): Very High Potency Topical Steroid Agents o CLOBETASOL EMOLLIENT (TOPICAL) o CLOBETASOL PROPIONATE CREAM (TOPICAL)* o CLOBETASOL PROPIONATE GEL (TOPICAL)* o CLOBETASOL PROPIONATE OINTMENT (TOPICAL)* o CLOBETASOL PROPIONATE SOLUTION (TOPICAL)* o HALOBETASOL PROPIONATE CREAM (TOPICAL) o HALOBETASOL PROPIONATE OINTMENT (TOPICAL) Reaching across Arizona to provide comprehensive quality health care for those in need 25

26. New Drug Recommendations Non-preferred Mayzent Rocklatan Mavenclad Evenity Diacomit Skyrizi Cutaquig Egaten Sunosi Rinvoq Vyndamax Reaching across Arizona to provide comprehensive quality health care for those in need 26