New Drug Updates in MO Healthnet Pharmacy Program - January 2021
Explore the latest additions and edits to the MO Healthnet Pharmacy Program for January 2021. Discover new drugs like Brexafemme for vulvovaginal candidiasis, Kerendia for chronic kidney disease, Loreev XR for anxiety disorders, and more. Dive into clinical and PDL edits for medications like Azstarys for ADHD, Bylvay for PFIC, and Nix Ultra Solution for Super Lice. Stay informed about these pharmaceutical advancements.
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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 19, 2021 OLIVIA RUSH, PHARM D PROGRAM INTEGRITY PHARMACIST
NEW DRUGS CLINICAL EDITS Common Trade Name Ingredient Name Indications Brexafemme 150mg Tablet Ibrexafungerp Citrate Indicated for the treatment of adult and post-menarchal pediatric females with vulvovaginal candidiasis (VVC). Systemic Antifungals Clinical Edit Kerendia 10mg Tablet Kerendia 20mg Tablet Finerenone Indicated to reduce the risk of sustained eGFR decline, end stage kidney disease, cardiovascular death, non-fatal myocardial infarction, and hospitalization for heart failure in adult patients with chronic kidney disease (CKD) associated with type 2 diabetes (T2D). Kerendia Clinical Edit To be discussed today Indicated for the treatment of anxiety disorders in adults who are receiving stable, evenly divided, three times daily dosing with lorazepam tablets. Benzodiazepines (Select Oral) Clinical Edit To be discussed today Loreev XR 1mg Capsule Loreev XR 2mg Capsule Loreev XR 3mg Capsule Lorazepam Nexviazyme 100mg Vial Avalglucosidase Alfa-Ngpt Indicated for the treatment of patients 1 year of age and older with late-onset Pompe disease (lysosomal acid alpha-glucosidase [GAA] deficiency). Pompe Disease Clinical Edit To be discussed today 2
NEW DRUGS PDL EDITS Common Trade Name Ingredient Name Indications Azstarys 26.1mg-5.2mg Capsule Azstarys 39.2mg-7.8mg Capsule Azstarys 52.3mg-10.4mg Capsule Serdexmethylphen/Dexmet hylphen Indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in patients 6 years of age and older. Methylphenidate, Long Acting PDL - Non-Preferred Bylvay 200mcg Pellet Bylvay 400mcg Pellet Bylvay 600mcg Pellet Bylvay 1,200mcg Pellet Kloxxado 8mg Spray Odevixibat Indicated for the treatment of pruritus in patients 3 months of age and older with progressive familial intrahepatic cholestasis (PFIC). Bile Salt Agents PDL - Non-Preferred To be discussed today Naloxone HCl Indicated for the emergency treatment of known or suspected opioid overdose, as manifested by respiratory and/or central nervous system depression, for adult and pediatric patients. Opiate Emergency Reversal Agents PDL Preferred effective Jan 2022 To be discussed today Indicated for the treatment of: Overactive bladder (OAB) in adult patients with symptoms of urge urinary incontinence, urgency, and urinary frequency, either alone or in combination with the muscarinic antagonist solifenacin succinate. Neurogenic detrusor overactivity (NDO) in pediatric patients aged 3 years and older and weighing 35 kg or more. Urinary Tract Antispasmodics PDL - Non-Preferred For ages 10 years - reason why they cannot take tablets Myrbetriq ER 8mg/ml Suspension Mirabegron 3
NEW DRUGS PDL EDITS Common Trade Name Ingredient Name Indications Nix Ultra Solution Mineral Oil/Dimethicone Specially designed to eliminate hard-to-kill Super Lice, which have developed resistance to many traditional lice treatments. Kills eggs too by suffocation. Antiparasitics, Topical PDL - Preferred Nymalize 60mg/10ml Solution Nimodipine Indicated for the improvement of neurological outcome by reducing the incidence and severity of ischemic deficits in adult patients with subarachnoid hemorrhage (SAH) from ruptured intracranial berry aneurysms regardless of their post-ictus neurological condition (i.e., Hunt and Hess Grades I-V). Calcium Channel Blockers (Dihydropyridines) PDL - Non-Preferred Indicated for the topical short-term and non-continuous chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised patients 12 years of age and older whose disease is not adequately controlled with topical prescription therapies or when those therapies are not advisable. Atopic Dermatitis Agents, Immunomodulators PDL - Non-Preferred Requires T/F of Elidel AND T/F of generic Protopic AND letter of medical necessity. Dose opt of 60g/month Indicated for the treatment of adult patients with moderate to severe systemic lupus erythematosus (SLE), who are receiving standard therapy. Targeted Immune Modulators, Select Agents PDL - Non-Preferred Step of Benlysta required. Opzelura 1.5% Cream Ruxolitinib Phosphate Saphnelo 300mg/2ml Vial Anifrolumab-Fnia 4
NEW DRUGS OPEN ACCESS Common Trade Name Ingredient Name Indications Hexatrione 40mg/2ml Ampule Triamcinolone Hexacetonide Indicated in rheumatological conditions. Rezurock 200mg Tablet Belumosudil Mesylate Indicated for the treatment of adult and pediatric patients 12 years and older with chronic graft-versus-host disease (chronic GVHD) after failure of at least two prior lines of systemic therapy. 5
NEW DRUGS PA CONTINUED Common Trade Name Ingredient Name Indications Accrufer 300mg Capsule Ferric Maltol Indicated for the treatment of iron deficiency in adults. Requires MHD review Trial and failure of one of MHD s OTC oral iron products Must provide medical necessity and reason why other oral products are not able to be used beyond GI upset. Indicated for the initial treatment of severe malaria in adult and pediatric patients. Treatment of severe malaria with Artesunate for Injection should always be followed by a complete treatment course of an appropriate oral antimalarial regimen. Diagnosis of Severe Malaria If Malaria is P. Vivax or P. Ovale must be given with another antimalarial agent (such as primaquine) that is active against the hypnozoite liver stage Artesunate 110mg Vial Artesunate Hydroxychloroquine 100mg Tablet Hydroxychloroquine 300mg Tablet Hydroxychloroquine 400mg Tablet Hydroxychloroquine Sulfate Indicated for the: Treatment of uncomplicated malaria due to Plasmodium falciparum, Plasmodium malariae, Plasmodium ovale, and Plasmodium vivax in adult and pediatric patients. Prophylaxis of malaria in geographic areas where chloroquine resistance is not reported in adult and pediatric patients. Treatment of rheumatoid arthritis in adults. Treatment of systemic lupus erythematosus in adults. Treatment of chronic discoid lupus erythematosus in adults Must show medical necessity as to why the participant can't use the 200mg tablets 6
NEW DRUGS PA CONTINUED Common Trade Name Ingredient Name Indications Tirosint-Sol 37.5mcg/ml Solution Tirosint-Sol 44mcg/ml Solution Tirosint-Sol 62.5mcg/ml Solution Levothyroxine Sodium indicated for: Hypothyroidism - As replacement therapy in primary (thyroidal), secondary (pituitary), and tertiary (hypothalamic) congenital or acquired hypothyroidism. Pituitary Thyrotropin (Thyroid-Stimulating Hormone, TSH) Suppression - As an adjunct to surgery and radioiodine therapy in the management of thyrotropin-dependent well-differentiated thyroid cancer. For ages 10 years - reason why they cannot take tablets. Indicated for: Treatment of acute uncomplicated influenza in patients 12 years of age and older who have been symptomatic for no more than 48 hours and who are: o otherwise healthy, or o at high risk of developing influenza-related complications. (1.1) Post-exposure prophylaxis of influenza in patients 12 years of age and older following contact with an individual who has influenza. Approval criteria - Justification of why oseltamivir cannot be used. Xofluza 80mg Tablet Baloxavir Marboxil 7
NEW DRUGS REFERENCE LIST Common Trade Name Ingredient Name Indications Invega Hafyera 1,092mg/3.5ml Syringe Invega Hafyera 1,560mg/5ml Syringe Paliperidone Palmitate Indicated for the treatment of schizophrenia in adults after they have been adequately treated with: A once-a-month paliperidone palmitate extended-release injectable suspension (e.g., INVEGA SUSTENNA) for at least four months or An every-three-month paliperidone palmitate extended-release injectable suspension (e.g., INVEGA TRINZA) for at least one three-month cycle. Antipsychotics - 2nd Generation (Atypical) Clinical Edit and Reference List Reference Product Indicated for the treatment of: Schizophrenia in adults Bipolar I disorder in adults o Acute treatment of manic or mixed episodes as monotherapy and as adjunct to lithium or valproate o Maintenance monotherapy treatment Antipsychotics - 2nd Generation (Atypical) Clinical Edit and Reference List - Non-Reference Product Check for Opioid use - delay initiation of Lybalvi for a minimum of 7 days after last use of short-acting opioids and 14 days after last use of long- acting opioids. Lybalvi 5-10mg Tablet Lybalvi 10-10mg Tablet Lybalvi 15-10mg Tablet Lybalvi 20-10mg Tablet Olanzapine/Samidorphan Malate 8
CLINICAL & FISCAL EDITS WITH NO ANNUAL CHANGES 15 Day Supply Oral Oncology Fiscal Edit Butalbital Combinations without Codeine Clinical Edit Butalbital Combinations Excessive Therapy Edit Diabetic Supply Quantity Limit Fiscal Edit Out-of-State, Non-Bordering Pharmacies Fiscal Edit Selzentry Clinical Edit 9
PREFERRED DRUG LIST EDITS WITH NO ANNUAL CHANGES Alzheimer s Agents, AChEIs and NMDA Receptor Antagonists GI Motility Agents, Chronic Sedative Hypnotics Somatostatin Analogs Anticonvulsants, Dravet Syndrome Antiemetics, THC Derivatives Anti-Parkinsonism, MAO-B Inhibitors Anti-Parkinsonism, Non-Ergot Dopamine Agonists 10
