AGENDA - Arkansas · Market status: Today, we have four (4) OTC PPI products available; Prilosec,...

AGENDA

State and Public School Life and Health Insurance Board Drug Utilization and Evaluation Committee

May 7, 2018

1:00 p.m.

EBD Board Room – 501 Building, Suite 500

I. Call to Order .................................................... Dr. Hank Simmons, Vice-Chairman

II. Approval of February 5, 2018 Minutes .......... Dr. Hank Simmons, Vice-Chairman

II. Old Business

a. Second Review of Drugs ................... Dr. Jill Johnson, Dr. Jarrod King, UAMS

IV. New Business

a. Formulary Clean-Up Items .............. Dr. Micah Bard, Dr. Dwight Davis, UAMS

b. Proton Pump Inhibitor Recommendation .................. Dr. Dwight Davis, UAMS

c. Class Reviews .................................... Dr. Jill Johnson, Dr. Jarrod King, UAMS

d. New Drugs ......................................... Dr. Jill Johnson, Dr. Jarrod King, UAMS

V. Board Report ................................................................... Dr. Dwight Davis, UAMS

2018 Upcoming Meetings

August 6, 2018, November 5, 2018

NOTE: All material for this meeting will be available by electronic means only

[email protected]

Notice: Silence your cell phones and other noise that is disruptive to the meeting. Keep

your personal conversations to a minimum.

mailto:[email protected]

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State and Public School Life and Health Insurance Board Drug Utilization and Evaluation Committee Minutes

May 7, 2018 The State and Public Life and Health Insurance Board, Drug Utilization and Evaluation Committee (DUEC) met on Monday, May 7, 2018 at 1:00 p.m., in the EBD Board Room, 501 Woodlane, Little Rock, AR.

Voting Members present: Non-Voting Members present:

Dr. Scott Pace, Chairman – Proxy – John Vinson Dr. Jill Johnson

Dr. Hank Simmons, Vice-Chairman Dr. Dwight Davis

Dr. Kat Neill Dr. Jarrod King

Laura Mayfield Dr. Micah Bard

Mike Boyd

Chris Howlett, EBD Executive Director, Employee Benefits Division

Members absent:

Dr. Appathurai Balamurugan

Dr. John Kirtley

Dr. William Golden

OTHERS PRESENT

Eric Gallo, Rhoda Classen, Jamie Levinsky, Shay Burleson, Shalada Toles, Allie Barker, EBD; Jessica Akins,

Health Advantage; Ronda Walthall, Wayne Whitley, Arkansas Highway Department; Jon Maguire, Erica,

Brumleve, GSK; Frances Bauman, Jason Lurk, Matt Strum, Nova Nordisk; Elizabeth Whittington, ACHI; Marc

Bagby, Lilly; Sean Seago, Merck; Mark Ross, Ralph Peyton, Charlotte Downs, Sanofi Genzyme; Jarrod King,

Dwight Davis, Sherry Byant, UAMS; Suzanne Woodall, MedImpact; Marc Watts, ASEA; Marvin “Bud”

McConkie, Allergen, Treg Long, ACS; Hyla Metcalf, Connie Hebert, AZ ONC; Marc Parker, Sunovion; Dave

Wood, ViiV; Sandra Wilson, AHM; Marrissa Keith, Angie Brown, BI; Brent Flaherty, MedImpact; Jim Chapman,

ABBVIE; Angela Brown, Boehringer-Ingelheim; Berverly Thornton, Collegium.

CALL TO ORDER

Meeting was called to order by Dr. Hank Simmons, Vice-Chairman, and he announced that we do have a

quorum today.

APPROVAL OF MINUTES

The request was made by Dr. Simmons to approve the February 5, 2018 minutes. He asked the members to

take a few minutes to look over the minutes and mention any edits that you might want to suggest. Dr. Davis

made the motion to approve. Dr. Neill seconded; all were in favor.

Minutes Approved.

I. Old Business

A. Second Review of Drugs: by Dr. Jill Johnson & Dr. Jarrod King, UAMS

a. Brexpiprazole (Rexultiâ)-- Exclude. b. Nintedanib (OFEVâ)— Exclude.

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c. Ixazomib (Ninlaroâ)— Cover T4 with PA d. Osimertinib (Tagrissoâ)—Exclude.

e. Nuplazid (pimavanserin) – Exclude.

Vinson questioned what we have done previously with Nuplazid.

Dr. Johnson stated that we have covered it.

Vinson asked what the rationale for coverage was. Was it based on efficacy?

Dr. Johnson stated that we looked at Parkinson’s disease adapted scale for assessment of positive symptoms in people who developed psychosis after their Parkinson’s disease diagnosis. On the scale, it was supposed to be a minimally clinically important difference was a three-point change in that scale. We voted to cover it because the three-point difference did not meet the minimally clinically important difference according to the FDA, but when you use the loftier seven-point difference on that scale, there was still a 20% absolute difference between groups. We thought that was indicative of the drugs effect so we covered it. In the last two weeks, the FDA has come out with the harms data.

Dr. Neill made a motion to approve all second review of drug recommendations. Mayfield seconded. All were in favor. Motion Approved.

II. New Business A. Class Review: by Dr. Jill Johnson and Dr. Jarrod King, UAMS

a. Plaque Psoriasis – Taltz and Siliq- move to T4 with PA with subject to rebates.

b. Osteoporosis Drugs -- Based on this evidence and cost effectiveness

studies, it is recommended: 1. Covering alendronate. 2. Reference pricing other bisphosphonates EXCEPT ibandronate (exclude). 3. If AE to alendronate, the alternative is IV zoledronic acid 4-5mg once yearly. 4. Exclude teriparatide. Grandfather current utilizers. 5. Continue to exclude abaloparatide. 6. Continue to exclude denosumab for this indication. 7. For pts who fracture while taking bisphosphonates, switch to ZA. The article says the cost per 1 fracture reduction after switching from alendronate is:

• a savings of $2294 for ZA • $141,716 more for denosumab • $794,304 more for teriparatide (roughly the same as abaloparatide

Dr. Neill questioned if there were any outstanding adverse potential reactions that would be exclusions for the zoledronic acid. Dr. Johnson stated that it is IV infusion.

Dr. Vinson asked if in the original clinical trials, didn’t they give them a loading dose of Vitamin D? Is there going to be a PA process to get the zoledronic acid and how would that play into the clinical recommendation for use? Dr. Johnson stated that she didn’t recommend authorizing zoledronic acid, we can, but we can’t make sure they take their Calcium and Vitamin D that they are supposed to take because they are over-the-counter and we can’t make it contingent upon that and monitor it. You could just offer it as a medical benefit.

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Mayfield made a motion to accept the recommendations as presented above. Dr. Neill seconded. All were in favor. Motion Approved.

c. Alpha 1 Antitrypsin – Exclude for new users

Dr. Neill questioned if this was only for COPD or is this all Alpha 1? It’s not all Alpha 1, it’s also trypsin deficiency, right? Dr. Johnson stated that was her understanding. She is not sure why those 4 are using it, but that is what they are for. It is for long term augmentation in people who had the deficiency and who have clinically evident emphysema. Dr. Simmons questioned how the drug is administered and how frequently is it administered?

Dr. Johnson answered IV infusion. It is coming through the pharmacy side. It is administered once weekly.

Dr. Simmons made a motion to send letters to the four current utilizers to inform them of discontinuation after 90 days. Dr. Neill seconded. All were in favor. Motion Approved.

d. PCSK9 Inhibitors – Table until more data becomes available

B. Formulary Clean-Up: by Dr. Micah Bard and Dr. Dwight Davis, UAMS Drug Name Drug Category / Use Current Coverage / Utilization

/ Notes Recommendation

Semprex-D® (acrivastine and pseudoephedrine)

Antihistamine/ Decongestant combination

Covered with no restriction – Tier 2 ($40) Total Cost/Rx = $504.01. Only 1 paid claim during 1Q2018

Exclude.

Memantine 5mg, 10mg (generic for Namenda®)

Alzheimer’s agent Covered w/prior authorization – Tier 2 ($40) Avg. Cost/Rx = $32 (5mg), $25 (10mg)

Move to Tier 1 with no restrictions, remove PA.

Ezetimibe (generic for Zetia®)

Lipid lowering agent Covered w/prior authorization – T2. Notes from February 2017 DUEC: Vytorin was NOT added to this PA. DUEC noted that Zetia is going generic later in 2016 and decided to exclude coverage of Vytorin. Once Zetia goes generic, members can get 2 cheap separate generic products leaving the plan with less of a balance.

Remove PA and cover at tier 1 with no restrictions

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Aripiprazole (generic for Abilify®)

Antipsychotic Agent Covered w/PA – T2 Price has dropped significantly (blended Avg. Cost/Rx is ~$33)


Celecoxib (generic for Celebrex®)

Non-steroidal anti-inflammatory agent (NSAID)

Celecoxib and Celebrex has been excluded from coverage from the beginning. The price of generic celecoxib has dropped significantly. NADAC/unit cost is $0.28/capsule (100mg) and $0.33/capsule (200mg)

Add generic celecoxib to coverage with no restrictions – T1

Fenortho® (fenoprofen) 200mg


Coverer w/no restrictions – T2. 1 claim during 1Q2018 cost $1,700.

Exclude.

Revatio® 20mg (sildenafil) PD5 Inhibitor (Pulmonary Arterial Hypertension treatment)

Coverer w/PA – T4. 3 Rxs during 1Q2018. Plan Paid $12,500. ($46.16/tablet)

Exclude brand name and only cover sildenafil.

Alosetron tablets (generic for Lotronex®)

IBS-D treatment in women

Covered w/o restrictions – T1. 2 Rxs during 1Q2018. Plan Paid $1,260/Rx ($21/tablet)

Move from Tier-1 to Tier-4

Vinson made a motion to approve all recommendations above. Dr. Neill seconded. All were in favor. Motion Approved.

2. Lidocaine-containing products Recommendation: Exclude prescription versions of lidocaine-containing products (5% or less) as 5% and lower are available OTC. Mayfield made a motion to approve the lidocaine-containing products recommendation as stated above. Dr. Neill seconded. All were in favor. Motion Approved.

C. Proton Pump Inhibitors: by Dr. Dwight Davis, UAMS

Background: The EBD plan has utilized Reference-Based Pricing as a cost-containment measure for several years. As a reminder, specific characteristics of reference-based pricing are:

• Involves drug categories where multiple agents are available AND

• Little to no clinical difference exists among agents AND

• Significant variation in price exists among agents

• The “Reference Price” is established based on the lowest net cost agent(s) in the category

• The “Reference Price” defines how much the Plan will pay per unit (tablet/capsule/package/etc.)

• Product cost exceeding the “Reference Price” is assumed by the Member

• Reference Based Pricing insulates the Plan from drug cost inflation and minimizes the effect of “copay coupons” on the Plan

The Proton Pump Inhibitor (PPI) category was the first category included in EBD’s Reference-Based Pricing program –

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began in 2005. Early in the program, omeprazole (generic for Prilosec) became available over-the-counter (OTC) and a much-reduced cost. Despite the significant cost advantage offered by omeprazole, clinical evidence demonstrated little to no difference among PPI products.

Market status: Today, we have four (4) OTC PPI products available; Prilosec, Prevacid, Nexium and Zegerid. Recommendation: Since adequate options are available OTC, we recommend removing PPIs from Plan coverage altogether. Member Impact: Almost 6,000 member are currently receiving a product/strength that is not available OTC – 56% of those are using pantoprazole (Protonix) and 37% are using omeprazole 40mg. Plan Savings: Annualized Plan Savings is estimated at $163,000.

Dr. Vinson stated that from a practical point of view, he would not want to see someone needing it for a medical reason. I hope that if we move to making them OTC that the physician could still write the prescription and the patient still be able to fill it, even if they have to pay the full amount. He doesn’t want it to not become a priority anymore. He is worried about the coordination of care around the whole picture. Dr. Simmons stated that if a physician wrote a prescription like that, would you be content for the plan to select the PPI that was supplied? Mayfield stated no, for example if you have an H Pylori infection and you need the triple therapy, and if all the PPI’s are over the counter she can see the patient saying “oh it’s not that important, it’s over the counter.” Dr. Davis stated to clarify, we do have several versions of the triple therapy and those would not be included in the recommendation, they would still be covered by prescription. Dr. Vinson still worries about the message it sends to the patient. Dr. Neill questioned if there was any data for dose escalation or is it just convenience and dosing? Dr. Johnson stated that you have to take it at the same time every day. Dr. Simmons stated that there is already a policy or mechanism in place that if I were to go for a triple therapy for H Pylori or something like that, I would be guaranteed reimbursement for my PPI. Dr. Davis stated that yes there are commercially available products that have the three drugs combined and you can get that without any restrictions at all. Dr. Simmons questioned if these drugs are removed from the prescription benefit, it doesn’t seem like any one would be inconvenienced by this recommendation. Dr. Davis stated that specific to H Pylori, that’s correct. Dr. Vinson stated that it is an operational challenge for prescribers, unless there was a PA. Mayfield questioned if the suspensions would be covered with a PA? Dr. Davis stated that there were no special coverage restrictions or policies. They were just thrown in there, as far as reference pricing, the suspensions aren’t typically touched on. They are not apples to apples comparison on units. One of the questions he would raise, at a minimum if we are going to table this, is there a reason on the generic Zegerid packets we couldn’t exclude them immediately? That is at least half the savings and only involves four patients. There are multiple other options in that class.

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Dr. Simmons asked that a motion be made to remove the PPI’s from the prescription benefit plan. Dr. Neill stated that her biggest concern is the messaging to the patient that they can still run it and pay the at-cost price. She would like to motion that there be a communication to members put together that would go with removing these from the prescription benefit plan to OTC. Howlett questioned with what outcome? What are we trying to besides asking them to all respond. Dr. Neill stated that it would be how we would recommend to patients to process when it moves off the prescription benefit plan. Howlett stated that there is a valid point but he thinks it is best to table it at this point. Dr. Vinson made a motion to remove from the prescription benefit plan a combination PPI sodium bicarbonate medication. Dr. Neill seconded. Motion Approved.

D. New Drugs: by Dr. Jill Johnson and Dr. Jarrod King, UAMS

1. Specialty Medications

a. Recommended Additions

BRAND NAME GENERIC NAME PRICING (AWP) INDICATION SIMILAR THERAPIES ON FORMULARY

DUEC VOTE

Symfi Lo 400-

300mg

efavirenx/lamivu/tenofov

disop

$65.38/tablet HIV HIV agents covered

T4

T4

Biktarvy 50-

200-25

Bictegrav/emtricit/tenofov

ala

$117.83/tablet HIV HIV agents covered

T4

T4

b. Recommended Exclusions


DUEC VOTE

Prolastin-C

1000mg/20mL

solution

Alpha-1-Proteinase

Inhibitor

$600/vial Alpha1-

antitrypsin

deficiency

Prolastin-C

1000mg solution

reconstituted

Rec:

exclude,

code 8

Erleada 60mg

tablet

apalutamide $109.20/tablet Prostate

cancer

Xtandi, Zytiga Exclude,

code 8

c. Tabled Drugs

Luxturna

1.5X10EX11

Voretigene Neparvovec-

Rzyl

Retinal

dystrophy

Tabled

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Symdeko

100-150mg

tablet

Tezacaftor/ivacaftor $480.00/tablet Cystic Fibrosis Kalydeco,

Orkambi

Tabled

Dr. Neill made a motion to approve all specialty drug recommendations. Mayfield seconded. All were in favor. Motion Approved.

2. Non-Specialty Medications

a. Recommended Additions


DUEC VOTE

Clenpiq 10 -

3.5/160

Sod Picosulf/Max Ox/Citric

Ac

$70.21 per

bottle

Laxative / Bowell

Prep

PrePopik T3

Lyrica CR

82.5mg,

165mg,

330mg

Pregabalin $15.324/tablet

, parity priced

Neuropathic Pain gabapentin RBP to

gabapen

tin

b. Recommended Exclusions BRAND NAME GENERIC NAME PRICING (AWP) INDICATION SIMILAR

THERAPIES ON FORMULARY

DUEC VOTE

Admelog

100U/ML -

3ML Pen

Insulin Lispro $108.20 / 3ML

Pen

Diabetes Humalog,

Novolog

Exclude, code

13

Admelog

100U/ML Vial

Insulin Lispro $280.20 / vial Diabetes Humalog,

Novolog

Exclude, code

13

Bonjesta

20mg-20mg

doxylamine

succinate/vit B6

$12.34/tablet Nausea/Vomiti

ng

Exclude, code

13. OTC

alternatives

Dithol 1.5%-

10%

diclofenac

sodium/menthol topical

solution

$2,894.70 /

bottle

Osteoarthritis Topical

NSAIDS

excluded

Exclude

DiThol.

Explore

covering

topical

NSAIDs

Impoyz 0.03%

Cream

clobetasol propionate $540.00/60gm

tube

Misc.

dermatological

conditions

Generic

topical

steroids

Exclude, code

13

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Lonhala

Magnair

Starter 25

mcg/ml vial-

nebulizer &

refill

glycopyrrolate $22.66/vial

($1,359/month)

COPD Spiriva Exclude, code

13

Methylphenida

te ER 72mg

Methylphenidate $22.81/tablet ADHD Multiple

generic

versions

Exclude code

13.

Noctiva 0.83,

1.66 Spray

desmopressin acetate $510.00/3.8gm

bottle, parity

priced

Adult nocturnal

polyuria

generic

desmopressi

n

Exclude, code

8.

Prednisolone-

Gatiflox-

Bromfenc

0.5%-1%

gatifloxacin/prednisolo

ne/ bromfenac

Ophthalmic

antibiotic,

glucocorticoid,

and NSAID

combo

prednisolone,

gatifloxacin,

and

bromfenac

ophthalmic

agents all

available Tier

1

Exclude code

13.

Roweepra XR

500mg, 750mg

levetiracetam 500mg

=$4.44/tablet

750mg

=$6.67/tablet

Partial onset

seizures in

epilepsy

Generic 24hr

ER

formulation

available

Exclude, code

13

Segluromet

2.5/500,

7.5/500,

2.5/1000,

7.5/1000

Ertugliflozin/metformin $5.36/tablet,

parity priced

Type-2

Diabetes

Jardiance,

Synjardy

Exclude, code

13, 1

Solosec 2GM

PKT

Secnidazole $324/package Antiprotozoal

Agent

metronidazol

e, tinidazole

Exclude code

13

Steglatro 5mg,

15mg tablet

Ertugliflozin Pidolate $10.728/tablet,

parity priced

Type-2

Diabetes

Jardiance,

Synjardy

Exclude, code

13, 1

Steglujan

5/100, 15/100

tablets

Ertugliflozin/Sitagliptin $20.94/tablet,

parity priced

Type-2

Diabetes

Jardiance,

Synjardy

Exclude, code

13, 1

Sublocade

100mg, 300mg

syringe

buprenorphine $1,896/syringe,

parity priced

Opioid

dependence

buprenorphin

e tablets

covered,

injections

Exclude code

13.

Alternative at

T1 is generic

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currently

excluded

buuprenorphin

e SL tabs.

Zypitamag

1mg, 2mg,

4mg tablet

pitavastatin

magnesium

$9.30/tablet,

parity priced

Hyperlipidemia atorvastatin,

lovastatin,

pravastatin,

rosuvastatin,

simvastatin

Exclude, code

13, 1

Mayfield made a motion to approve all non-specialty drug recommendations. Dr. Neill seconded. All were in favor. Motion Approved.

V. Board Report: by Dr. Dwight Davis, UAMS Dr. Davis reported that there was no further business at this time. Dr. Vinson stated that he would like to know of any feedback on the lidocaine patch. Dr. Simmons asked for a motion to adjourn. Dr. Vinson motioned to adjourn. Dr. Neill seconded. Meeting Adjourned.

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*New Drug Code Key:

1 Lacks meaningful clinical endpoint data; has shown efficacy for surrogate endpoints only.

2 Drug’s best support is from single arm trial data

3 No information in recognized information sources (PubMed or Drug Facts & Comparisons or Lexicomp)

4

Convenience Kit Policy - As new drugs are released to the market through Medispan, those drugs described as “kits will not be considered for inclusion in the plan and will therefore be excluded products unless the product is available solely as a kit. Kits typically contain, in addition to a pre-packaged quantity of the featured drug(s), items that may be associated with the administration of the drug (rubber gloves, sponges, etc.) and/or additional convenience items (lotion, skin cleanser, etc.). In most cases, the cost of the “kit” is greater than the individual items purchased separately.

Medical Food Policy - Medical foods will be excluded from the plan unless two sources of peer-reviewed, published medical literature supports the use in reducing a medically necessary clinical endpoint.

A medical food is defined below:

5

A medical food, as defined in section 5(b)(3) of the Orphan Drug Act (21 U.S.C. 360ee(b)(3)), is “a food which is formulated to be consumed or administered eternally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.” FDA considers the statutory definition of medical foods to narrowly constrain the types of products that fit within this category of food. Medical foods are distinguished from the broader category of foods for special dietary use and from foods that make health claims by the requirement that medical foods be intended to meet distinctive nutritional requirements of a disease or condition, used under medical supervision, and intended for the specific dietary management of a disease or condition. Medical foods are not those simply recommended by a physician as part of an overall diet to manage the symptoms or reduce the risk of a disease or condition, and all foods fed to sick patients are not medical foods. Instead, medical foods are foods that are specially formulated and processed (as opposed to a naturally occurring foodstuff used in a natural state) for a patient who is seriously ill or who requires use of the product as a major component of a disease or condition’s specific dietary management.

6

Cough & Cold Policy - As new cough and cold products enter the market, they are often simply re-formulations or new combinations of existing products already in the marketplace. Many of these existing products are available in generic form and are relatively inexpensive. The new cough and cold products are branded products and are generally considerably more expensive than existing products. The policy of the ASE/PSE prescription drug program will be to default all new cough and cold products to “excluded” unless the DUEC determines the product offers a distinct advantage over existing products. If so determined, the product will be reviewed at the next regularly scheduled DUEC meeting.

7

Multivitamin Policy - As new vitamin products enter the market, they are often simply re-formulations or new combinations of vitamins/multivitamins in similar amounts already in the marketplace. Many of these existing products are available in generic form and are relatively inexpensive. The new vitamins are branded products and are generally considerably more expensive than existing products. The policy of the ASE/PSE prescription drug program will be to default all new vitamin/multivitamin products to “excluded” unless the DUEC determines the product offers a distinct advantage over existing products. If so determined, the product will be reviewed at the next regularly scheduled DUEC meeting.

8 Drug has limited medical benefit &/or lack of overall survival data or has overall survival data showing

minimal benefit

9 Not medically necessary

10 Peer -reviewed, published cost effectiveness studies support the drug lacks value to the plan.

11

Oral Contraceptives Policy - OCs which are new to the market may be covered by the plan with a zero dollar, tier 1, 2, or 3 copay, or may be excluded. If a new-to-market OC provides an alternative product not similarly achieved by other OCs currently covered by the plan, the DUEC will consider it as a new drug. IF the drug does not offer a novel alternative or offers only the advantage of convenience, it may not be considered for inclusion in the plan.

12 Other

13 Insufficient clinical benefit OR alternative agent(s) available

of 2

EBD Formulary Clean-Up

DUEC – May 7, 2018

Drug Name Drug Category / Use Current Coverage / Utilization / Notes Recommendation

Semprex-D® (acrivastine and pseudoephedrine)

Antihistamine/decongestant combination

Covered with no restriction – Tier 2 ($40) Total Cost/Rx = $504.01. Only 1 paid claim during 1Q2018

Exclude – other less expensive antihistamine/decongestant combinations are available – many are over-the-counter.

Memantine 5mg, 10mg (generic for Namenda®)

Alzheimer’s agent Covered w/prior authorization – Tier 2 ($40) Avg. Cost/Rx = $32 (5mg), $25 (10mg)

Move to Tier 1 with no restrictions – price has dropped significantly

Ezetimibe (generic for Zetia®)

Lipid lowering agent Covered w/prior authorization – T2. Notes from February 2017 DUEC: Vytorin was NOT added to this PA. DUEC noted that Zetia is going generic later in 2016 and decided to exclude coverage of Vytorin. Once Zetia goes generic, members can get 2 cheap separate generic products leaving the plan with less of a balance.


Aripiprazole (generic for Abilify®)

Antipsychotic Agent Covered w/PA – T2 Price has dropped significantly (blended Avg. Cost/Rx is ~$33)


Celecoxib (generic for Celebrex®)


Celecoxib and Celebrex has been excluded from coverage from the beginning. The price of generic celecoxib has dropped significantly. NADAC/unit cost is $0.28/capsule (100mg) and $0.33/capsule (200mg)

Add generic celecoxib to coverage with no restrictions – T1

Fenortho® (fenoprofen) 200mg


Coverer w/no restrictions – T2. 1 claim during 1Q2018 cost $1,700.

Exclude. Other generic options of fenoprofen are available at a lower cost ($250/Rx)

of 2

Revatio® 20mg (sildenafil) PD5 Inhibitor (Pulmonary Arterial Hypertension treatment)

Coverer w/PA – T4. 3 Rxs during 1Q2018. Plan Paid $12,500. ($46.16/tablet)

Exclude. Generic sildenafil 20mg is available for $0.27/tablet

Alosetron tablets (generic for Lotronex®)

IBS-D treatment in women Covered w/o restrictions – T1. 2 Rxs during 1Q2018. Plan Paid $1,260/Rx ($21/tablet)

Move from Tier-1 ($15/Rx) to Tier-4 ($100/Rx)

Lidocaine-containing products – January 1, 2018 – March 31, 2018

Drug Subcategory Description Label Name Utilizing Member

Count

Rx Count

Total Cost Paid

Amount Copay

Amount Plan

Pd/Rx Copay/Rx

BULK CHEMICALS LIDOCAINE POWDER 1 2 $20.68 $0.00 $0.00 $0.00 $0.00

HEMORRHOIDAL PREP, ANTI-INFAM STEROID/LOCAL ANESTH

LIDOCAINE-HC 2.8-0.55% GEL 1 1 $123.22 $108.22 $15.00 $108.22 $15.00

HEMORRHOIDAL PREP, ANTI-INFAM STEROID/LOCAL ANESTH

LIDOCAINE-HC 3-1% CREAM KIT 1 1 $154.49 $0.00 $0.00 $0.00 $0.00

HEMORRHOIDALS, LOCAL RECTAL ANESTHETICS

LIDOCAINE ANORECTAL 5% CREAM

3 3 $136.08 $84.34 $30.00 $28.11 $10.00

TOPICAL ANTI-INFLAMMATORY STEROID-LOCAL ANESTHETIC

LIDOCAINE-HC 3-0.5% CREAM 2 2 $164.98 $134.98 $30.00 $67.49 $15.00

TOPICAL LOCAL ANESTHETICS LIDOCAINE 3% CREAM 12 13 $933.89 $758.75 $175.14 $58.37 $13.47

TOPICAL LOCAL ANESTHETICS LIDOCAINE 5% OINTMENT 80 96 $25,816.94 $24,021.17 $1,584.19 $250.22 $16.50

TOPICAL LOCAL ANESTHETICS LIDOCAINE 5% OINTMENT 26 41 $5,317.38 $4,678.36 $639.02 $114.11 $15.59

TOPICAL LOCAL ANESTHETICS LIDOCAINE 5% PATCH 7 10 $1,466.89 $1,306.91 $159.98 $130.69 $16.00

TOPICAL LOCAL ANESTHETICS LIDOCAINE-PRILOCAINE CREAM 81 93 $4,344.64 $2,697.02 $1,243.50 $29.00 $13.37

LOCAL ANESTHETICS LIDOCAINE 2% VISCOUS SOLN 187 199 $2,735.40 $495.50 $1,539.24 $2.49 $7.73

LOCAL ANESTHETICS LIDOCAINE HCL 2% JELLY 19 24 $409.72 $77.40 $270.08 $3.23 $11.25

LOCAL ANESTHETICS LIDOCAINE HCL 4% SOLUTION 2 2 $47.84 $28.43 $19.41 $14.22 $9.71

Totals 422 487 $41,672.15 $34,391.08 $5,705.56 $70.62 $11.72

Recommendation: Exclude prescription versions of lidocaine-containing products (5% or less) as 5% and lower are available OTC.

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EBD Proton Pump Inhibitors

January 1, 2018 – March 31, 2018

Background: The EBD plan has utilized Reference-Based Pricing as a cost-containment measure for several years. As a reminder, specific characteristics of

reference-based pricing are:

Involves drug categories where multiple agents are available AND

Little to no clinical difference exists among agents AND

Significant variation in price exists among agents

The “Reference Price” is established based on the lowest net cost agent(s) in the category

The “Reference Price” defines how much the Plan will pay per unit (tablet/capsule/package/etc.)

Product cost exceeding the “Reference Price” is assumed by the Member

Reference Based Pricing insulates the Plan from drug cost inflation and minimizes the effect of “copay coupons” on the Plan

The Proton Pump Inhibitor (PPI) category was the first category included in EBD’s Reference-Based Pricing program – began in 2005. Early in the program,

omeprazole (generic for Prilosec) became available over-the-counter (OTC) and a much-reduced cost. Despite the significant cost advantage offered by

omeprazole, clinical evidence demonstrated little to no difference among PPI products.

Plan Spend History: The table below summarizes the Plan Spend for the EBD plan for PPI products.

Year # of Rxs EBD Paid

2005 84,000 $4.5 million

2012 101,600 $2.6 million

2014 94,400 $1.2 million

2016 87,200 $155,000

2018 - estimated 86,500 $163,000

Market status: Today, we have four (4) OTC PPI products available; Prilosec, Prevacid, Nexium and Zegerid.

Recommendation: Since adequate options are available OTC, we recommend removing PPIs from Plan coverage altogether.

Member Impact: Almost 6,000 member are currently receiving a product/strength that is not available OTC – 56% of those are using pantoprazole (Protonix)

and 37% are using omeprazole 40mg.

Plan Savings: Annualized Plan Savings is estimated at $163,000.

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Grey shading = Over-The-Counter (OTC) options

Brand Name Label Name Rx/OTC

Utilizing

Member

Count

Rx Count Total CostTotal Plan

Paid

Total

Member

Paid

Avg.

Cost/Rx

Plan

Paid/Rx

Member

Paid/Rx

DEXILANT DEXILANT DR 60 MG CAPSULE Rx 44 89 $25,779.02 $2,280.11 $23,498.91 $289.65 $25.62 $264.03

DEXILANT DEXILANT DR 30 MG CAPSULE Rx 1 3 $837.27 $27.00 $810.27 $279.09 $9.00 $270.09

ESOMEPRAZOLE MAGNESIUM ESOMEPRAZOLE MAG DR 40 MG CAP Rx 117 204 $7,483.79 $2,147.40 $5,336.39 $36.69 $10.53 $26.16

ESOMEPRAZOLE MAGNESIUM ESOMEPRAZOLE MAG DR 20 MG CAP Rx 31 44 $1,607.87 $593.40 $1,014.47 $36.54 $13.49 $23.06

FIRST-LANSOPRAZOLE FIRST-LANSOPRAZOLE 3 MG/ML Rx 3 11 $527.41 $263.98 $120.00 $47.95 $24.00 $10.91

LANSOPRAZOLE LANSOPRAZOLE DR 30 MG CAPSULE Rx 187 352 $7,544.59 $4,284.00 $3,260.59 $21.43 $12.17 $9.26

LANSOPRAZOLE LANSOPRAZOLE ODT 15 MG TABLET Rx 1 1 $400.65 $385.65 $15.00 $400.65 $385.65 $15.00

LANSOPRAZOLE LANSOPRAZOLE DR 15 MG CAPSULE OTC 10 17 $521.86 $153.00 $314.41 $30.70 $9.00 $18.49

LANSOPRAZOLE SM LANSOPRAZOLE DR 15 MG CAP OTC 1 2 $35.70 $5.70 $30.00 $17.85 $2.85 $15.00

LANSOPRAZOLE GNP LANSOPRAZOLE DR 15 MG CAP OTC 1 1 $15.33 $0.00 $0.00 $15.33 $0.00 $0.00

NEXIUM NEXIUM DR 40 MG CAPSULE Rx 3 8 $3,059.93 $108.00 $2,951.93 $382.49 $13.50 $368.99

NEXIUM 24HR NEXIUM 24HR 20 MG CAPSULE OTC 7 13 $487.02 $238.80 $248.22 $37.46 $18.37 $19.09

NEXIUM 24HR NEXIUM 24HR 20 MG CAPSULE OTC 1 3 $113.22 $50.40 $62.82 $37.74 $16.80 $20.94

OMEPRAZOLE OMEPRAZOLE DR 20 MG CAPSULE OTC 5,219 9,693 $53,433.49 $451.20 $43,484.79 $5.51 $0.05 $4.49

OMEPRAZOLE OMEPRAZOLE DR 20 MG TABLET OTC 26 40 $1,251.60 $447.23 $787.32 $31.29 $11.18 $19.68

OMEPRAZOLE OMEPRAZOLE DR 40 MG CAPSULE Rx 2,180 4,066 $37,484.17 $361.75 $29,978.61 $9.22 $0.09 $7.37

OMEPRAZOLE OMEPRAZOLE DR 10 MG CAPSULE Rx 31 61 $1,104.26 $60.49 $765.48 $18.10 $0.99 $12.55

OMEPRAZOLE SM OMEPRAZOLE DR 20 MG TABLET OTC 1 1 $48.48 $3.48 $45.00 $48.48 $3.48 $45.00

OMEPRAZOLE-SODIUM BICARBONATE OMEPRAZOLE-BICARB 40-1,680 PKT Rx 2 4 $12,941.64 $12,621.64 $320.00 $3,235.41 $3,155.41 $80.00

OMEPRAZOLE-SODIUM BICARBONATE OMEPRAZOLE-BICARB 20-1,680 PKT Rx 2 2 $5,308.74 $5,278.74 $30.00 $2,654.37 $2,639.37 $15.00

PANTOPRAZOLE SODIUM PANTOPRAZOLE SOD DR 40 MG TAB Rx 3,157 6,238 $43,946.81 $762.35 $35,796.67 $7.05 $0.12 $5.74

PANTOPRAZOLE SODIUM PANTOPRAZOLE SOD DR 20 MG TAB Rx 167 302 $2,450.89 $40.41 $1,895.05 $8.12 $0.13 $6.28

PREVACID PREVACID 30 MG SOLUTAB Rx 3 10 $3,796.44 $81.00 $3,715.44 $379.64 $8.10 $371.54

PREVACID PREVACID 15 MG SOLUTAB Rx 2 3 $1,054.90 $22.50 $1,032.40 $351.63 $7.50 $344.13

PREVACID PREVACID 30 MG SOLUTAB Rx 1 1 $421.66 $9.00 $412.66 $421.66 $9.00 $412.66

PREVACID 24HR PREVACID 24HR DR 15 MG CAPSULE OTC 6 15 $575.08 $326.26 $248.82 $38.34 $21.75 $16.59

PRILOSEC PRILOSEC DR 10 MG SUSPENSION Rx 2 4 $1,077.16 $917.16 $160.00 $269.29 $229.29 $40.00

PRILOSEC OTC PRILOSEC OTC 20.6 MG TABLET OTC 203 367 $11,981.59 $3,944.73 $7,633.80 $32.65 $10.75 $20.80

PROTONIX PROTONIX 40 MG SUSPENSION Rx 2 6 $4,801.37 $4,321.37 $480.00 $800.23 $720.23 $80.00

RABEPRAZOLE SODIUM RABEPRAZOLE SOD DR 20 MG TAB Rx 26 57 $1,827.34 $698.10 $1,129.24 $32.06 $12.25 $19.81

Totals 11,437 21,618 $231,919.28 $40,884.85 $165,578.29 $10.73 $1.89 $7.66

DUEC

January 1, 2018 - April 02,

2018

BRAND NAME GENERIC NAME GPIDs

SPECIALTY DRUGS

Prolastin-C 1000mg/20mL

solution

Alpha-1-Proteinase Inhibitor 44288

Biktarvy 50-200-25 Bictegrav/emtricit/tenofov ala 44426

Erleada 60mg tablet apalutamide 44446

Luxturna 1.5X10EX11 Voretigene Neparvovec-Rzyl 44296

Symdeko 100-150mg tablet Tezacaftor/ivacaftor 44444

Symfi Lo 400-300mg efavirenx/lamivu/tenofov disop 44425

NON-SPECIALTY DRUGS

Admelog 100U/ML - 3ML Pen Insulin Lispro 96719

Admelog 100U/ML Vial Insulin Lispro 5679

Bonjesta 20mg-20mg doxylamine succinate/vit B6 42645

Clenpiq 10 - 3.5/160 Sod Picosulf/Max Ox/Citric Ac 44202

Dithol 1.5%-10% diclofenac sodium/menthol topical

solution

44394

Impoyz 0.03% Cream clobetasol propionate 44155

Lonhala Magnair Starter 25

mcg/ml vial-nebulizer & refill

glycopyrrolate 44206, 44209

Lyrica CR 82.5mg, 165mg,

330mg

Pregabalin 43988, 43987,

43986

Methylphenidate ER 72mg Methylphenidate 44239

Noctiva 0.83, 1.66 Spray desmopressin acetate 43129, 43138

Prednisolone-Gatiflox-

Bromfenc 0.5%-1%

gatifloxacin/prednisolone/ bromfenac 44486

Roweepra XR 500mg, 750mg levetiracetam 14305, 20765

Segluromet 2.5/500, 7.5/500,

2.5/1000, 7.5/1000

Ertugliflozin/metformin 44284, 44286,

44285, 44287

Solosec 2GM PKT Secnidazole

43866

Steglatro 5mg, 15mg tablet Ertugliflozin Pidolate 44259, 44248

Steglujan 5/100, 15/100

tablets

Ertugliflozin/Sitagliptin 44237, 44238

Sublocade 100mg, 300mg

syringe

buprenorphine 44186, 44187

Zypitamag 1mg, 2mg, 4mg

tablet

pitavastatin magnesium 43614,

43615,43616

LINE EXTENSIONS -

COVERED

PRICING (AWP) INDICATION SIMILAR THERAPIES ON

FORMULARY/AWP

$600/vial Alpha1-antitrypsin deficiency Prolastin-C 1000mg solution

reconstituted

$117.83/tablet HIV HIV agents covered T4

$109.20/tablet Prostate cancer Xtandi, Zytiga

Retinal dystrophy

$480.00/tablet Cystic Fibrosis Kalydeco, Orkambi

$65.38/tablet HIV HIV agents covered T4

$108.20 / 3ML Pen Diabetes Humalog, Novolog

$280.20 / vial Diabetes Humalog, Novolog

$12.34/tablet Nausea/Vomiting

$70.21 per bottle Laxative / Bowell Prep PrePopik

$2,894.70 / bottle Osteoarthritis Topical NSAIDS excluded

$540.00/60gm tube Misc. dermatological conditions Generic topical steroids

$22.66/vial

($1,359/month)

COPD Spiriva

$15.324/tablet, parity

priced

Neuropathic Pain gabapentin

$22.81/tablet ADHD Multiple generic versions

$510.00/3.8gm bottle,

parity priced

Adult nocturnal polyuria generic desmopressin

Ophthalmic antibiotic,

glucocorticoid, and NSAID

combo

prednisolone, gatifloxacin, and

bromfenac ophthalmic agents all

available Tier 1500mg =$4.44/tablet

750mg =$6.67/tablet

Partial onset seizures in

epilepsy

Generic 24hr ER formulation

available

$5.36/tablet, parity priced Type-2 Diabetes Jardiance, Synjardy

$324/package Antiprotozoal Agent metronidazole, tinidazole


priced

Type-2 Diabetes Jardiance, Synjardy


priced

Type-2 Diabetes Jardiance, Synjardy

$1,896/syringe, parity

priced

Opioid dependence buprenorphine tablets covered,

injections currently excluded

$9.30/tablet, parity priced Hyperlipidemia atorvastatin, lovastatin, pravastatin,

rosuvastatin, simvastatin

Jill's NOTES DUEC VOTE DUEC

DATE

IB VOTE IB DATE

Rec: exclude,

code 8

05 07 18

T4 05 07 18

Exclude, code 8 05 07 18

Discuss 05 07 18

Discuss 05 07 18

T4 05 07 18

05 07 18

05 07 18


" 05 07 18

Exclude, code

13. OTC

alternatives

05 07 18

T3 05 07 18

Exclude DiThol.

Explore covering

topical NSAIDs

05 07 18



RBP to

gabapentin

05 07 18

(no sheet),

exclude code 13.

05 07 18

Exclude, code 8. 05 07 18

(no sheet),

exclude code 13.

05 07 18


Exclude, code

13, 1

05 07 18

Exclude code 13 05 07 18

Exclude, code

13, 1

05 07 18

Exclude, code

13, 1

05 07 18

Exclude code 13.

Alternative at T1

is generic

buuprenorphine

SL tabs.

05 07 18

Exclude, code

13, 1

05 07 18

AGENDA - Arkansas · Market status: Today, we have four (4) OTC PPI products available; Prilosec,...

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Transcript of AGENDA - Arkansas · Market status: Today, we have four (4) OTC PPI products available; Prilosec,...