AHCCCS Pharmacy and Therapeutics Committee October 20, 2015 1 Reaching across Arizona to provide...

AHCCCS Pharmacy and Therapeutics CommitteeOctober 20, 2015

1Reaching across Arizona to provide comprehensive quality health care for those in need

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Introductions

Reaching across Arizona to provide comprehensive quality health care for those in need

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1. MRPDL History and Purpose

2. AzAHP Feedback on MRPDL3. Next Steps with MRPDL4. Committee Name and

Purpose5. Committee Operational

Policy Draft Review

Goals of Today’s Meeting


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AHCCCS Coverage: Medications

1. Medically necessary2. Cost effective 3. Federally reimbursable


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Name of drug list

• MRPDL• Drug List• Preferred Drug List• Formulary


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• Developed due to provider feedback

• Evaluated utilization trend across contractors

• All therapeutic classes and individual drugs reviewed

• Consensus based recommendations:

1 vote per health plan

MRPDL History: Recap


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MRPDL History: Recap


ACUTE # Drugs

10-1-12 621

1-1-13 740

10-20-15 749

ALTCS # Drugs

10-1-12 640

1-1-13 760

10-20-15 769

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1-1-13 MRPDL Additions

1. Anthelmintics2. Pediculosides/Scabicides3. Antimalarials4. Antineoplastic and Misc. agents for Prostate5. Ophthalmic Agents for Glaucoma6. Blood Modifiers 7. Antidiarrheal Agents8. Cardiovascular Agents – Angina, atrial fibrillation9. Women’s Health – progesterone


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MRPDL: Current Functions

• Assist providers when selecting clinically appropriate medications for AHCCCS members

• Specifies which drugs:o Are preferred agents (HCV)o Require step therapyo Require PA to ensure clinically appropriate medication useo Have quantity limits (QL)

• Meds not listed on the MRPDL available through Prior Authorization


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MRPDL: Current AHCCCS Process for Changes

• Submit a written request to AHCCCS pharmacy department• Requests must include the following information:

(1) Medication requested (2) Dosage forms, strengths and corresponding costs of the medication

requested; (3) Average daily dosage;(4) FDA indication and accepted off–label use; (5) Advantages or disadvantages of the medication over currently available

products on the MRPDL; (6) Adverse effects reported with the medication; (7) Specific monitoring requirements and costs associated with these

requirements; and(8) Detailed clinical summary.


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AzAHP Feedback 9-14-15: MRPDL

• Most therapeutic categories require coverage of most, if not all, meds in class

• Request a standardized process that provides flexibility and transparency


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CDC: Most Frequently Prescribed Therapeutic Classes

• Analgesics• Antihyperlipidemic agents• Antidepressants


http://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm

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MRPDL1. Atorvastatin2. Lovastatin3. Pravastatin4. Simvastatin

Available 1. Atorvastatin2. Lovastatin3. Pravastatin4. Simvastatin5. Fluvastatin6. Pitavastatin7. Rosuvastatin

Antihyperlipidemic Agents: Statins


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AzAHP Feedback 9-14-15: MRPDL

• Most therapeutic categories require coverage of most, if not all, meds in class

AHCCCS position: MRPDL needs to be re-evaluated in its entirety based on significant changes since 10-1-12


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AzAHP Feedback 9-14-15: MRPDL• Request a standardized process that

provides flexibility and transparency

AHCCCS position: agree that standardization, flexibility, and transparency are required at all levels of system (provider, MCO/RBHA, and AHCCCS)


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AzAHP Feedback: Benzos

• All benzos QL 120 tablets per month• No consideration of various strengths

(safety issue)• Not clear if ER dosage forms covered

AHCCCS position: Agree that benzodiazepine needs to be reevaluated in its entirety


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MRPDL: BenzodiazepinesGeneric Brand QL

Alprazolam Xanax 120

Buspirone Buspar 120

Clonazepam Klonopin 120

Chlordiazepoxide Librium 120

Clorazepate Dipotassium Tranxene 120

Diazepam Valium 120

Lorazepam Ativan 120

Oxazepam Serax 120


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AzAHP Feedback

Narcotic Cough Preparations• Current QL=480ml • Recommend lower limit =240ml

AHCCCS position: agree with recommendation


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MRPDL: Narcotic Cough Preparations

Generic Name Brand Name QL

Guaifenesin/CodeineCheratussin AC,

Mytussin AC, Various 480 ml

Guaifenesin/Codeine/ Pseudoephedrine Cheratussin DAC 480 ml

Hydrocodone/Homatropine Hydromet, HCTussin 480 ml

Promethazine/Codeine Various 480 ml


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AzAHP Feedback• Recommend remove pantoprazole

from MRPDL due to cost

AHCCCS position: need to evaluate further before making decision• Pantoprazole is inexpensive (priced at less than $10 per

month)• Pantoprazole is used by many providers due to other PPI side

effect profiles (i.e. omeprazole diarrhea)


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MRPDL • Recommend one preferred agent in

following categories:o Corticosteroid inhalerso Combination inhalerso Anticholinergic inhalers

AHCCCS position: need to re-evaluate in its entirety


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AzAHP Feedback


Generic Brand Special Req.Steroid Inhalers Beclomethasone QVAR

Budesonide Pulmicort RespulesPA Required for > 5 years of age

Fluticasone Flovent

Mometasone Asmanex Twisthaler Combination Products Budesonide/ Formoterol Symbicort ST Fluticasone / Salmeterol Advair HFA/Diskus ST Ipratropium /Albuterol Combivent Inhaler Mometasone/ Formoterol Dulera STAnticholinergics Aclindinium Bromide Tudorza Pressair Ipratropium Atrovent HFA Tiotropium Spiriva

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AzAHP Feedback: GH• Recommend health plans select one

Growth Hormone as a preferred agent

AHCCCS position: Request denied as GH is one class that AHCCCS is seeking supplemental rebate http://www.azahcccs.gov/commercial/pharmacyupdates.aspx


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Other AzAHP Feedback• PAH Agents

o Make sildenafil the preferred agent

• Gout agentso Remove Uloric o Remove or place QL on Colcrys

• ARBo Remove Benicar

• Remove Ciprodex Otic• Remove or use PA or step therapy for Lidocaine Ointment• Remove Qualaquin or restrict use for tx of malaria• Remove Nystatin/Triamcinolone combination product


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Next Steps with MRPDL: Discussion

• “Start from scratch” vs. use current MRPDL as starting point

• Who to review?o Development/update of MRPDL by P&T—

committee review up next


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BREAK


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Committee Name and Purpose

• Drug Utilization Review Board (DURB)o Sec 1927 SS Acto AHCCCS waived in State Plan o Drug rebate program req. for MCO/FFS

• Pharmacy and Therapeutics Committee


http://www.azahcccs.gov/Reporting/Downloads/MedicaidStatePlan/EntireStatePlan.pdf

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Committee Functions

Core Functions of DURP Current level where addressed

1. Developing and submitting recommendations for drug list

AHCCCS, DBHS

2. Suggest clinical prior authorizations on outpatient prescription drugs

DBHS, MCOExceptions: AHCCCS- HCV, Tobacco Cessation

3. Recommend educational interventions for Medicaid providers

MCO, RBHA

4. Review drug utilization MCO, RBHA


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Committee operational draft policy review


AHCCCS Pharmacy and Therapeutics Committee October 20, 2015 1 Reaching across Arizona to provide...

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