Read Pharmacy News - Volume 9 Issue 2 - Provider Communications - Passport Health Plan text version


DATE MARCH 2009 VOLUME 9 ISSUE 2 HELPFUL NUMBERS FOR PROVIDERS Passport Health Plan PerformRx: (800) 578-0898 Bin: 600428 Processor control: 02920000 Passport Advantage PerformRx: (866) 533-5490 Bin: 012353 Processor control: 03650000 Injectables: (866) 533-5490, options 2,2,5 HELPFUL NUMBERS FOR MEMBERS Passport Health Plan 1-800-578-0603, option #2 Passport Advantage 1-800-578-0603, option #1 WEBSITE NEW IN THIS ISSUE · Exclusive Network Pharmacy Educational Presentation: April 7, 2009 · Enhanced Online Searchable Formularies Now Available · Recent FDA Advisories · P&T Committee Review

Exclusive Network Pharmacy Educational Presentation: April 7, 2009

We encourage all Passport Health Plan (PHP) and Passport Advantage (PAD) network pharmacies to attend the exclusive upcoming medical education presentation sponsored by PerformRx and Daiichi-Sankyo, Inc.: WHEN: WHERE: Tuesday, April 7, 2009 6:00 p.m. ­ 8:00 p.m. The Brown Hotel 335 West Broadway Louisville, KY 40202 (502) 583-1234 All network PHP and PAD pharmacies 6:00 p.m. "Pharmacoeconomics of Hypertension" Presented by William Liu, PharmD, CGP 7:30 p.m. Brief Q&A Session and Educational Symposium (Focusing on new PHP claims processing edits) RSVP: Attendance will be limited to 100 individuals. Please RSVP by March 27, 2009 to secure your spot! To register, e-mail [email protected], call (502) 585-7986, or fax (502) 585-8462.


All medications may be subject to edits to limit quantities dispensed, day's supply, and drug-drug interactions at the point of service. Appropriate diagnosis, drug therapy length and approved indications will be used in determining medical necessity. Committee decisions are based upon relevant medical literature that is evidence based, peer reviewed, and English language based, using appropriate study designs. Price(s) listed are AWP from First Data Bank as of 01-20-2006. These are displayed as a r eference only and intended to be a learning tool for providers for the costs of therapy prescribed for a one-month period unless otherwise indicated. Prices are calculated from AWP using the lower dose strengths applicable to therapy for 30-day supply calculated.


Enhanced Online Searchable Formulary Now Available for PHP and PAD!

We are pleased to announce the Passport Health Plan (PHP) and Passport Advantage (PAD) formularies are now available online in an enhanced, searchable format. Providers and their staff are encouraged to access these user-friendly tools that: · Allowsearchesviabrandname,genericname,ortherapeuticclass; · Denotepriorauthorizationrequirementsandofferaccesstoauthorizationcriteria,includingbutnot limitedtosteptherapyrequirements; · Displaytheclass,copaymenttier,andquantitylimits(ifapplicable)foreachmedication;and, · Exhibitallmedicationswithinthesameclass. The searchable formularies are found online under the "Pharmacy" tab at: · www.passporthealthplan.comforPHP;or · for PAD.

Recent FDA Advisories Affecting Network Pharmacies and Providers

The Federal Food and Drug Administration (FDA) recently issued advisories on the following drugs: 2/23/09: TheFDAnotifiedhealthcareprofessionalsthattreatmentwithzonisamidecancausemetabolic acidosis in some patients. 2/19/09: The FDA issued a Public Health Advisory on three confirmed and one possible report of progressive multifocal leukoencephalopathy (PML), a rare brain infection, in patients using the psoriasis drug Raptiva. 2/12/09: The FDA and Roche Laboratories notified healthcare professionals of the introduction of a CellCeptMedicationGuide.FDAregulationsrequireapharmacisttodistributeacopyofthe Medication Guide to every patient who fills a CellCept prescription from this point forward. 2/4/09: The FDA is working with the manufacturer to further evaluate the incidence of serious bleeding events and mortality in patients who received Xigris. 2/3/09: ETHEX & Ther-Rx Corporation issued a voluntary nationwide recall of prescription prenatal and iron supplements to wholesale level. 2/3/09: ETHEX Corporation issued a voluntary expansion to the retail level of a previously announced recall on certain products. 1/26/09: The FDA notified healthcare providers to re-evaluate the need for starting or continuing treatment with a PPI (including Prilosec OTC) in patients taking clopidogrel. The manufacturer of Plavix has agreed to work with the FDA to obtain additional information on the effects of genetic factors and other drugs (especially the proton pump inhibitors (PPIs)) on the effectiveness of clopidogrel. Please visit for more information.

The Pharmacy & Therapeutics Committee Reviewed the Following Medications on February 12, 2009

Note: The bolded name indicates which drug, brand or generic, is available. Please refer to the "Passport Health Plan Drug Status" column to view the formulary status for each medication.

Brand Name (Generic Name) Aldara® (Imiquimod 5% Cream) Indication Indicated for the treatment of mucous membrane warts, actinic keratosis or superficial basal cell carcinoma. Passport Health Plan Drug Status Remove step therapy requirements. Preferred Drug List Alternatives Condylox® (Podofilox 0.5% Gel) $218.52 (3.5gm) Podofilox 0.5% Solution (Condylox®) $86.24 (3.5ml) Add step therapy requirement of trial and failure of generic Flonase. Remain preferred without step therapy for pregnant and lactating members. Fluticasone Propionate (Flonase®) : $14.40 (120 Actuations) Nasonex® (Mometasone Furoate) $65.40 (120 Actuations) Niaspan® (Niacin ExtendedRelease) $63.58-$224.90 (30-60 Tablets) Simvastatin (Zocor®) $5.15-$6.80 (30 Tablets) None $66.00 ­ $83.10 (30 Tablets) $63.58-$224.90 (30-60 Tablets) $93.95 (120 Actuations) Cost per 30 day supply (or per unit) $497.28 (24 packet)

Rhinocort AQ® (Budesonide)

Indicated for nasal polyps, allergic and non-allergic rhinitis.

Simcor® (Simvastatin/Niacin Extended-Release)

Treatment of primary Add to Preferred hypercholesterolemia, Drug List. mixed dyslipidemia, hypertriglyceridemia when treatment with simvastatin or niacin extended-release monotherapy is considered inadequate. Treatment of hypertension. Tekturna HCT is not indicated for initial therapy. Add to Preferred Drug. List with step therapy requirement of trial and failure of two generic preferred ACE inhibitors.

Tekturna® and Tekturna HCT®

Travatan® and Travatan Z® Oxycodone /Acetaminophen 2.5mg-325mg Tablets (Percocet®) Stavudine

Reduction of intraocular Add to Preferred pressure (IOP) by increas- Drug List. ing outflow of aqueous humor. Relief of moderate to moderately severe pain. Treatment of HIV-1 infection in combination with other antiretroviral agents. Remain non-preferred. Add to Preferred Drug List.

Xalatan®(Latanoprost) 0.005% $69.05 (2.5mL) Oxycodone /Acetaminophen (Percocet®) 5mg-325mg Tablets None

$69.05 (2.5mL)

2.5mg/325mg Tablet - $1.64 15mg cap -$1.85 20mg cap -$1.91 30mg cap -$1.99 40mgcap -$5.96

AczoneTM (Dapsone) 5% Topical Gel

Indicated for the topical Remain treatment of acne vulgaris. non-preferred.

Clindamycin 1% Gel (Cleocin-T®): $11.07 (30gm) Erythromycin 2% Gel (Erygel®): $7.20 (30gm) Erythromycin/Benzoyl Peroxide Gel (Benzamycin®): $23.07 (23.3gm) Tretinoin 0.025% Gel (Retin-A®): $29.42 (30gm)

$126.44 (30gm)

AktenTM (Lidocaine) 3.5% Ophthalmic Gel BanzelTM (Rufinamide) Tablets

A local anesthetic indiRemain cated for ocular surface non-preferred. anesthesia during ophthalmologic procedures. Adjunctive treatment of Remain seizures associated with non-preferred. Lennox-Gastaut syndrome in all members four years and older. Cutaneous treatment of acne vulgaris when comedones, papules and pustules are present. Remain non-preferred.


$31.87 (5mL)

Lamotrigine (Lamictal®): $264.89-$394.27 (60-120 Tablets)

$79.70-$637.50 (60-240 Tablets)

EpiduoTM (Adapalene 0.1%/ Benzoyl Peroxide 2.5%) Topical Gel

Clindamycin 1% Gel (Cleocin-T®): $11.07 (30gm) Erythromycin 2% Gel (Erygel®):$7.20 (30gm) Erythromycin/Benzoyl Peroxide Gel (Benzamycin®): $23.07 (23.3gm) Tretinoin 0.025% Gel (Retin-A®): $29.42 (30gm)

$178.07 (45gm)

Hycamtin® (Topotecan)

Treatment of patients with relapsed small cell lung cancer.

Remain non-preferred.


0.25mg: $672.57 (10 Capsules) 1mg: $2690.25 (10 Capsules) $103.14-$257.84 (60-150 Tablets)

PrandiMetTM (Repaglinide and Metformin)Tablets

An adjunct to diet and ex- Remain ercise to improve glycemic non-preferred. control in adults with Type 2 Diabetes mellitus who are already treated with meglitinide and metformin or who have inadequate glycemic control on meglitinide alone or metformin alone. Treatment of thrombocytopenia in members with chronic immune (idiopathic) thrombocytopenic purpura who have an insufficient response to corticosteroids, immunoglobulins, or splenectomy. Remain non-preferred.

Metformin (Glucophage®): $5.32-$13.29 (60-150 Tablets) Prandin® (Repaglinide): $103.14-$257.84 (60-150 Tablets) Starlix® (Nateglinide): $141.30-$146.80 (90 Tablets) None

Promacta® (Eltrombopag) Tablets

$1,753.13-$3,506.25 (30 Tablets)

TrilipixTM (Fenofibric Acid) Capsules

Primary hypercholesterolemia or mixed dyslipidemia; hypertriglyceridemia Combination therapy with statins for mixed dyslipidemia An anti-inflammatory or immunosuppressive agent. Also indicated for the treatment of certain endocrine conditions and for palliation of certain neoplastic conditions.

Remain non-preferred.

Gemfibrozil (Lopid®): $14.93 (60 Tablets) Tricor® (Fenofibrate): $38.39-$115.16 (30 Tablets)

$36.59-$109.78 (30 capsules)

VeripredTM 20 (Prednisolone Sodium Phosphate 20mg/5mL) Oral Solution

Remain non-preferred.

Prednisolone Sodium Phosphate 15mg/5mL Solution (Orapred®) $23.07 (100mL or 300mg Total Dose) Prednisolone Sodium Phosphate 5mg/5mL Solution (Pediapred®): $38.33 (300mL or 300mg Total Dose) Prednisolone Anhydrous 15mg/5mL Solution (Prelone®) $11.40 (100mL or 300mg Total Dose)

$42.03 (75mL or 300mg Total Dose)

Xenazine® (Tetrabenazine) Tablets EuraxTM (Crotamiton) Topical Suspension

Indicated for the treatment of chorea associated with Huntington's disease. For the eradication of scabies and for symptomatic treatment of pruritic skin.

Remain non-preferred. Remain non-preferred.

None Eurax Lotion ­ $14.77 per bottle Eurax Cream - $13.85 per bottle

$873.38-$3,493.50 (30-60 Tablets) $96.18 per bottle


Pharmacy News - Volume 9 Issue 2 - Provider Communications - Passport Health Plan

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