january 12, 2021 drug classes to be reviewed: january 12, 2021 … · 2020. 12. 7. · pdl drug...

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PDL Drug Class Review Announcement January 12, 2021 Drug Classes to be reviewed: Anti-Parkinson’s Agents; Calcitonin-Gene Receptor Protein (CGRP) Inhibitors; Atypical Antipsychotics – Oral; Anxiolytics; Bile salts; Cardiovascular – Alpha-Blockers, Beta-Blockers & Combinations, Calcium Channel Blockers; Diabetes Management – Insulins; Glucagon, Self-Administered; Growth Hormones; Hemorrhoidal, Anorectal and Related Topical Anesthetic Agents; Immune Globulins; Intranasal Rhinitis Agents; Leukotriene Modifiers; Lipotropics – Statins, Statin Combinations, Other; Lithium Agents; Multiple Sclerosis Agents; Neurocognitive Disorder Agents; Ophthalmics - Allergy Agents, Anti-Inflammatory Agents, Glaucoma Agents; Sedative/Hypnotics - Non-Benzodiazepine, Benzodiazepine; and Topical Steroids – Low, Medium, High, Very High Potency. These drug classes will be reviewed at the January 12, 2021 P&T Committee meeting from 1-5pm. The meeting will be held virtually. Dossiers and Supplemental Rebate offers are due to Magellan by December 8, 2020. Please provide your public comments to Jessica Czechowski, Clinical Account Manager ([email protected]) no later than January 5, 2021 to ensure they are included in the information supplied to the P&T Committee members. Please carbon copy Brittany Schock, PDL Pharmacist ([email protected]) on all clinical information and public comment submissions. Anti-Parkinson’s Agents Brand Name Generic Name Dopa Decarboxylase Inhibitors Carbidopa/Levodopa ER tablet, ODT Duopa Carbidopa/Levodopa enteral suspension Inbrija Levodopa capsule for inhalation Lodosyn Carbidopa tablet Carbidopa tablet Rytary ER Carbidopa/Levodopa ER capsule Sinemet Carbidopa/Levodopa tablet Carbidopa/Levodopa tablet Stalevo Carbidopa/Levodopa/Entacapone tablet Carbidopa/Levodopa/Entacapone tablet Dopamine Agonists Pramipexole tablet

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Page 1: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

PDL Drug Class Review Announcement

January 12, 2021

Drug Classes to be reviewed: Anti-Parkinson’s Agents; Calcitonin-Gene Receptor Protein (CGRP) Inhibitors; Atypical Antipsychotics – Oral; Anxiolytics; Bile salts; Cardiovascular – Alpha-Blockers, Beta-Blockers & Combinations, Calcium Channel Blockers; Diabetes Management – Insulins; Glucagon, Self-Administered; Growth Hormones; Hemorrhoidal, Anorectal and Related Topical Anesthetic Agents; Immune Globulins; Intranasal Rhinitis Agents; Leukotriene Modifiers; Lipotropics – Statins, Statin Combinations, Other; Lithium Agents; Multiple Sclerosis Agents; Neurocognitive Disorder Agents; Ophthalmics - Allergy Agents, Anti-Inflammatory Agents, Glaucoma Agents; Sedative/Hypnotics - Non-Benzodiazepine, Benzodiazepine; and Topical Steroids – Low, Medium, High, Very High Potency. These drug classes will be reviewed at the January 12, 2021 P&T Committee meeting from 1-5pm. The meeting will be held virtually. Dossiers and Supplemental Rebate offers are due to Magellan by December 8, 2020. Please provide your public comments to Jessica Czechowski, Clinical Account Manager ([email protected]) no later than January 5, 2021 to ensure they are included in the information supplied to the P&T Committee members. Please carbon copy Brittany Schock, PDL Pharmacist ([email protected]) on all clinical information and public comment submissions. Anti-Parkinson’s Agents

Brand Name Generic Name

Dopa Decarboxylase Inhibitors

Carbidopa/Levodopa ER tablet, ODT

Duopa Carbidopa/Levodopa enteral suspension

Inbrija Levodopa capsule for inhalation

Lodosyn Carbidopa tablet

Carbidopa tablet

Rytary ER Carbidopa/Levodopa ER capsule

Sinemet Carbidopa/Levodopa tablet

Carbidopa/Levodopa tablet

Stalevo Carbidopa/Levodopa/Entacapone tablet

Carbidopa/Levodopa/Entacapone tablet

Dopamine Agonists

Pramipexole tablet

Page 2: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Ropinirole tablet

Apokyn Apomorphine cartridge

Kynmobi Apomorphine sublingual film

Mirapex ER Pramipexole ER tablet

Pramipexole ER tablet

Neupro Rotigotine patch

Parlodel Bromocriptine capsule, tablet

Bromocriptine capsule, tablet

Requip XL Ropinirole ER tablet

Ropinirole ER tablet

MAO-B Inhibitors

Selegiline capsule, tablet

Azilect Rasagiline tablet

Rasagiline tablet

Zelapar Selegiline ODT tablet

Xadago Safinamide tablet

Other Agents

Amantadine capsule, solution, tablet

Benztropine Mesylate tablet

Trihexyphenidyl elixir, tablet

Comtan Entacapone tablet

Entacapone tablet

Gocovri ER Amantadine ER capsule

Nourianz Istradefylline tablet

Ongentys Opicapone capsule

Osmolex ER Amantadine ER tablet

Tasmar Tolcapone tablet

Tolcapone tablet

Page 3: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Atypical Antipsychotics, Oral Brand Name Generic Name

Abilify/Abilify Mycite Aripiprazole tablet, Mycite Kit

Aripiprazole tablet, ODT tablet, oral solution

Caplyta Lumateperone capsule

Clozaril Clozapine tabs, ODT

Clozapine tabs, ODT

Fanapt Iloperidone tablet, pack

Fazaclo Clozapine ODT

Geodon Ziprasidone capsule

Ziprasidone capsule

Invega ER Paliperidone ER tablet

Paliperidone ER tablet

Latuda Lurasidone tablet

Nuplazid Pimavanserin capsule, tablet

Rexulti Brexpiprazole tablet

Risperdal Risperidone tablet, oral solution

Risperidone tablet, ODT, oral solution

Saphris Asenapine SL tablet

Secuado Asenapine patch

Seroquel/Seroquel XR Quetiapine tablet, ER tablet

Quetiapine tablet, ER tablet

Symbyax Olanzapine/fluoxetine capsule

Olanzapine/fluoxetine capsule

Versacloz Clozapine oral suspension

Vraylar Cariprazine capsule

Zyprexa/Zyprexa Zydis Olanzapine ODT, tablet

Olanzapine ODT, tablet

Page 4: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Anxiolytics

Brand Name Generic Name

Buspirone tablet

Chlordiazepoxide capsule

Clorazepate tablet

Diazepam oral concentrate, solution, tablet

Oxazepam capsule

Ativan Lorazepam tablet, Intensol concentrate

Lorazepam tablet, oral concentrate

Lorazepam tablet

Tranxene T-Tab Clorazepate tablet

Clorazepate tablet

Xanax/Xanax XR Alprazolam tablet/ER tablet

Alprazolam tablet/ER tablet, ODT tablet

Bile Salts Brand Name Generic Name

Actigall Ursodiol capsule

Ursodiol capsule

Chenodal Chenodiol tablet

Cholbam Cholic acid capsule

Ocaliva Obeticholic acid tablet

Urso/Urso Forte Ursodiol tablet

Ursodiol tablet

Calcitonin-Gene Receptor Protein (CGRP) Inhibitors

Brand Name Generic Name

Aimovig Erenumab-aooe auto-injector

Ajovy Fremanezumab-vfrm auto-injector, syringe

Page 5: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Emgality Galcanezumab-gnlm pen, syringe

Nurtec ODT Rimegepant ODT tablet

Ubrelvy Ubrogepant tablet

Cardiovascular – Alpha-Blockers Brand Name Generic Name

Minipress Prazosin capsule

Prazosin capsule

Cardiovascular – Beta-Blockers Brand Name Generic Name

Single Agent

Acebutolol capsule

Betaxolol tablet

Bisoprolol tablet

Labetalol tablet

Pindolol tablet

Propranolol solution, tablet

Timolol tablet

Betapace Sotalol tablet

Sotalol tablet

Bystolic Nevibolol tablet

Corgard Nadolol tablet

Nadolol tablet

Coreg Carvedilol tablet

Carvedilol tablet

Coreg CR Carvedilol ER capsule

Carvedilol ER capsule

Hemangeol Propranolol solution

Page 6: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Inderal LA Propranolol ER capsule

Propranolol ER capsule

Inderal XL Propranolol ER capsule

Innopran XL Propranolol ER capsule

Kaspargo Metoprolol succinate sprinkle capsule

Metoprolol tartrate tablet

Lopressor Metoprolol tartrate tablet

Metoprolol tartrate tablet

Sotylize Sotalol solution

Tenormin Atenolol tablet

Atenolol tablet

Toprol XL Metoprolol succinate tablet

Metoprolol succinate tablet

Combinations

Metoprolol-HCTZ tablet

Nadolol-Bendroflumethiazide tablet

Propranolol-HCTZ tablet

Tenoretic Atenolol-Chorthalidone tablet

Atenolol-Chorthalidone tablet

Ziac Bisoprolol-HCTZ tablet

Bisoprolol-HCTZ tablet

Cardiovascular – Calcium Channel Blockers Brand Name Generic Name

Diltiazem ER capsule

Felodipine ER tablet

Isradipine capsule

Nicardipine capsule

Nimodipine capsule

Page 7: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Verapamil tablet

Adalat CC Nifedipine ER tablet

Nifedipine ER tablet

Calan SR Verapamil ER tablet

Verapamil ER tablet

Cardizem Diltiazem tablet

Diltiazem tablet

Cardizem CD Diltiazem ER capsule

Diltiazem CD/ER capsule

Cardizem LA Diltiazem ER/LA tablet

Diltiazem ER/LA tablet

Katerzia Amlodipine suspension

Norvasc Amlodipine tablet

Amlodipine tablet

Nymalize Nimodipine solution, oral syringe

Procardia Nifedipine capsule

Nifedipine capsule

Procardia XL Nifedipine ER tablet

Nifedipine ER tablet

Sular Nisoldipine ER tablet

Nisoldipine ER tablet

Tiazac ER Diltiazem ER capsule

Diltiazem ER capsule

Verelan/Verelan PM Verapamil ER pellet capsule

Verapamil ER/ER PM capsule

Page 8: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Diabetes Management - Insulins Brand Name Generic Name

Rapid-acting

Admelog Insulin lispro Solostar, vial

Afrezza Insulin regular cartridge, unit

Apidra Insulin glulisine Solostar, vial

Fiasp Insulin aspart FlexTouch, penfill, vial

Humalog/Humalog Jr. Insulin lispro cartridge, Kwikpen, vial

Insulin lispro pen/Jr. pen, vial

Lyumjev Insulin lispro-aabc

Novolog Insulin aspart cartridge, Flexpen, vial

Insulin aspart cartridge, pen, vial

Short-acting

Humulin R Regular insulin Kwikpen, vial

Novolin R Regular insulin Kwikpen, vial

Intermediate-acting

Humulin N Insulin NPH Kiwkpen, vial

Novolin N Insulin NPH Flexpen, vial

Long-acting

Basaglar Insulin glargine Kwikpen

Lantus Insulin glargine Solostar, vial

Levemir Insulin detemir Flextouch, vial

Semglee Insulin glargine pen, vial

Toujeo/Toujeo Max Insulin glargine Solostar

Tresiba Insulin degludec Flextouch, vial

Insulin Mixtures

Humalog Mix 50/50 50% insulin lispro protamine/50% insulin lispro Kwikpen, vial

Page 9: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Humalog Mix 75/25 75% insulin lispro protamine/25% insulin lispro Kwikpen, vial

75% insulin lispro protamine/25% insulin lispro Kwikpen, vial

Humulin 70/30 70% insulin NPH/30% insulin regular Kwikpen, vial

Novolin 70/30 70% insulin NPH/30% insulin regular Flexpen, vial

Novolog Mix 70/30 70% insulin aspart protamine/30% insulin aspart Flexpen, vial

70% insulin aspart protamine/30% insulin aspart Flexpen, vial

Glucagon, Self-Administered Brand Name Generic Name

Baqsimi Glucagon spray

Glucagen Hypokit Glucagon kit

Glucagon Emergency Kit Glucagon kit

Gvoke Glucagon Hypopen, syringe

Growth Hormones Brand Name Generic Name

Genotropin Somatropin cartridge, Miniquick pen

Humatrope Somatropin cartridge, vial

Norditropin Somatropin Flexpro pen

Nutropin AQ Somatropin Nuspin injector

Omnitrope Somatropin cartridge, vial

Saizen Somatropin cartridge, vial

Serostim Somatropin vial

Zomacton Somatropin vial

Zorbtive Somatropin vial

Page 10: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Hemorrhoidal, Anorectal and Related Topical Anesthetic Agents

Brand Name Generic Name

Hydrocortisone-Pramoxine 1%-1% cream

Lidocaine cream, ointment, topical solution

Lidocaine-Hydrocortisone 3%-0.5% cream/cream kit (also), 3%-1% cream kit, 2%-2% cream kit

Lidocaine-Hydrocortisone 3%-2.5% gel/gel kit, 2.8-0.55% gel

Lidocaine-Prilocaine cream

Anusol-HC Proctosol-HC Proctozone-HC Procto-Med HC

Hydrocortisone 2.5% cream

Hydrocortisone 2.5% cream

Colocort Cortenema

Hydrocortisone 100 mg/60 mL enema

Hydrocortisone 100 mg/60 mL enema

Cortifoam Hydrocortisone acetate 10% aerosol

Epifoam Hydrocortisone-Pramoxine foam

Pliaglis Lidocaine-Tetracaine cream

Proctofoam-HC Hydrocortisone-Pramoxine 1%-1% foam

Procto-Pak Hydrocortisone 1% cream

Hydrocortisone 1% cream

Rectiv Nitroglycerin 0.4% ointment

Synera Lidocaine-Tetracaine patch

Page 11: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Immune Globulins Brand Name Generic Name

Bivigam Immune Globulin IV solution

Cutaquig Immune Globulin-hipp SC solution

Cuvitru Immune Globulin SC solution

Flebogamma Dif Immune Globulin IV solution

Gammagard Immune Globulin SC solution

Gammagard S/D Immune Globulin IV powder vial

Gammaked Immune Globulin IV/SC solution

Gammaplex Immune Globulin IV solution

Gamunex-C Immune Globulin IV/SC solution

Hizentra Immune Globulin SC solution syringe, vial

Hyqvia Immune Globulin-Hyaluronidase SC kit/pack

Octagam Immune Globulin IV solution

Panzyga Immune Globulin-ifas IV solution

Privigen Immune Globulin IV solution

Xembify Immune Globulin-klhw SC solution

Intranasal Rhinitis Agents Brand Name Generic Name

Azelastine 0.1% (137 mcg), 0.15% spray

Budesonide (generic Rhinocort Aqua) spray OTC

Flunisolide (generic Nasarel) spray

Fluticasone spray RX/OTC

Ipratropium (generic Atrovent) spray

Triamcinolone (generic Nasacort AQ) spray OTC

Beconase AQ Beclomethasone spray

Dymista Azelastine/Fluticasone spray

Azelastine/Fluticasone spray

Nasonex Mometasone spray

Page 12: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Mometasone spray

Omnaris Ciclesonide spray

Patanase Olopatadine spray

Olopatadine spray

Qnasl/Qnasl Children’s Beclomethasone spray

Xhance Fluticasone spray

Zetonna Ciclesonide spray

Leukotriene Modifiers Brand Name Generic Name

Accolate Zafirlukast tablet

Zafirlukast tablet

Singulair Montelukast tablet, chewable tablet, granules

Montelukast tablet, chewable tablet, granules

Zyflo Zileuton ER tablet

Zileuton ER tablet

Lipotropics Brand Name Generic Name

Statins

Fluvastatin capsule

Lovastatin tablet

Altoprev Lovastatin ER tablet

Crestor Rosuvastatin tablet

Rosuvastatin tablet

Ezallor Rosuvastatin sprinkle capsules

Lescol XL Fluvastatin ER tablet

Fluvastatin ER tablet

Lipitor Atorvastatin tablet

Atorvastatin tablet

Page 13: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Livalo Pitavastatin tablet

Pravachol Pravastatin tablet

Pravastatin tablet

Zocor Simvastatin tablet

Simvastatin tablet

Zypitamag Pitavastatin tablet

Statin Combinations

Caduet Amlodipine/Atorvastatin tablet

Amlodipine/Atorvastatin tablet

Vytorin Ezetimibe/Simvastatin tablet

Ezetimibe/Simvastatin tablet

Other

Fenofibrate capsule, tablet

Antara Fenofibrate capsule

Colestid Colestipol granules, tablet

Colestipol granules, tablet

Fenoglide Fenofibrate tablet

Fenofibrate tablet

Fibricor Fenofibric Acid tablet

Fenofibric Acid tablet

Lipofen Fenofibrate capsule

Fenofibrate capsule

Lopid Gemfibrozil tablet

Gemfibrozil tablet

Lovaza Omega-3 Ethyl Esters capsule

Omega-3 Ethyl Esters capsule

Nexletol Bempedoic acid tablet

Nexlizet Bempedoic acid-Ezetimibe tablet

Niaspan ER Niacin ER tablet

Page 14: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Niacin ER tablet

Prevalite Cholestyramine-Aspartame powder

Questran / Questran Light Cholestyramine-Sugar/Cholestyramine-Aspartame powder

Cholestyramine-Sugar/Cholestyramine-Aspartame powder

Tricor Fenofibrate tablet

Fenofibrate tablet

Trilipix Fenofibric Acid DR capsule

Fenofibric Acid DR capsule

Vascepa Icosapent ethyl capsule

Icosapent ethyl capsule

Welchol Colesevelam packet, tablet

Colesevelam packet, tablet

Zetia Ezetemibe tablet

Ezetemibe tablet

Lithium Agents Brand Name Generic Name

Lithium carbonate capsule

Lithium citrate solution

Lithobid ER Lithium carbonate ER tablet

Lithium carbonate ER tablet

Multiple Sclerosis Agents

Brand Name Generic Name

Symptom Management Therapies

Ampyra Dalfampridine tablet

Dalfampridine tablet

Page 15: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Disease Modifying Therapies

Aubagio Teriflunomide tablet

Avonex Interferon Beta 1a PFS, kit

Bafiertam Monomethyl fumarate DR capsule

Betaseron Interferon Beta 1b vial, kit

Copaxone Glatiramer acetate syringe

Glatiramer acetate syringe

Extavia Interferon Beta 1b vial, kit

Gilenya Fingolimod capsule

Glatopa Glatiramer acetate syringe

Kesimpta Ofatumumab pen

Mavenclad Cladribine tablet

Mayzent Siponimod tablet

Plegridy Peginterferon Beta 1a syringe, pen

Rebif/Rebif Rebidose Interferon Beta 1a syringe

Tecfidera Dimethyl Fumarate capsule

Dimethyl Fumarate capsule

Vumerity Diroximel DR capsule

Zeposia Ozanimod capsule, kit

Neurocognitive Disorder Agents

Brand Name Generic Name

Rivastigmine capsule

Aricept Donepezil tablet

Donepezil tablet, ODT

Exelon Rivastigmine patch

Rivastigmine patch

Namenda/Namenda XR Memantine IR tablet, ER capsule, titration pack

Memantine tablet, oral solution, ER capsule, pack

Page 16: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Namzaric Memantine/Donepezil ER capsule

Razadyne ER Galantamine ER caps

Galantamine IR tabs, oral solution, ER caps

Ophthalmic, Allergy Agents

Brand Name Generic Name

Azelastine drops

Cromolyn drops

Epinastine drops

Alaway (OTC) Ketotifen furmarate (OTC) drops

Ketotifen furmarate (OTC) drops

Alocril Nedocromil sodium drops

Alomide Lodoxamide tromethamine drops

Alrex Loteprednol drops

Bepreve Bepotastine besilate drops

Lastacaft Alcaftadine drops

Pataday Rx/OTC Olopatadine Rx/OTC drops

Olopatadine (Rx) drops

Patanol Olopatadine drops

Olopatadine drops

Pazeo Olopatadine drops

Zaditor (OTC) Ketotifen fumarate (OTC) drops

Ketotifen fumarate (OTC) drops

Zerviate Cetirizine drops

Ophthalmics, Anti-Inflammatory Agents

Brand Name Generic Name

Bromfenac drops

Dexamethasone drops

Diclofenac drops

Page 17: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Flurbiprofen drops

Acular/Acular LS Ketorolac drops

Ketorolac drops

Acuvail Ketorolac/PF drops

Bromsite Bromfenac drops

Durezol Difluprednate drops

Eysuvis Loteprednol drops

Flarex Fluorometholone Acetate drops

FML Forte/Liquifilm/S.O.P. Fluorometholone drops, ointment

Fluorometholone drops

Ilevro Nepafenac drops

Inveltys Loteprednol drops

Lotemax/Lotemax SM Loteprednol drops, gel, ointment

Loteprednol drops

Maxidex Dexamethasone drops

Nevanac Nepafenac droptainer

Omnipred Prednisolone Acetate drops

Pred Forte Prednisolone Acetate drops

Prednisolone Acetate drops

Pred Mild Prednisolone Acetate drops

Prolensa Bromfenac drops

Ophthalmics, Glaucoma Agents

Brand Name Generic Name

Single-Component

Betaxolol 0.5% drops

Bimatoprost 0.03% drops

Brimonidine 0.2% drops

Carteolol 1% drops

Page 18: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Levobunolol 0.5% drops

Alphagan P Brimonidine 0.1%, 0.15% drops

Brimonidine 0.15% drops

Azopt Brinzolamide 1% drops

Betoptic S Betaxolol 0.25% drops

Iopidine Apraclonidine 0.5%, 1% drops

Apraclonidine 0.5% drops

Isopto Carpine Pilocarpine 1%, 2%, 4% drops

Pilocarpine 1%, 2%, 4% drops

Istalol Timolol 0.5% drops

Timolol 0.5% drops

Lumigan Bimatoprost 0.1% drops

Phospholine Iodide Echothiophate 0.125% drops

Rhopressa Netarsudil 0.02% drops

Timoptic Timolol 0.25%, 0.5% drops

Timolol 0.25%, 0.5% drops

Timoptic Ocudose Timolol PF 0.25%, 0.5% drops

Timoptic-XE Timolol GFS 0.25%, 0.5%

Timolol GFS 0.25%, 0.5%

Travatan Z Travoprost 0.004% drops

Travoprost 0.004% drops

Trusopt Dorzolamide 2% drops

Dorzolamide 2% drops

Vyzulta Latanoprostene Bunod 0.024% drops

Xalatan Latanoprost 0.005% drops

Latanoprost 0.005% drops

Xelpros Latanoprost 0.005% drops

Zioptan Tafluprost 0.0015% PF drops

Combination Products

Page 19: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Combigan Brimonidine/Timolol 0.2%/0.5%

Cosopt/Cosopt PF Dorzolamide-Timolol 2%-0.5%/PF drops

Dorzolamide-Timolol 2%-0.5%/PF drops

Rocklatan Netarsudil 0.02%/Latanoprost 0.005% drops

Simbrinza Brinzolamide/Brimonidine 1%/0.2% drops

Sedative Hypnotics

Brand Name Generic Name

Non-Benzodiazepine

Zaleplon capsule

Ambien/Ambien CR Zolpidem IR tablet, ER tablet

Zolpidem IR tablet, ER tablet

Belsomra Suvorexant tablet

Dayvigo Lemborexant tablet

Edluar Zolpidem SL tablet

Zolpidem SL tablet

Intermezzo Zolpidem SL tablet

Zolpidem SL tablet

Lunesta Eszopiclone tablet

Eszopiclone tablet

Rozerem Ramelteon tablet

Ramelteon tablet

Zolpimist Zolpidem oral solution/spray

Benzodiazepine

Estazolam tablet

Flurazepam capsule

Halcion Triazolam tablet

Triazolam tablet

Restoril Temazepam capsule

Temazepam capsule

Page 20: January 12, 2021 Drug Classes to be reviewed: January 12, 2021 … · 2020. 12. 7. · PDL Drug Class Review Announcement . January 12, 2021 . Drug Classes to be reviewed: Anti-Parkinson’s

Topical Steroids Brand Name Generic Name

Low Potency

Alclometasone 0.05% cream, 0.05% ointment

Desonide 0.05% cream, 0.05% lotion, 0.05% ointment

Fluocinolone 0.01% cream

Hydrocortisone 1% (Rx) cream, 2.5% cream, 2.5% lotion, 1% (Rx) ointment, 2.5% ointment

Capex Fluocinolone 0.01% shampoo

Derma-Smoothe-FS/ Scalp Fluocinolone 0.01% oil/ 0.01% scalp oil

Fluocinolone 0.01% oil/ 0.01% scalp oil

Desonate Desonide 0.05% gel

Synalar Fluocinolone 0.01% solution

Fluocinolone 0.01% solution

Synalar TS Fluocinolone 0.01%/Skin Cleanser Kit

Texacort Hydrocortisone 2.5% solution

Medium Potency

Betamethasone Dipropionate 0.05% cream, 0.05% lotion

Betamethasone Valerate 0.1% cream, 0.1% lotion, 0.1% ointment

Fluocinonide-E 0.05% cream

Flurandrenolide 0.05% cream, 0.05% lotion, 0.05% ointment

Hydrocortisone valerate 0.2% cream, 0.2% ointment

Mometasone 0.1% cream, 0.1% ointment, 0.1% solution

Triamcinolone 0.025% cream, 0.1% cream, 0.025% lotion, 0.1% lotion, 0.025% ointment, 0.1% ointment

Beser Fluticasone 0.05% lotion; 0.05% emollient Kit

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Fluticasone 0.05% lotion

Cloderm Clocortolone 0.1% cream, 0.1% cream pump

Clocortolone 0.1% cream, 0.1% cream pump

Cordran Flurandrenolide tape

Cutivate Fluticasone 0.05% cream, 0.05% lotion

Fluticasone 0.05% cream, 0.05%, lotion, 0.005% ointment

Dermatop Prednicarbate 0.1% ointment

Prednicarbate 0.1% ointment, 0.1% cream

Kenalog Triamcinolone 0.147 mg/g spray

Triamcinolone 0.147 mg/g spray

Locoid/Locoid Lipocream Hydrocortisone butyrate 0.1% lotion, hydrocortisone-emollient 0.1% cream

Hydrocortisone butyrate 0.1% cream, 0.1% ointment, 0.1% lotion, 0.1% solution, hydrocortisone-emollient 0.1% cream

Luxiq Betamethasone 0.12% foam

Betamethasone 0.12% foam

Pandel Hydrocortisone probutate 0.1% cream

Psorcon Diflorasone 0.05% cream

Diflorasone 0.05% cream

Synalar Fluocinolone 0.025% cream, 0.025% ointment

Fluocinolone 0.025% cream, 0.025% ointment

Synalar Fluocinolone/emollient 0.025% cream, 0.025% ointment Kit

Trianex Triamcinolone 0.05% ointment

Triamcinolone 0.05% ointment

High Potency

Amcinonide 0.1% cream, 0.1% lotion

Betamethasone dipropionate 0.05% ointment

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Betamethasone dipropionate/propylene glycol, (augmented) 0.05% cream

Diflorasone 0.05% ointment

Fluocinonide 0.05% cream, 0.05% gel, 0.05% ointment, 0.05% solution

Triamcinolone 0.5% cream, 0.5% ointment

Apexicon-E Diflorasone/emollient 0.05% cream

Halog Halcinonide 0.1% cream, 0.1% ointment, 0.1% solution

Halcinonide 0.1% cream

Topicort Desoximetasone 0.05% cream, 0.25% cream, 0.05% gel, 0.05% ointment, 0.25% ointment

Desoximetasone 0.05% cream, 0.25% cream, 0.05% gel, 0.05% ointment, 0.25% ointment

Very High Potency

Clobetasol emollient 0.05% cream

Bryhali Halobetasol 0.01% lotion

Clobex Clobetasol 0.05% lotion, 0.05% shampoo, 0.05% spray

Clobetasol 0.05% lotion, 0.05% shampoo, 0.05% spray, 0.05% gel

Clodan Clobetasol 0.05% shampoo, cleanser kit

Clobetasol 0.05% shampoo

Diprolene Betamethasone dipropionate/propylene glycol, (augmented) 0.05% ointment

Betamethasone dipropionate/propylene glycol, (augmented) 0.05% ointment, 0.05% lotion, 0.05% gel

Lexette Halobetasol 0.05% foam

Halobetasol 0.05% foam

Olux/Olux-E Clobetasol 0.05% foam, Clobetasol-emollient 0.05% foam

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Clobetasol 0.05% foam, Clobetasol-emollient 0.05% foam

Temovate Clobetasol 0.05% cream, 0.05% ointment

Clobetasol 0.05% cream, 0.05% ointment, 0.05% solution, 0.05% lotion, 0.05% gel

Topicort Desoximetasone 0.25% spray

Desoximetasone 0.25% spray

Tovet Clobetasol emollient 0.05% foam, 0.05% emollient foam kit

Clobetasol emollient 0.05% foam

Ultravate Halobetasol 0.05% cream, 0.05% lotion, 0.05% ointment

Halobetasol 0.05% cream, 0.05% ointment

Ultravate X Halobetasol/Lactic Acid 0.05%-10% cream combo pack, 0.05%-10% ointment combo pack

Vanos Fluocinonide 0.1% cream

Fluocinonide 0.1% cream