Preferred Drug List (PDL)

Implementation

November 20th 2019

Agenda

• PDL Overview

• Drug Class Specific Disruptions

• Member Communication

• Provider Communication

• Prior Authorization Requests

• Supplemental Formulary

• Q&A

Uniform State PDL

• Implementation set for 1/1/2020

• MCOs must only cover preferred drugs within 140

drug classes listed on PDL

• 19 Drug Classes Grandfathered

• MCOs must follow DHS prior authorization criteria

for all drugs within 140 drug classes

PDL – Grandfathered Classes

• Anticonvulsants, Oral

• Antidepressants, Other

• Antidepressants, SSRIs

• Antiparkinson’s Agents

• Antipsychotics

• Cytokine and CAM Antagonists

• Hereditary Angioedema Agents

• Hepatitis C Treatments

• HIV/AIDS Antiretrovirals

• Idiopathic Pulmonary Fibrosis (IPF)

Agents

• Immunosuppressives, Oral

• MABs -Anti-IL, Anti-IgE

• Multiple Sclerosis Agents

• Oncology Agents, Oral

• Pancreatic Enzymes

• Pulmonary Arterial Hypertension

(PAH) Agents, Oral and Inhaled

• Stimulants and Related Agents

• Thalidomide and Derivatives

• Ulcerative Colitis Agents

Hypoglycemics, Insulin and Related Agents

Non-Preferred Drug Members Preferred Alternative

HUMALOG 100 UNITS/ML KWIKPEN 1007 INSULIN LISPRO 100 UNIT/ML PEN

BASAGLAR 100 UNIT/ML KWIKPEN 976 LANTUS SOLOSTAR 100 UNIT/ML

ADMELOG SOLOSTAR 100 UNIT/ML 496 NOVOLOG 100 UNIT/ML FLEXPEN

TOUJEO SOLOSTAR 300 UNIT/ML 402 LANTUS SOLOSTAR 100 UNIT/ML

HUMALOG 100 UNIT/ML VIAL 184 INSULIN LISPRO 100 UNIT/MLVIAL

ADMELOG 100 UNIT/ML VIAL 113 NOVOLOG 100 UNIT/ML VIAL

HUMALOG 200 UNITS/ML KWIKPEN 87 INSULIN LISPRO 100 UNIT/ML PEN

HUMULIN N 100 UNIT/ML VIAL 54 INSULIN LISPRO 100 UNIT/MLVIAL

HUMULIN R 100 UNIT/ML VIAL 53 INSULIN LISPRO 100 UNIT/MLVIAL

TOUJEO MAX SOLOSTAR 300UNIT/ML 40 LANTUS SOLOSTAR 100 UNIT/ML

Blood Glucose Meters and Test Strips

Non-Preferred Drug Members Preferred Alternative

FREESTYLE LITE TEST STRIP 1027 CONTOUR TEST STRIP

FREESTYLE PREC NEO TEST STRIPS 149 CONTOUR TEST STRIP

FREESTYLE LITE METER 178 CONTOUR METER

FREESTYLE TEST STRIPS 45 CONTOUR METER

FREESTYLE FREEDOM LITE METER 40 CONTOUR METER

FREESTYLE INSULINX TEST STRIP 3 CONTOUR TEST STRIP

FREESTYLE INSULINX TEST STRIPS 3 CONTOUR TEST STRIP

PRECISION XTRA TEST STRIPS 1 CONTOUR TEST STRIP

ACCU-CHEK GUIDE TEST STRIP 1 CONTOUR TEST STRIP

PRODIGY NO CODING TEST STRIPS 1 CONTOUR TEST STRIP

Glucocorticoids, Inhaled

Non-Preferred Drug Members Preferred Alternative

BREO ELLIPTA 100-25 MCG INH 406 FLUTICASONE-SALMETEROL 250-50

BREO ELLIPTA 200-25 MCG INH 364 FLUTICASONE-SALMETEROL 500-50

QVAR REDIHALER 80 MCG 362 FLOVENT 100 MCG DISKUS

QVAR REDIHALER 40 MCG 254 FLOVENT 50 MCG DISKUS

ARNUITY ELLIPTA 100 MCG INH 42 FLOVENT 100 MCG DISKUS

ARNUITY ELLIPTA 200 MCG INH 17 FLOVENT 250 MCG DISKUS

WIXELA 500-50 INHUB 11 FLUTICASONE-SALMETEROL 500-50

WIXELA 250-50 INHUB 12 FLUTICASONE-SALMETEROL 250-50

BUDESONIDE 1 MG/2 ML INH SUSP 7 BUDESONIDE 0.5 MG/2 ML SUSP

WIXELA 100-50 INHUB 4 FLUTICASONE-SALMETEROL 100-50

Antifungals, Topical

Non-Preferred Drug Rx Count Preferred Alternative

KETOCONAZOLE 2% CREAM 1010 CLOTRIMAZOLE 1% CREAM

CLOTRIMAZOLE 1% CREAM 973 CLOTRIMAZOLE 1% CREAM*

NYSTATIN-TRIAMCINOLONE CREAM 193 CLOTRIMAZOLE-BETAMETHASONE CRM

CICLOPIROX 0.77% GEL 91 CICLOPIROX 0.77% CREAM

NYSTATIN-TRIAMCINOLONE OINTM 84 CLOTRIMAZOLE-BETAMETHASONE CRM

CLOTRIMAZOLE-BETAMETHASONE LOT 38 CLOTRIMAZOLE-BETAMETHASONE CRM

The FieldNon-Preferred Drug Members Preferred Alternative

NAPROXEN SODIUM 550 MG TAB 380 NAPROXEN 500 MG TABLET

ERYTHROMYCIN-BENZOYL GEL 377 CLINDAMYCIN-BENZOYL PEROXIDE 1%-5% Gel

TRETINOIN 0.025% CREAM 338 RETIN-A 0.025% CREAM

BETAMETHASONE DP 0.05% OINT 291 BETAMETHASONE DP 0.05% CRM OR LOT

VENTOLIN HFA 90 MCG INHALER 241 ALBUTEROL HFA 90 MCG INHALER

CARISOPRODOL 350 MG TABLET 218 CYCLOBENZAPRINE 5 OR 10 MG TABLET

MUPIROCIN 2% CREAM 207 MUPIROCIN 2% OINTMENT

ALREX 0.2% EYE DROPS 194 LOTEMAX 0.5% EYE DROPS

HALOBETASOL PROP 0.05% OINTMNT 179 CLOBETASOL 0.05% OINTMENT

STEGLATRO 5 MG TABLET 168 INVOKANA 100 MG TABLET*

TRAVATAN Z 0.004% EYE DROP 155 LATANOPROST 0.005% EYE DROPS

STEGLATRO 15 MG TABLET 142 INVOKANA 300 MG TABLET*

SUBOXONE 8 MG-2 MG SL FILM 90 BUPRENORPHINE-NALOXONE 8-2 MG SL FILM

Prior Authorization Additions

• SGLT2s

• DPP4s

• GLP1 Injectables

• Alzheimer’s Medications

• Buprenorphine

• Colchicine

• Age limit on Benzodiazepines

– Under 21 requires PA

– No PA on anticonvulsants (clonazepam, clobazam, diazepam rectal gel)

• Stimulants and related agents – 18 years and older PA required

Prior Authorization Removals

• MAT generics with exception of single agent buprenorphine

• Long Acting Injectable Antipsychotics

• Pregablin

• Elidel/Protopic – removal of step therapy through topical steroid

• Avonex

• Betaseron

• Glatiramer

• Rebif

Prior Authorization Reviews

• All PDL drugs have specific criteria

• Antihistamines example:

Supplemental Formulary*

• Multivitamins

• Diabetic Supplies

• Melatonin

• Tylenol

• Antacids

• Antiarrhythmics

• Heparin

• Glucose tabs/inj

• Antidiarrheals

• Vaccines

• Laxatives

• Diuretics

• Cough/Cold

• Solu-medrol

• Diagnostics

• Medical Supplies

• Cystic Fibrosis

• Freestyle Libre CGM

More information

Visit hpplans.com/Providers

*Not All Inclusive List

Supplemental Formulary Prior Authorizations

• Acthar gel

• Apokyn

• Kuvan

• Nuedexta

• Palynziq

• Pulmozyme

Pharmacy

• Spinraza

Medical

• Early Refills

Administrative

• Strensiq

• Synagis

• Targretin gel

• Tolvaptan

• Xyrem

• Zyvox (linezolid)

• IVIG

• Non-Formulary/Non-PDL

Member Communication

• 10,740 Members sent notices on 11/1/19

• Catch up disruption letters to be sent 12/1/19

• Notice Posted on HPP Website

• Members with prior authorizations approved will not be disrupted.

– Request for trial and failure of formulary alternatives upon renewal.

• Members in Case Management given additional outreaches

• Calls regarding medications triaged to pharmacists to discuss alternatives

Member Communication Examples

4 Disrupted Medications 1 Disrupted Medication

Provider Communication

• Provider Letters sent out 11/1/2019

• 4,379 Providers who have written a

Rx in past 3 months

• NaviNet Communication

– Member Specific

– Formulary Alternatives Provided

Temporary Supply

• Members are eligible for a temporary supply of medication

that deny for prior authorization once per year per

medication

• Pharmacist receive a code that can be entered at pharmacy

for a 5 or 15 day temporary supply

– 5 days for new starts

– 15 days for ongoing treatment

• If medication filled within the last 34 days

• This will NOT override prescriptions denying due to DUR

Moving Forward

• Publish DHS prior authorization guidelines to HPP website

• Send feedback to DHS

– https://papdl.com/contact

• Send catch up letters to new members disrupted

• Publish member specific info to NaviNet

• DHS P&T to meet once a year in September

– Weekly files will mark new products to non-formulary

– Potential for brands to be switched to non-preferred, generic to preferred

• DHS DUR Board to publish new criteria twice yearly

– March and September