summary review | 2021
TRANSCRIPT
Summary Review | 2021
THERAPEUTICCATEGORY CRITERIA STEP ONE AGENTS STEP TWO AGENTS STEP THREE
AGENTS
ACE Inhibitors(ACEi)
New utilizer of steptwo agents with trialof step one agents
amlodipine besylate-benazepril hcl, benazepril &hydrochlorothiazide,benazepril hcl, captopril,captopril &hydrochlorothiazide,enalapril maleate, enalaprilmaleate &hydrochlorothiazide,fosinopril sodium, fosinoprilsodium &hydrochlorothiazide,lisinopril, lisinopril &hydrochlorothiazide,moexipril hcl, moexipril-hydrochlorothiazide,perindopril erbumine,quinapril hcl, quinapril-hydrochlorothiazide,ramipril, trandolapril
trandolapril-verapamil hcl
ADHD (ER only)
amphetamine-dextroamphetamine,dexmethylphenidate hcl,dextroamphetamine sulfate,Metadate ER,methylphenidate hcl
Adhansia XR, Adzenys XR-ODT, Cotempla XR-ODT,Daytrana, Dyanavel XR,methylphenidate hcl,Mydayis, QuilliChew ER,Relexxii, Vyvanse
Azstarys, Concerta,Focalin XR
ADHD (IR only)
amphetamine-dextroamphetamine,Dexedrine,dexmethylphenidate hcl,dextroamphetamine sulfate,methylphenidate hcl,Zenzedi
amphetamine sulfate,dextroamphetamine sulfate,Evekeo, Evekeo ODT,methamphetamine hcl,methylphenidate hcl,ProCentra, Zenzedi
WellManaged Generics: Summary Review 2021 | Page 1
Summary Review | 2021
THERAPEUTICCATEGORY CRITERIA STEP ONE AGENTS STEP TWO AGENTS STEP THREE
AGENTS
AngiotensinReceptor Blockers(ARBs)
New utilizer of stepthree agents withtrial of step one andtwo agents
amlodipine besylate-olmesartan medoxomil,amlodipine besylate-valsartan, candesartancilexetil, candesartancilexetil-hydrochlorothiazide,eprosartan mesylate,irbesartan, irbesartan-hydrochlorothiazide,losartan potassium,losartan potassium &hydrochlorothiazide,olmesartan medoxomil,olmesartan medoxomil-amlodipine-hydrochlorothiazide,olmesartan medoxomil-hydrochlorothiazide,telmisartan, valsartan,valsartan-hydrochlorothiazide
amlodipine-valsartan-hydrochlorothiazide,telmisartan-amlodipine,telmisartan-hydrochlorothiazide
aliskiren fumarate,Byvalson, Edarbi,Edarbyclor,Tekturna, TekturnaHCT
AntidepressantsSSRI/SNRI
New utilizer of stepthree agents withtrial of step one andtwo agents
bupropion hcl, citalopramhydrobromide,desvenlafaxine succinate,duloxetine hcl, escitalopramoxalate, fluoxetine hcl,fluvoxamine maleate,paroxetine hcl, sertralinehcl, venlafaxine hcl
fluoxetine hcl, fluvoxaminemaleate, paroxetine hcl,venlafaxine hcl
desvenlafaxine,Drizalma Sprinkle,Khedezla, Pexeva,Trintellix, Viibryd,Viibryd Starter Pack
Benign Prostatichyperplasia (BPH)
alfuzosin hcl, doxazosinmesylate, dutasteride,finasteride, tamsulosin hcl,terazosin hcl
dutasteride-tamsulosin hcl,silodosin Cardura XL
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Summary Review | 2021
THERAPEUTICCATEGORY CRITERIA STEP ONE AGENTS STEP TWO AGENTS STEP THREE
AGENTS
Beta Blockers (BB)New utilizer of steptwo agents with trialof step one agents
acebutolol hcl, atenolol,atenolol & chlorthalidone,betaxolol hcl, bisoprolol &hydrochlorothiazide,bisoprolol fumarate,carvedilol, labetalol hcl,metoprolol &hydrochlorothiazide,metoprolol succinate,metoprolol tartrate,pindolol, propranolol &hydrochlorothiazide,propranolol hcl, Sorine,sotalol hcl, Sotalol HCl (AF),sotalol hcl (afib/afl), timololmaleate
Bystolic, carvedilolphosphate, Corzide, InderalXL, InnoPran XL, metoprololtartrate, nadolol, nadolol &bendroflumethiazide,nebivolol hcl
BisphosphonatesNew utilizer of steptwo agents with trialof step one agents
alendronate sodium,ibandronate sodium risedronate sodium
Calcium ChannelBlockers (CCBs)
New utilizer of steptwo agents with trialof step one agents
Afeditab CR, amlodipinebesylate, Cartia XT, Dilt-XR,diltiazem hcl, diltiazem hclcoated beads, diltiazem hclextended release beads,felodipine, isradipine,Matzim LA, nicardipine hcl,nifedipine, Taztia XT, TiadyltER, verapamil hcl, VerelanPM
Cardizem LA, diltiazem hclcoated beads, Katerzia,nimodipine, nisoldipine
Cholesterol Agents -Fibrates
New utilizer of steptwo agents with trialof step one agents
choline fenofibrate,fenofibrate, fenofibratemicronized, fenofibric acid,Fibricor, gemfibrozil,Lipofen, Triglide
Antara, fenofibrate,fenofibrate micronized
Cholesterol Agents -Statins
New utilizer of stepthree agents withtrial of step one andtwo agents
atorvastatin calcium,lovastatin, pravastatinsodium, rosuvastatincalcium, simvastatin
amlodipine besylate-atorvastatin calcium,ezetimibe, ezetimibe-simvastatin, fluvastatinsodium
Altoprev, EzallorSprinkle, FloLipid,Livalo, Roszet,Zypitamag
COX-2Inhibitors/NSAIDs
New utilizer of stepthree agents withtrial of step one andtwo agents
Cataflam, celecoxib,diclofenac potassium,diclofenac sodium,etodolac, fenoprofencalcium, flurbiprofen, IBU,ibuprofen, indomethacin,ketoprofen, ketorolactromethamine, meloxicam,nabumetone, naproxen,piroxicam, ProFeno,Relafen, sulindac
celecoxib, fenoprofencalcium, Fenortho,indomethacin, ketoprofen,meclofenamate sodium,Nalfon, oxaprozin, tolmetinsodium
Relafen DS
DementiaNew utilizer of steptwo agents with trialof step one agents
donepezil hydrochloride,galantamine hydrobromide,memantine hcl, rivastigminetartrate
memantine hcl, Namzaric,rivastigmine
Erectile DysfunctionNew utilizer of steptwo agents with trialof step one agents
sildenafil citrate, vardenafilhcl tadalafil
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Summary Review | 2021
THERAPEUTICCATEGORY CRITERIA STEP ONE AGENTS STEP TWO AGENTS STEP THREE
AGENTS
high potency topicalsteroids
betamethasonedipropionate augmented,desoximetasone,fluocinonide, triamcinoloneacetonide (topical)
amcinonide, betamethasonedipropionate (topical),clocortolone pivalate,Cloderm, Cloderm Pump,desoximetasone,fluocinonide, halcinonide,Impoyz, Triderm
ApexiCon E,diflorasonediacetate, Psorcon
inflammatory boweldisease (IBD)
balsalazide disodium,mesalamine
Dipentum, mesalamine,Pentasa
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Summary Review | 2021
THERAPEUTICCATEGORY CRITERIA STEP ONE AGENTS STEP TWO AGENTS STEP THREE
AGENTS
LOW POTENCYtopical STEROIDS
Ala-Cort, alclometasonedipropionate, Anti-ItchMaximum Strength, AveenoAnti-Itch Max St, CVS Anti-Itch Maximum Strength,CVS Cortisone IntenseHealing, CVS CortisoneMaximum Strength, CVSEczema Anti-Itch, EQHydrocortisone Plus, EQLAnti-Itch Intensive Heal,EQL Anti-Itch MaximumStrength, fluocinoloneacetonide, hydrocortisone(rectal), hydrocortisone(topical), hydrocortisoneacetate (topical),HydroSKIN, Noble FormulaHC, Preparation H, Procto-Pak, PX Hydrocream, RAAnti-Itch MaximumStrength, Recort Plus, TGTAnti-Itch MaximumStrength, TGT Anti-Itch PlusOatmeal, TGT Anti-Itch/Aloe/Vit E
desonide, fluocinoloneacetonide
Ala Scalp, Capex,Dermasorb TA,Desonate,hydrocortisone(topical), MiCort-HC,Texacort, Verdeso
Medium POTENCYTOPICAL STEROIDS
betamethasone valerate,fluticasone propionate,hydrocortisone butyrate,mometasone furoate,triamcinolone acetonide(topical)
betamethasone valerate,desoximetasone,fluocinolone acetonide,fluocinonide emulsifiedbase, hydrocortisonebutyrate, hydrocortisonevalerate, prednicarbate
Beser,desoximetasone,flurandrenolide,fluticasonepropionate,hydrocortisonebutyrate,hydrocortisonebutyrate hydrophiliclipo base, Nolix,Sernivo,triamcinoloneacetonide (topical),Trianex, Triderm,Tritocin
Muscle relaxants
baclofen, carisoprodol,cyclobenzaprine hcl,methocarbamol,orphenadrine citrate,tizanidine hcl, Vanadom
carisoprodol, Metaxall,metaxalone, tizanidine hcl Skelaxin
Neuropathic PainNew utilizer of steptwo agents with trialof step one agents
gabapentin, pregabalin Lyrica CR, pregabalin,pregabalin (once-daily)
OphthlamicProstaglandins
New utilizer of stepthree agents withtrial of step one andtwo agents
latanoprost bimatoprost, bimatoprost(topical), Lumigan Travatan Z, Vyzulta
OphthlamicQuinoloneAntibiotics
New utilizer of stepthree agents withtrial of step one andtwo agents
ciprofloxacin hcl (ophth),ofloxacin (ophth) moxifloxacin hcl (ophth)
Besivance,moxifloxacin hcl(ophth)
Overactive BladderAntimuscarinics
New utilizer of stepthree agents withtrial of step one andtwo agents
oxybutynin chloride,tolterodine tartrate,trospium chloride
tolterodine tartrate,trospium chloride
darifenacinhydrobromide,Gemtesa, Myrbetriq,solifenacinsuccinate, Toviaz
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Summary Review | 2021
THERAPEUTICCATEGORY CRITERIA STEP ONE AGENTS STEP TWO AGENTS STEP THREE
AGENTS
parkinson's disease
carbidopa-levodopa,pramipexoledihydrochloride, ropinirolehydrochloride, selegiline hcl
carbidopa-levodopa-entacapone, pramipexoledihydrochloride, rasagilinemesylate, ropinirolehydrochloride, Rytary,Stalevo 100, Stalevo 200,Stalevo 75, Xadago
Neupro
Proton PumpInhibitors
New utilizer of stepthree agents withtrial of step one andtwo agents
lansoprazole, omeprazole,pantoprazole sodium
esomeprazole magnesium,esomeprazole strontium
AcipHex Sprinkle,Dexilant,esomeprazolemagnesium,NexIUM,pantoprazolesodium, PriLOSEC,rabeprazole sodium
Second GenerationAntipsychotics
aripiprazole, quetiapinefumarate, risperidone,ziprasidone hcl, ZyPREXA,ZyPREXA Zydis
aripiprazole, asenapinemaleate, Fanapt, Latuda,paliperidone, quetiapinefumarate, Rexulti, Vraylar
Invega, SEROquelXR
Sedative Hypnotics:Insomnia
New utilizer of stepthree agents withtrial of step one andtwo agents
estazolam, eszopiclone,flurazepam hcl, temazepam,triazolam, zaleplon,zolpidem tartrate
Edluar
very HIGH POTENCYTOPICAL STEROIDS
betamethasonedipropionate (topical),betamethasonedipropionate augmented,clobetasol propionate,Cormax Scalp Application,halobetasol propionate
clobetasol propionate,clobetasol propionateemollient base, Clodan,desoximetasone,fluocinonide
clobetasolpropionate,clobetasolpropionate emulsion,diflorasonediacetate,halobetasolpropionate, Lexette,Tovet, Ultravate
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