Maryland Pharmacy Program PDL P&T Meeting The Sheppard Pratt Conference Center
Maryland Pharmacy ProgramPDLP& T Meeting
Brian Pinto (Chairperson); Vijay Reddy (Vice-Chairman); Donald Yee; MarieMackowick; Winston Wong; Mary Ellen Moran; Steven Daviss; Renee Riddix-Hilliard;Wallace Johnson
Athos Alexandrou (Maryland Pharmacy Program Director); Dixit Shah (MarylandPharmacy Program Deputy Director); Alex Taylor (Division Chief, Clinical PharmacyServices); Paul Holly; Dennis Klein; Angela Chavis
The public meeting of the PDL P&T Committee was called to order by the Chairperson,Dr. Pinto, at 9:15 a.m. The meeting began with brief introductions of all therepresentatives including the P&T Committee members, DHMH, ACS, and ProviderSynergies. Three new P&T members were introduced: Helen G. Anderson, Consumer (inabsentia), Lisa Hadley, M.D. (Physician – in absentia), and Renee Riddix-Hilliard(Pharmacist – present). The Committee then approved the minutes from the previousP&T Committee meeting held on August 20, 2009 with a notation that the P&Trecommendation related to the Antipsychotics be noted to refer to tiering for treatment-naïve patients only (see page 12 of those minutes).
Dr. Pinto then asked Mr. Taylor to provide a status update on the Medicaid PharmacyProgram. Mr. Taylor re-stated the importance of the Medicaid PDL which has saved
millions of dollars on prescription drugs that have allowed the State to manage costswithout reducing covered services. The failing economy continues to significantly reduceMaryland’s revenues and has increased the Medicaid Program enrollmentssimultaneously. The Governor in early 2010 announced additional revenue projectionsthat show an additional $2 billion shortfall.
Mr. Taylor emphasized that every Marylander must do their part including the variousState agencies including the Maryland Medicaid Pharmacy Program and the advisorycommittees like the P&T Committee, Medicaid prescribers, Medicaid providers andMedicaid recipients. The P&T Committee should work collectively to makerecommendations that are safe, clinically appropriate and fiscally responsible. The goal isto cast the widest net for healthcare services and pharmacy benefits to the greatestnumber of Medicaid recipients.
Mr. Taylor re-stated Maryland’s participation in Drug Effectiveness Review Project(DERP) as a collaboration tool with ten other states and the Canadian Agency for Drugs,Technologies and Health to gain access to supplemental clinical information that willafford P&T members with a broader evidence base from which recommendations may beformed. The State’s participation in DERP is in addition to the current therapeutic classreviews provided by Provider Synergies.
Mr. Taylor re-iterated the mechanisms to obtain a PDL prior authorization through aphone call or a fax. The current compliance rate is over 94% which means that mostprescribers are able to find a satisfactory option for therapy. The pharmacy hotlineremains active averaging about 1151 calls each month with about 23% of them relating tothe PDL. Mr. Taylor asked that all cell phones be placed on mute and he thanked theP&T Committee members for their dedicated service. He concluded with a request to theChairperson to entertain a motion to require a 2/3 vote to re-open discussion on atherapeutic class that had already been deliberated and voted upon. After discussion, theCommittee passed a motion to require a simple majority vote to re-open discussion as ageneral operating practice of the P&T Committee.
Dr. Pinto acknowledged that it was time for the public presentation period to begin. Ascustomary, there is no question/answer period, pre-selected speakers have 5 minutes witha timer. Affiliation Class/Drug of Interest Affiliation Class/Drug of Interest
Dr. Pinto thanked the presenters for all their input. A presentation by the claimsprocessor, ACS, by Dr. Karriem Farrakhan was given. After providing a handout to theCommittee members, he pointed out in a chart the 550 PDL PA requests for non-preferred drugs in the prior quarter (4th quarter 2009). He also stated that the chart of thefirst page showed the rank order of the Top Ten PDL classes for number of new PArequests during the fourth quarter of 2009. Approximately 83 percent of the total PDLprior authorizations were part of the Top Ten PDL classes. He also stated that there wasa lack of availability in some generics for the Narcotic Analgesics and the InhaledGlucocorticoids which may have contributed to their appearance in the Top Ten list (e.g. Oxycontin, Pulmicort). An expanded chart on the following pages of the report identifiedthe specific drug and their related PDL PA.
Dr. Yee asked why there were no PDL PA requests for Abilify. Dr. Farrakhan respondedby saying that Abilify is actually a Tier 2 Preferred Product and would not show up onthis report since it is preferred. Dr. Daviss then followed up by asking about thosepatients who request a Tier 2 preferred (Abilify or Zyprexa) whose history does notinclude a Tier 1 or Tier 2 agent. Dr. Farrakhan stated that there does appear to be trendthat patients using the Tier 2 preferred agents are switching to other agents (possibly non-preferred agents), but they are not going without medication. Dr. Daviss then asked aboutthe 30 day emergency supply for the Tier 2 agents which Dr. Farrakhan did not have thestatistics for at that time. A request for provision of information by ACS related toemergency supply of Tier 2 Preferred Antipsychotics was made and accepted.
Dr. Johnson raised the question about the Analgesics, Narcotics that appear amongst theTop Ten Classes with PDL Prior Authorizations. Dr. Farrakhan reiterated that theshortages in some of the generics for many of the narcotics was driving some of theincrease. Dr. Johnson asked about specific pain conditions (e.g. fibromyalgia) and the
scrutiny associated with pain management as a possible tool to further delineate what isdriving this increase in PA requests.
Dr. Mackowick re-visited the antipsychotic class again with a question about the numberof prior authorizations for treatment-naïve patients on the Tier 2 preferred agents. Aftersome discussion, Dr. Pinto suggested that a call for questions a couple of weeks prior tothe next meeting be sent out to ensure that questions related to PDL prior authorizationrequests and so forth be circulated and sent to the attention of the claims processor toensure that there is adequate lead time to address the Committee’s questions.
Dr. Pinto then introduced the start of the therapeutic class reviews. He stated that therewere thirteen classes that had no recommended changes from the existing PDL. TheCommittee agreed to leave these categories unchanged. Immediately following werereview of thirteen classes with single drug reviews of Terbinex, Colcrys, Ulesfia, Saphris,Invega Sustenna, Simponi, Stelara, Onglyza, Zipsor, Bepreve, Acuvail, Ozurdex,Besivance, Zenpep, Effient, Intuniv and Nuvigil. Next, the review of seventeen classeswith modified recommendations from the existing PDL were completed. Finally, thereview of three new categories was conducted. The following table reflects the votingresults for each of the affected therapeutic categories:
Voting Result Maintain current Preferred agents: fentanyl
transdermal, methadone, morphine ER, Kadian
Maintain current Preferred agents: metronidazole, neomycin, Alinia, Tindamax, Vancocin Maintain current preferred agents: Arixtra, Fragmin, Lovenox Maintain current preferred agents: cetirizine (all Maintain current preferred products: Imitrex (all forms), Maxalt/Maxalt MLT, Relpax Maintain current Preferred agents: Aranesp, Procrit Maintain current Preferred agents: Genotropin, Norditropin, Nutropin, Nutropin AQ Voting Result Maintain current preferred product: ribavirin, Pegasys Maintain current Preferred agents: nateglinide, Maintain current Preferred agents: ActoPlusMet, Actos, Avandamet, Avandaryl, Avandia, Duetact Maintain current Preferred agents: mupirocin ointment Maintain current Preferred agents: chloral hydrate, estazolam, flurazepam, temazepam (except 7.5mg and 22.5 mg), triazolam, zaleplon, zolpidem, Rozerem Maintain current Preferred agents: baclofen, carisoprodol, carisoprodol compound, chlorzoxazone, cyclobenzaprine, dantrolene, methocarbamol, orphenadrine, orphenadrine compound, tizanidine Single Drug Reviews Voting Result DO NOT ADD: Terbinex DO NOT ADD: Colcrys ADD: Ulesfia ADD*: Invega Sustenna, Saphris
(P&T recommendations differ from those of ProviderSynergies.)
DO NOT ADD: Simponi, Stelara Single Drug Reviews Voting Result ADD: Onglyza DO NOT ADD: Zipsor DO NOT ADD: Bepreve DO NOT ADD: Acuvail, Ozurdex DO NOT ADD: Besivance DO NOT ADD: Zenpep DO NOT ADD: Effient ADD: Intuniv DO NOT ADD: Nuvigil Voting Result ADD – sulfacetamide/sulfur, Benzaclin, Epiduo, Nuox REMOVE – Duac Other Preferred agents: benzoyl peroxide, clindamycin, erythromycin, tretinoin, Azelex, Clinac BPO, Differin ADD – Reprexain, Zamicet DO NOT ADD – levorphanol, Nucynta, Onsolis REMOVE – meperidine Other Preferred agents: generics (except fentanly buccal and oxycodone/ibuprofen), Ibudone Voting Result ADD – quinapril/quinapril HCTZ, ramipril DO NOT ADD – perindopril REMOVE – Aceon (Brand name), Avapro/Avalide, Benicar/Benicar HCT Other Preferred agents: benazepril/benazepril HCTZ, enalapril/enalapril HCTZ, fosinopril/fosinopril HCTZ, lisinopril/lisinopril HCTZ, Cozaar/Hyzaar, Diovan/Diovan HCT, Micardis/Micardis HCT ADD – Lotrel (Brand Name), Valturna Other Preferred agents: amlodipine/benazepril, Azor, Exforge/Exforge HCT ADD – Depakote Sprinkles (Brand Name), Equetro DO NOT ADD – Lamictal ODT, Lamictal XR, Sabril REMOVE – Other Preferred agents – generics, Carbatrol, Celontin, Diastat, Dilantin Infatab, Felbatol, Keppra XR, Peganone, Trileptal Suspension DO NOT ADD – betaxolol Other Preferred agents: generics, Innopran XL, Levatol, Toprol XL (Brand name) ADD – Gelnique*, Toviaz REMOVE – Detrol, Detrol LA, Oxytrol, Sanctura, Sanctura XR Other Preferred agents: oxybutynin, Enablex, Vesicare
(P&T recommendation for Gelnique differs from thatof Provider Synergies.)
Voting Result REMOVE – Avodart Other Preferred agents: doxazosin, terazosin, Flomax, Proscar (Brand Name only), Uroxatral REMOVE– Dynacirc CR, Sular Other preferred products: generics (amlodipine, diltiazem, felodipine, isradipine, nicardipine, nifedipine ER, verapamil) ADD – Antara DO NOT ADD – fenofibric acid, Fibricor (Brand name) REMOVE – fenofibrate Other Preferred products: generics (cholestyramine, colestipol, gemfibrozil), Niacor, Niaspan, Tricor, Trilipix ADD – Lescol/Lescol XL, Simcor Other Preferred products: lovastatin, pravastatin, simvastatin, Crestor, Lipitor DO NOT ADD – Extavia REMOVE - Avonex Other Preferred products: Betaseron, Copaxone, Rebif ADD – neomycin/polymyxin/HC, ofloxacin, Coly Mycin S, Cortisporin TC DO NOT ADD – Cetraxal Other Preferred products: CiproDex ADD – Tracleer, Ventavis DO NOT ADD – Adcirca, Tyvaso Other Preferred agents: Letairis, Revatio Voting Result REMOVE – Eliphos Other Preferred agents – Fosrenol, Phoslo, Renagel DO NOTADD – Prevacid OTC REMOVE – Prevacid Solutab Other Preferred agents: lansoprazole, omeprazole, omeprazole OTC REMOVE – mesalamine rectal, sfRowasa Other Preferred agents: sulfasalazine, Asacol, Canasa New Class Voting Result ADD – Leukine, Neupogen DO NOT ADD – Neulasta ADD – Lyrica, Savella DO NOT ADD – Cymbalta ADD – azathioprine, cyclosporine modified, mycophenolate mofetil, Cellcept (Brand name), Gengraf (Brand name), Neoral (Brand name), Prograf (Brand name only), Rapamune, Sandimmune (Brand name) DO NOT ADD – cyclosporine, tacrolimus, Azasan, Myfortic
~ The State will continue to monitor the pricing of generic drug products (both new and existing) andcontinues to maintain autonomy to modify or adjust the PDL status of multi-source brands and/or genericdrugs that may become necessary as a result of fluctuations in market conditions (e.g. changes in Federalrebates, supplemental rebates, etc.).
After the conclusion of the review of the therapeutic classes, Dr. Pinto turned the meetingover to Mr. Taylor to conduct the election of the Vice Chairperson position. Dr. Reddywill assume the Chairmanship at the next scheduled meeting of the P&T Committee. Dr. Marie Mackowick was voted unanimously for the Vice Chairmanship. Mr. Taylor
acknowledged Dr.Pinto’s service as Chairman for the prior two years and commendationswere noted.
Finally, Dr. Pinto announced the next meeting will be Thursday, August 19, 2010 at 9amat the Sheppard Pratt Conference Center. With no further business, the meetingadjourned at 12:15pm.
Global Gene Expression Profiling in Neonatal Rat Myocardium inResponse to the Anti-diabetic Drug RosiglitazoneChao-Jen Wong 1,∗, Elliot Kleiman 1, Frank Gonzales 3, Paul Paolini 1,2,1. Computational Science Research Center, San Diego State University, San Diego, CA, USA2. Department of Biology, San Diego State University, San Diego, CA, USA3. School of Public Health, San Diego State Univers
Anna Serefko1, Aleksandra Szopa1, Piotr WlaŸ2, Gabriel Nowak3,4,Maria Radziwoñ-Zaleska5, Micha³ Skalski5, Ewa Poleszak1Chair and Department of Applied Pharmacy, Medical University of Lublin, ChodŸki 1, PL 20-093 Lublin, Poland Department of Animal Physiology, Faculty of Biology and Biotechnology, Maria Curie-Sk³odowska University,Akademicka 19, PL 20-033 Lublin, Poland!Department of Neurob