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Maryland Pharmacy Program
PDL P&T Meeting

The Sheppard Pratt Conference Center Maryland Pharmacy ProgramPDLP& T Meeting Attendees:
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 Proceedings:
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.
Class/Drug of Interest
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,
Maintain current Preferred agents: Genotropin,
Norditropin, Nutropin, Nutropin AQ
Voting Result
Maintain current preferred product: ribavirin,
Maintain current Preferred agents: nateglinide,
Maintain current Preferred agents: ActoPlusMet,
Actos, Avandamet, Avandaryl, Avandia, Duetact
Maintain current Preferred agents: mupirocin
Maintain current Preferred agents: chloral
hydrate, estazolam, flurazepam, temazepam (except
7.5mg and 22.5 mg), triazolam, zaleplon, zolpidem,
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,
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,
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,
(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
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,
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,
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
DO NOT ADD – cyclosporine, tacrolimus, Azasan,
~ 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.


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