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AGENDA

State and Public School Life and Health Insurance Board Drug Utilization and Evaluation Committee

October 1, 2018

1:00 p.m.

EBD Board Room – 501 Building, Suite 500

I. Call to Order ................................................................... Dr. Scott Pace, Chairman

II. Approval of May 2018 Minutes ..................................... Dr. Scott Pace, Chairman

II. Old Business

a. Second Review of Drugs ...................................... Dr. Rachael McCaleb, UAMS

IV. New Business

a. Formulary Clean-Up Items .............. Dr. Micah Bard, Dr. Dwight Davis, UAMS

b. Rebate Summary ......................................................... Dr. Dwight Davis, UAMS

c. Rx to OTC Category Change .......................................... Dr. Micah Bard, UAMS

d. New Drugs ............................................................ Dr. Rachael McCaleb, UAMS

2018 Upcoming Meetings

November 5, 2018

NOTE: All material for this meeting will be available by electronic means only

[email protected]

Notice: Silence your cell phones and other noise that is disruptive to the meeting. Keep

your personal conversations to a minimum.

mailto:[email protected]

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State and Public School Life and Health Insurance Board Drug Utilization and Evaluation Committee Minutes

October 1, 2018 The State and Public Life and Health Insurance Board, Drug Utilization and Evaluation Committee (DUEC) met on Monday, October 1, 2018 at 1:00 p.m., in the EBD Board Room, 501 Woodlane, Little Rock, AR.

Voting Members present: Non-Voting Members present:

Dr. Scott Pace, Chairman Dr. Rachel McCaleb

Dr. Hank Simmons, Vice-Chairman Dr. Dwight Davis

Dr. Kat Neill Dr. Ashley McPhee

Laura Mayfield Dr. Micah Bard

Dr. Appathurai Balamurugan - Teleconference

Dr. John Kirtley

Dr. William Golden

Chris Howlett, EBD Executive Director, Employee Benefits Division

OTHERS PRESENT

Rhoda Classen, Shay Burleson, Shalada Toles, Cheryl Reed, Bonnie Casey, Allie Barker, EBD; Jessica Akins,

Health Advantage; Jon Maguire, Erica Brumleve, GSK; Frances Bauman, Jason Lurk, Nova Nordisk; Elizabeth

Montgomery, ACHI; Charlotte Downs, Sanofi Genzyme; Dwight Davis, Micah Bard, Sherry Byant, UAMS; Clay

Patrick, EBRx; Suzanne Woodall, MedImpact; Treg Long, ACS; Sandra Wilson, AHM; Jim Chapman, ABBVIE;

Gene Wingo, Biogen; Takisha Sanders, HA; Sean Seago, MERCK; Aaron Shaw, BI; John Vinson, Lauren

Jimerson, APA-Arrx; Mark Adlason, Stephen Carroll, AllCare; Sheila Weddington, MG Samuel, Retirees

CALL TO ORDER

Meeting was called to order by Dr. Scott Pace, Chair, and he announced that we do have a quorum today.

APPROVAL OF MINUTES

The request was made by Dr. Pace to approve the May 7, 2018 minutes. He asked the members to take a few

minutes to look over the minutes and mention any edits that you might want to suggest. Dr. Simmons made

the motion to approve. Dr. Kirtley seconded; all were in favor.

Minutes Approved.

I. New Business

A. Formulary Clean-Up: by Dr. Micah Bard and Dr. Dwight Davis, UAMS

Label Name Recommendation

CLOZAPINE 25 MG TABLET Exclude Oral Dissolving Tablets (ODT) formulation

of clozapine. Generic clozapine is available in 25mg, 50mg, 100mg and 200mg strengths.

CLOZAPINE ODT 100 MG TABLET

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RISPERIDONE 0.5 MG TABLET

Exclude Oral Dissolving Tablet (ODT) formulation of risperidone. Generic risperidone is available in

0.25mg, 0.5mg, 1mg, 2mg, 3mg, 4mg strengths.

RISPERIDONE 0.5 MG ODT

RISPERIDONE 3 MG TABLET

RISPERIDONE 3 MG ODT

OXAYDO 7.5 MG TABLET Exclude Oxaydo. It is an oxycodone-containing

Abuse-Deterrent formulation. It is available in 5mg and 7.5mg tablets. EBD has historically excluded

the Abuse-Deterrent products. ACTOPLUS MET XR 15-1,000 MG TB

Exclude ActosPlus Met and its generic version. Members can take pioglitazone and metformin

separately.

ACTOPLUS MET XR 30-1,000 MG TB

PIOGLITAZONE-METFORMIN 15-500

PIOGLITAZONE-METFORMIN 15-850

PIOGLITAZONE HCL 15 MG TABLET



METFORMIN HCL 1,000 MG TABLET

METFORMIN HCL 500 MG TABLET

METFORMIN HCL 850 MG TABLET

METFORMIN HCL ER 500 MG TABLET

METFORMIN HCL ER 750 MG TABLET

RYTARY ER 48.75 MG-195 MG CAP Exclude Rytary and branded Sinemet CR. Generic

carbidopa-levodopa ER is available in 25/100, 50/200 strenghts (same as Sinemet CR). Rytary ER

is available in 23.75-95mg, 36.25-145mg, 48.75-195mg and 61.25-245mg strengths.

SINEMET CR 50-200 TABLET

CARBIDOPA-LEVO ER 50-200 TAB

DIGOXIN 125 MCG TABLET

Exclude brand-name Lanoxin. Most utilization is with generic digoxin.

DIGOXIN 250 MCG TABLET

LANOXIN 125 MCG TABLET

LANOXIN 250 MCG TABLET

TOBI PODHALER Currently T1; Move to T4 Specialty; change day

supply requirement to 56.

TOBRAMYCIN 300 MG/5 ML AMPULE

TEMOZOLOMIDE 5 MG CAPSULE

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Currently T1; Move to T4 Specialty. TEMOZOLOMIDE 100 MG CAPSULE


EPICERAM (EMOLLIENT COMBINATION NO. 32)

Exclude Epiceram. It is an emollient indicated for dry and itchy skin. There are multiple lower cost

emollients available in the marketplace. (example: CeraVe)

Discussion: Metformin Dr. Pace: Is the Metformin in that product an osmotic Metformin or is it just the regular Metformin? Dr. Davis: I am not sure about that, but we can look into that. Dr. Pace: Yes, I would like to know that. If it is the osmotic one, then it has some implications on the cost.

The asthmatic preparations are far more expensive than the traditional Metformin. But they may have already been excluded.

Dr. Davis: Yes, they have already been excluded. Tobramycin Dr. Kirtley: When we have birth control that only has 21 active doses, and nothing else in it. Is it okay that

we are billing it as a 21-day supply or are we having a MedImpact audit on that? Dr. Bard: That is a good question. I think you could argue either way, it could be a 28-day supply or a 56-

day supply. Dr. Kirtley: I have no problem with saying that a 56-day supply is appropriate on a single copay, but at the

same time, I think we would tell the auditors not to audit because it is a 21-day supply for 21 active doses or a 28-day supply for 28 active doses.

Dr. Bard: We did tell the auditors that we wanted to handle it to where there was no impact. This is for going forward so we don’t run into the issue again. One thing to consider when voting on this, changing it to a 56-day supply would mean two copays for the patient. We could also put a limit in there where it would only charge us one copay.

Dr. Neill: There should not be two copays on this. Dr. Pace: We should pull this one out and make a separate motion on that. Dr. Neill: When communication goes to the member, do they get an automatic communication about

how to appropriately crush and utilize the generic tablets, since the ODT’s will be excluded. Dr. Davis: This will all go through the Board to be approved. We could make immediate changes to the

plan to stop any new starts, and then provide communication directly to the member that allows them 90 days’ grace period to get this switched. We would put all the information in there.

Dr. Simmons made a motion to approve all recommendations above except for Tobramycin. Dr. Kirtley seconded. All were in favor. Motion Approved. Dr. Kirtley made a motion to adopt the suggestion for Tobramycin that up to a 56-day billing supply would be

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counted as one copay, recognizing that the 28 days of use is followed by 28 days of nonuse, and would fall under Tier 4. Dr. Simmons seconded. Motion Approved.

B. Rebate Summary: by Dr. Dwight Davis, UAMS

EBRx is seeking permission from the DUEC to pursue rebate contracts, where possible, within these categories. Coverage policies as established by the DUEC will not be altered as a result of such contracting.

The drug categories listed below represent previously reviewed topics of the DUEC. Currently, drugs within these categories have specific formulary placement and, in many cases, established prior authorization/coverage policies in place. EBD currently reimburses for these products consistent with its coverage policies, but receives no rebate revenue in return.

Drug Category Sample Products Annualized EBD Spend

Multiple Sclerosis Agents Aubagio®, Gilenya®, Tecfidera®, Betaseron®, Copaxone®/Glatopa®, Rebif®, etc.

$9.3 million

Misc. Antineoplastic Agents (Tyrosine Kinase Inhibitors)

Imbruvica®, Jakafi®, Sprycel®, Sutent®, Tagrisso®, Tarceva®, Tykerb®, Votrient®

$6.3 million

Colony Stimulating Factors, Hematopoietic Agents

Neupogen®, Granix®, Zarzio®, Neulasta®, Epogen®, Procrit®, Aranesp®, Leukine®

$175K (pharmacy only)

Pulmonary Arterial Hypertension Agents

Adcirca®, Adempas®, Letairis®, Opsumit®, Tracleer®, Uptravi®

$2.5 million

Pancreatic Enzymes Creon®, Pancreaze®, Zenpep® $770K

5-ASA Agents (Ulcerative Colitis Agents)

Apriso®, Canasa®, Delzicol®, Lialda®, Pentasa®

$890K

Totals $19.9 million

Dr. Kirtley made a motion to pursue rebate contracting opportunities as presented. Dr. Simmons seconded. Discussion: Dr. Golden: Are all these drugs interchangeable or aren’t they somewhat different? Dr. Davis: We need to evaluate that. Dr. Golden: We need to be very cautious in some of those categories. Dr. Davis: We will have to do some grouping and are going to have to evaluate them. Motion Approved. Dr. Pace: Is there any reason to believe that EBRx should be able to negotiate four times as many rebate

dollars as a major PBM. Dr. Davis: I don’t know that we are earning more rebates that United Healthcare was, we are sharing

100% back to the plan. Dr. Pace: That is the point I was making, the dollars are probably not any bigger, they are just all making it

back to the health plan. Dr. Kirtley: There is a carve out though. When we were trying to figure out what was going on with rebate

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dollars, we even asked about a specific class of our main two spend points on therapeutic immune modulators and were told there was no rebate for either one. We have a specificity of contracting in our rebate where there is potentially a lot of money on the table for a $10 million dollar spend that we were told there was no negotiated rebate on at all.

Dr. Davis: I’ve also been told on occasion, that there are contracts that we’re earning more per unit or percentage wise than some of the big PBM’s because of the ability to drive the market share.

Dr. Golden: Something I find irksome at UAMS, is that copays are often more expensive than the cost of a drug when you pay cash. Do we have a policy about that for our plan.

Dr. Bard: On our plan, if the cost of the drug is less than the copay, then the patient pays the cost of the drug.

C. Rx to OTC Category Change: by Micah Bard, UAMS

The following therapeutic categories and specific product names have been reviewed by First Databank and changed from “Rx” to “OTC”. The Plan normally does not cover “OTC” medications, however, since these have been paid for due to the previous “Rx” designation, a decision will need to be made on how to handle these products going forward.

Therapeutic Categories Product Names

Multivitamin, Pediatric, Prenatal, and Geriatric Preparations Vitamin B, B12, D Mineral Replacement (Calcium, Zinc, Fluoride, Iron) Antioxidant Multivitamin Combinations Folic Acid Preparations Electrolyte Depleters Herbal Drugs Metabolic Deficiency Agents Dietary Supplement, Misc Protein Replacement Urinary pH Modifiers Bulk Chemicals Protein Replacement

Centratex®, Dailyvite®, Enlyte®, Fabb®, Ferocon®, Ferrex® (150 Forte/Plus, 28), Ferrocite Plus®, Folbee Plus®, Folgard®, Folivane-F®, Folivane Plus®, Folplex 2.2®, Hematinic Plus®, Hemocyte Plus®, Icar-C Plus®, Iferex 150 Forte®, Integra® F/Plus, Multigen® Folic/Plus, Multivitamin w/Fluoride, Nephro-Vite®, Poly-Iron 150 Forte®, Renal Caps®, Rena-Vite Rx®, Se-Tan Plus®, Sodium Fluoride, Tandem Plus®, Triphrocaps®, Virt-Caps®, Virt-Vite/Plus®, Vol-Care Rx®, Vol-Plus®, Irospan®, Vasculera®, Rheumate®

Recommendation: Exclude.

Dr. Pace: We already have a policy on medical foods to exclude them, so how are these slipping through and being paid?

Dr. Bard: That is a good question. We don’t know how they got through. Dr. Pace: It seems that there are some products have slipped into the system that we have paid claims on

but doesn’t make any sense to. Dr. Bard: In the past, for the formulary, we have been operating as a “closed formulary” when in actuality

it hasn’t been built that way in the MedImpact system. We are currently working on that to get the formulary closed down. What we do is when new drugs come out, we have to send in change orders to MedImpact to have those drugs excluded. If no action is taken by us on those in six months, they will just start covering the medications. Weekly, we get a file with new drugs that come out and after reviewing, we send those to MedImpact to cover or not cover. We are in the final steps of closing the formulary, so from that point on, we would only tell MedImpact which drugs we are going to add to the formulary and everything else would just stay off.

Dr. Kirtley made a motion to adopt the recommendations as presented. Dr. Neill made a second.

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Motion Approved.

D. New Drugs: by Dr. Rachel McCaleb and Dr. Ashley McPhee, UAMS

1. Non-Specialty Medications

a. Recommended Additions

BRAND NAME GENERIC NAME PRICING (AWP) INDICATION SIMILAR THERAPIES ON FORMULARY

DUEC VOTE

Retacrit Epoetin Alfa $132.36 / 10,000

units

Anemia

Epogen, Procrit

Epogen, Procrit T4PA, Seek

Rebates

Siklos Hydroxyurea

100mg

$6 / tablet Sickle Cell

Anemia

Hydroxyurea

500 mg capsules

T4, QL #30/m (if need #2/d, go to the alternative Droxia. Age restriction <4years of age.

b. Recommended Exclusions


DUEC VOTE

Rhopressa

0.02%

Netarsudil

Mesylate

$274.80 / Bottle Elevated

Intraocular

Pressure

Exclude, code 13. Timolol and latanoprost are the alternatives.

Osmolex ER Amantadine $18 / tablet Parkinson

Disease

Generic

amantadine IR

tablets

Exclude, code 13

Lucemyra Lofexidine HCl $24.83 / tablet Opioid

Withdrawal

Exclude, code 13

Imvexxy Estradiol $27 / insert Vulvar and

vaginal atrophy

Generic estradiol

vaginal cream

and tablets

Exclude, code 13

Crysvita Burosumab $4080 / 10mg vial Exclude, code 1 & 8.

Roxybond Oxycodone HCl

15mg, 30mg

$9.34 / 12.44 per

tablet

Pain Multiple

oxycodone

generics

Exclude, code 13

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Buprenorphine/

Naloxone

Bupren/Naloxone

8-2mg

film

$8.80/ film Opioid

Withdrawal

Buprenorphine/N

aloxone SL

tablets and films

Exclude code 13.

POS

msg: covered

alternative is

generic SL tablets.

Remove PA. QL

#60/30.

Dr. Simmons made a motion to approve all non-specialty drug recommendations. Dr. Kirtley seconded. All were in favor. Motion Approved.

2. Specialty Medications

a. Recommended Additions


DUEC VOTE

Cimduo 300-

300mg

Lamivudine/Ten

ofovir

Disop Fum

$40.22 / tablet HIV T4

Yonsa Abiraterone Acet,

submicronized

$92.10 / tablet Prostate

Cancer

T4PA; explore

rebates between

Yonsa & Zytiga

Olumiant Baricitinib $82.20 / tablet Rheumatoid

Arthritis

T4PA, QL 30/30.

Include

in RA PA criteria

only (for

now).

Idelvion FACTOR IX

RECOM, ALBUMIN

FUSION

$5.28/unit Hemophilia T4PA

Symtuza DARUNAVIR/COB/

EMTRI/TENOF

ALAF

T4; move Prezcobix

to T4

Fulphila PEGFILGRASTIM-

JMDB

$5,010 / 0.6 mL T4PA; explore

rebates

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b. Recommended Exclusions

BRAND NAME

GENERIC NAME PRICING (AWP)

INDICATION SIMILAR THERAPIES ON FORMULARY

DUEC VOTE

Jynarque Tolvaptan $279.45 /

tablet

Hyponatremia;

Autosomal

dominant

polycystic kidney

disease

Exclude, code

1

Tavalisse Fostamatinib Disodium $189 /

tablet

Immune

thrombocytopeni

a (ITP)

Exclude, code

1

Doptelet Avatrombopag maleate $1080 /

tablet

Chronic liver

disease

associated

thrombocytopenia

Exclude, code

13

Palynziq Pegvaliase $1171.20 /

ML

Phenylketonuria

(PKU)

Exclude, code

1 & 8

Dexonto dexamethasone sodium phosphate Exclude, code

3

Braftovi ENCORAFENIB $109.77 /

tablet

Melanoma Exclude, code

1, revisit

2/2019

Mektovi BINIMETINIB $73.18 /

tablet

Melanoma Exclude code

1 & 8

Tibsovo IVOSIDENIB Exclude, code

1 & 8; revisit

2.2019

IFE-PG20 ALPROSTADIL IN SODIUM CHLORIDE Exclude, code

3 & 13

IFE-BIMIX

30/1

PAPAVERINE/PHENTOLAMINE/WATE

R

Exclude, code

3 & 13

Lokelma SODIUM ZIRCONIUM CYCLOSILICATE Exclude, code

13

Macrilen MACIMORELIN ACETATE NA Medical

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Onpattro PATISIRAN SODIUM, LIPID COMPLEX NA Medical

Galafold MIGALASTAT HCL Exc, code1;

revisit 9/2019

Poteligeo MOGAMULIZUMAB-KPKC NA Medical

Ilumya TILDRAKIZUMAB-ASMN Exclude, code

13

Mulpleta LUSUTROMBOPAG Exclude, code

13

Orlissa ELAGOLIX SODIUM Exclude, code

13 & 1

c. Tabled Drugs

Aimovog Erenumab $690 / dose Migraine

Prophylaxis

Tabled

Dr. Kirtley made a motion to approve all specialty drug recommendations except Aimovog and Symtuza. Dr. Simmons seconded. All were in favor. Motion Approved.

Dr. Kirtley made a motion to table Aimovog until next meeting. Dr. Neill seconded. All were in favor. Motion Approved. Dr. McCaleb: Symtuza, a new agent that will enter in at a Tier 4. Looking at other drugs in that class, the Prezcobix would go from a Tier 3 to a Tier 4. Dr. Simmons moves to approve the recommendation on Symtuza. Dr. Kirtley seconded. All were in favor. Motion Approved. Dr. Pace asked for a motion to adjourn. Dr. Kirtley motioned to adjourn. Dr. Neill seconded. Meeting Adjourned.

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*New Drug Code Key:

1 Lacks meaningful clinical endpoint data; has shown efficacy for surrogate endpoints only.

2 Drug’s best support is from single arm trial data

3 No information in recognized information sources (PubMed or Drug Facts & Comparisons or Lexicomp)

4

Convenience Kit Policy - As new drugs are released to the market through Medispan, those drugs described as “kits will not be considered for inclusion in the plan and will therefore be excluded products unless the product is available solely as a kit. Kits typically contain, in addition to a pre-packaged quantity of the featured drug(s), items that may be associated with the administration of the drug (rubber gloves, sponges, etc.) and/or additional convenience items (lotion, skin cleanser, etc.). In most cases, the cost of the “kit” is greater than the individual items purchased separately.

Medical Food Policy - Medical foods will be excluded from the plan unless two sources of peer-reviewed, published medical literature supports the use in reducing a medically necessary clinical endpoint.

A medical food is defined below:

5

A medical food, as defined in section 5(b)(3) of the Orphan Drug Act (21 U.S.C. 360ee(b)(3)), is “a food which is formulated to be consumed or administered eternally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation.” FDA considers the statutory definition of medical foods to narrowly constrain the types of products that fit within this category of food. Medical foods are distinguished from the broader category of foods for special dietary use and from foods that make health claims by the requirement that medical foods be intended to meet distinctive nutritional requirements of a disease or condition, used under medical supervision, and intended for the specific dietary management of a disease or condition. Medical foods are not those simply recommended by a physician as part of an overall diet to manage the symptoms or reduce the risk of a disease or condition, and all foods fed to sick patients are not medical foods. Instead, medical foods are foods that are specially formulated and processed (as opposed to a naturally occurring foodstuff used in a natural state) for a patient who is seriously ill or who requires use of the product as a major component of a disease or condition’s specific dietary management.

6

Cough & Cold Policy - As new cough and cold products enter the market, they are often simply re-formulations or new combinations of existing products already in the marketplace. Many of these existing products are available in generic form and are relatively inexpensive. The new cough and cold products are branded products and are generally considerably more expensive than existing products. The policy of the ASE/PSE prescription drug program will be to default all new cough and cold products to “excluded” unless the DUEC determines the product offers a distinct advantage over existing products. If so determined, the product will be reviewed at the next regularly scheduled DUEC meeting.

7

Multivitamin Policy - As new vitamin products enter the market, they are often simply re-formulations or new combinations of vitamins/multivitamins in similar amounts already in the marketplace. Many of these existing products are available in generic form and are relatively inexpensive. The new vitamins are branded products and are generally considerably more expensive than existing products. The policy of the ASE/PSE prescription drug program will be to default all new vitamin/multivitamin products to “excluded” unless the DUEC determines the product offers a distinct advantage over existing products. If so determined, the product will be reviewed at the next regularly scheduled DUEC meeting.

8 Drug has limited medical benefit &/or lack of overall survival data or has overall survival data showing

minimal benefit

9 Not medically necessary

10 Peer -reviewed, published cost effectiveness studies support the drug lacks value to the plan.

11

Oral Contraceptives Policy - OCs which are new to the market may be covered by the plan with a zero dollar, tier 1, 2, or 3 copay, or may be excluded. If a new-to-market OC provides an alternative product not similarly achieved by other OCs currently covered by the plan, the DUEC will consider it as a new drug. IF the drug does not offer a novel alternative or offers only the advantage of convenience, it may not be considered for inclusion in the plan.

12 Other

13 Insufficient clinical benefit OR alternative agent(s) available

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EBD Formulary Clean-up Items

Drug Utilization and Evaluation Committee

October 1, 2018

Label Name Utilizing

Members Rx

Count Days

Supply Quantity Total Cost

Paid Amount

Copay Amount

Brand / Generic

Plan Pd/Rx

Plan Pd/Unit

DACON

CLOZAPINE 25 MG TABLET 1 10 70 67 $57.28 $0.00 $57.28 Generic $0.00 $0.00 0.95

CLOZAPINE ODT 100 MG TABLET 1 3 90 270 $1,866.21 $1,626.21 $240.00 Generic $542.07 $6.02 3.00

Recommendation: Exclude Oral Dissolving Tablets (ODT) formulation of clozapine. Generic clozapine is available in 25mg, 50mg, 100mg and 200mg

strengths.


Members Rx

Count Days


Paid Amount

Copay Amount

Brand / Generic

Plan Pd/Rx

Plan Pd/Unit

DACON

RISPERIDONE 0.5 MG TABLET 40 86 2,748 4,146 $699.92 $65.98 $539.75 Generic $0.77 $0.02 1.51

RISPERIDONE 0.5 MG ODT 1 4 120 480 $706.80 $646.80 $60.00 Generic $161.70 $1.35 4.00

RISPERIDONE 3 MG TABLET 14 32 961 1,103 $296.19 $110.13 $160.62 Generic $3.44 $0.10 1.15

RISPERIDONE 3 MG ODT 1 3 90 90 $643.74 $598.74 $45.00 Generic $199.58 $6.65 1.00

Recommendation: Exclude Oral Dissolving Tablet (ODT) formulation of risperidone. Generic risperidone is available in 0.25mg, 0.5mg, 1mg, 2mg, 3mg,

4mg strengths.


Members Rx

Count Days


Paid Amount

Copay Amount

Brand / Generic

Plan Pd/Rx

Plan Pd/Unit

DACON

OXAYDO 7.5 MG TABLET 1 1 30 90 $913.57 $873.57 $40.00 SS Brand $873.57 $9.71 3.00

Recommendation: Exclude Oxaydo. It is an oxycodone-containing Abuse-Deterrent formulation. It is available in 5mg and 7.5mg tablets. EBD has

historically excluded the Abuse-Deterrent products.

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Members Rx

Count Days


Paid Amount

Copay Amount

Brand / Generic

Plan Pd/Rx

Plan Pd/Unit

DACON

ACTOPLUS MET XR 15-1,000 MG TB 4 6 180 300 $3,244.60 $3,004.60 $240.00 SS Brand $500.77 $10.02 1.67

ACTOPLUS MET XR 30-1,000 MG TB 3 7 270 270 $5,782.47 $5,422.47 $360.00 SS Brand $774.64 $20.08 1.00

7 13 450 570 $9,027.07 $8,427.07 $600.00 $648.24

PIOGLITAZONE-METFORMIN 15-500 16 39 1,518 3,003 $8,211.66 $6,980.58 $737.88 Generic $178.99 $2.32 1.98

PIOGLITAZONE-METFORMIN 15-850 28 62 2,130 4,440 $12,147.60 $10,768.80 $1,050.00 Generic $173.69 $2.43 2.08

44 101 3,648 7,443 $20,359.26 $17,749.38 $1,787.88 $175.74

PIOGLITAZONE HCL 15 MG TABLET 190 374 14,192 14,650 $3,855.99 $158.02 $3,250.82 Generic $0.42 $0.01 1.03



757 1,513 58,855 59,346 $18,124.70 $694.52 $16,079.23 $0.46

METFORMIN HCL 1,000 MG TABLET 2,581 4,831 204,731 404,358 $33,342.35 $1,949.91 $26,759.50 Generic $0.40 $0.00 1.98

METFORMIN HCL 500 MG TABLET 3,239 5,953 242,820 539,581 $35,614.88 $1,570.17 $28,084.05 Generic $0.26 $0.00 2.22

METFORMIN HCL 850 MG TABLET 207 386 15,570 32,447 $2,976.00 $101.40 $2,382.33 Generic $0.26 $0.00 2.08

METFORMIN HCL ER 500 MG TABLET 1,802 3,380 139,108 354,770 $32,550.29 $1,697.27 $26,839.91 Generic $0.50 $0.00 2.55

METFORMIN HCL ER 750 MG TABLET 143 265 10,855 18,900 $3,208.75 $288.69 $2,316.51 Generic $1.09 $0.02 1.74

7,972 14,815 613,084 1,350,056 $107,692.27 $5,607.44 $86,382.30 $0.38

Recommendation: Exclude ActosPlus Met and its generic version. Members can take pioglitazone and metformin separately.

of 4


Members Rx

Count Days

Supply Quantity

Total Cost

Paid Amount

Copay Amount

Brand / Generic

Plan Pd/Rx

Plan Pd/Unit

DACON

RYTARY ER 48.75 MG-195 MG CAP 1 3 90 1,440 $4,255.98 $4,135.98 $120.00 SS Brand $1,378.66 $2.87 16.00

SINEMET CR 50-200 TABLET 1 1 30 150 $426.62 $346.62 $80.00 MS Brand $346.62 $2.31 5.00

CARBIDOPA-LEVO ER 50-200 TAB 37 72 2,640 6,045 $7,726.14 $6,376.80 $1,225.21 Generic $88.57 $1.05 2.29

Recommendation: Exclude Rytary and branded Sinemet CR. Generic carbidopa-levodopa ER is available in 25/100, 50/200 strenghts (same as Sinemet

CR). Rytary ER is available in 23.75-95mg, 36.25-145mg, 48.75-195mg and 61.25-245mg strengths.


Members Rx

Count Days

Supply Quantity

Total Cost

Paid Amount

Copay Amount

Brand / Generic

Plan Pd/Rx

Plan Pd/Unit

DACON

DIGOXIN 125 MCG TABLET 92 180 7,203 7,324 $5,639.44 $2,081.99 $3,320.01 Generic $11.57 $0.28 1.02

DIGOXIN 250 MCG TABLET 70 129 5,424 5,293 $4,715.65 $1,858.50 $2,189.62 Generic $14.41 $0.35 0.98

LANOXIN 125 MCG TABLET 1 2 60 60 $757.50 $597.50 $160.00 MS Brand $298.75 $9.96 1.00

LANOXIN 250 MCG TABLET 1 1 90 90 $1,133.26 $893.26 $240.00 MS Brand $893.26 $9.93 1.00

Recommendation: Exclude brand-name Lanoxin. Most utilization is with generic digoxin.


Members Rx

Count Days


Paid Amount

Copay Amount

Brand / Generic

Plan Pd/Rx Plan

Pd/Unit DACON

TOBI PODHALER 1 2 60 448 $20,523.40 $20,523.40 $0.00 SS

Brand

$10,261.70 $45.81 7.47

TOBRAMYCIN 300 MG/5 ML

AMPULE

4 6 174 1680 $17,838.00 $17,748.00 $90.00 Generic $2973.00 $10.62 5.00

**Note: Currently, these medications and all specialty list medications have a day supply limit of 31. This medication, however, is taken for 28 days

consecutively, followed by a 28 day drug holiday. According to MedImpact, the day supply when processing a prescription should be 56. Because we

have it set up for a max of 31 days, this is causing unnecessary audits for the pharmacies processing these prescriptions.

Recommendation: Currently T1; Move to T4 Specialty; change day supply requirement to 56.

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Members Rx

Count Days


Paid Amount

Copay Amount

Brand / Generic

Plan Pd/Rx

Plan Pd/Unit

DACON

TEMOZOLOMIDE 5 MG CAPSULE 2 4 99 45 $399.20 $248.25 $62.07 Generic $99.80 $8.87 0.45

TEMOZOLOMIDE 20 MG CAPSULE 1 1 15 15 $263.81 $211.05 $2,189.62 Generic $263.81 $17.59 1.00


3 8 178 120 $10,510.51 $7,983.76 $775.50 Generic $1,313.81 $87.59 0.67


3 5 144 75 $9,381.57 $8,961.31 $240.00 Generic $1,876.31 $125.09 0.52

Recommendation: Currently T1; Move to T4 Specialty.


Members Rx

Count Days


Paid Amount

Copay Amount

Brand / Generic

Plan Pd/Rx

Plan Pd/Unit

DACON

EPICERAM (EMOLLIENT COMBINATION NO. 32)

2 3 30 675 $17,668.41 $17,428.41 $240.00 SS Brand $5,889.47 $65.44 3.00

Recommendation: Exclude Epiceram. It is an emollient indicated for dry and itchy skin. There are multiple lower cost emollients available in the

marketplace. (example: CeraVe)

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Manufacturer Rebate Discussion

EBD Drug Utilization and Evaluation Committee

October 1, 2018

Background:

In late 2016, EBRx began negotiating manufacturer rebates on behalf of EBD. This approach was

initiated after EBD and its stakeholders became frustrated with the rebate management process under

the Plan’s previous pharmacy benefit manager, Catamaran / OptumRx.

The goals of this program include:

Align our rebate opportunities with our formulary by establishing the clinical basis of our

formulary FIRST and then pursuing rebate contracts as opposed to the reverse order.

Establish a credible rebate contract solicitation process that aligns with EBD’s formulary

guidelines as set forth by the DUEC and Board.

Establish a transparent cash flow and reporting process whereby EBD receives 100% of all

pharmaceutical manufacturer-generated revenue and documentation of all revenues reported

at the drug/NDC level.

The objectives of this program include:

Therapeutic categories would be identified by EBRx for which incremental rebate revenue would

be possible

EBRx would conduct the evidence-based review and present findings to the DUEC

The DUEC, based on initial clinical evaluation, would provide general guidance to EBRx in

structuring manufacturer rebate bid solicitations

EBRx would receive the manufacturer bids, perform financial and member disruption analyses,

and award the contract(s) to the winning bidder(s).

EBRx handles member/provider communications pertaining to the changes as well as

communicating/testing of changes in the MedImpact adjudication system.

To date, the following drug categories have been addressed by this process:

Insulin Products (Humulin®, Humalog®, Lantus®, Toujeo®)

Misc. Andidiabetic Agents (Victoza®, Jardiance® / Synjardy®)

Hepatitis C Agents (Zepatier®)

Anticoagulants (Eliquis®, Xarelto®)

Growth Hormones (Norditropin®)

Targeted Immune Modulators (Enbrel®, Humira®)

Respiratory Agents (ProAir®, QVAR®, Asmanex®, Dulera®, Symbicort®, Combivent®, Spiriva®,

Stiolto®)

Botulinum Toxins (Xeomin®, Dysport®)

The total annualized rebate revenue earned to EBD through this process has experienced a four-fold in

contrast to the process under OptumRx’ control.

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The drug categories listed below represent previously reviewed topics of the DUEC. Currently, drugs

within these categories have specific formulary placement and, in many cases, established prior

authorization/coverage policies in place. EBD currently reimburses for these products consistent with

its coverage policies, but receives no rebate revenue in return.

EBRx is seeking permission from the DUEC to pursue rebate contracts, where possible, within these

categories. Coverage policies as established by the DUEC will not be altered as a result of such

contracting.

Drug Category

Sample Products

Annualized EBD Spend

Multiple Sclerosis Agents

Aubagio®, Gilenya®, Tecfidera®, Betaseron®, Copaxone®/Glatopa®, Rebif®, etc.

$9.3 million

Misc. Antineoplastic Agents (Tyrosine Kinase Inhibitors)

Imbruvica®, Jakafi®, Sprycel®, Sutent®, Tagrisso®, Tarceva®, Tykerb®, Votrient®

$6.3 million

Colony Stimulating Factors, Hematopoietic Agents

Neupogen®, Granix®, Zarzio®, Neulasta®, Epogen®, Procrit®, Aranesp®, Leukine®

$175K (pharmacy only)

Pulmonary Arterial Hypertension Agents

Adcirca®, Adempas®, Letairis®, Opsumit®, Tracleer®, Uptravi®

$2.5 million

Pancreatic Enzymes

Creon®, Pancreaze®, Zenpep®

$770K

5-ASA Agents (Ulcerative Colitis Agents)

Apriso®, Canasa®, Delzicol®, Lialda®, Pentasa®

$890K

Totals

$19.9 million

FDB Update on the Prescription Designation on Dietary Supplements and Medical Foods.

The following therapeutic categories and specific product names have been reviewed by First Databank

and changed from “Rx” to “OTC”. The Plan normally does not cover “OTC” medications, however, since

these have been paid for due to the previous “Rx” designation, a decision will need to be made on how

to handle these products going forward.

The class change from “Rx” to “OTC” came from an internal review by FDB, in which they identified

products classified incorrectly as “Rx”, when in fact they had not been approved through the FDA as

such and should be classified as “OTC”. Please note that any supplements that have gone through the

FDA approval process and already have an NDA or ANDA will remain classified as “Rx”.

Therapeutic Categories Product Names

Multivitamin, Pediatric, Prenatal, and Geriatric Preparations Vitamin B, B12, D Mineral Replacement (Calcium, Zinc, Fluoride, Iron) Antioxidant Multivitamin Combinations Folic Acid Preparations Electrolyte Depleters Herbal Drugs Metabolic Deficiency Agents Dietary Supplement, Misc Protein Replacement Urinary pH Modifiers Bulk Chemicals Protein Replacement

Centratex®, Dailyvite®, Enlyte®, Fabb®, Ferocon®, Ferrex® (150 Forte/Plus, 28), Ferrocite Plus®, Folbee Plus®, Folgard®, Folivane-F®, Folivane Plus®, Folplex 2.2®, Hematinic Plus®, Hemocyte Plus®, Icar-C Plus®, Iferex 150 Forte®, Integra® F/Plus, Multigen® Folic/Plus, Multivitamin w/Fluoride, Nephro-Vite®, Poly-Iron 150 Forte®, Renal Caps®, Rena-Vite Rx®, Se-Tan Plus®, Sodium Fluoride, Tandem Plus®, Triphrocaps®, Virt-Caps®, Virt-Vite/Plus®, Vol-Care Rx®, Vol-Plus®, Irospan®, Vasculera®, Rheumate®

Recommendation: Exclude.

**Note: State of Arkansas, Act 1096: This Act amends Ark. Code Ann. § 23-79-703 to require coverage of

necessary foods for the treatment of certain inherited metabolic disorders. To our knowledge, none of

the recommended excluded medications fall into this category. A prior authorization can be obtained if

one of the medications is deemed medically necessary.

agenda - transform.ar.gov€¦ · exclude brand-name lanoxin. most utilization is with generic...

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