Pharmacy and Therapeutics Committee

New York State Office Of Medicaid Management
Pharmacy and Therapeutics Meeting Summary from Previous Meeting - March 30, 2006

Agenda

The Medicaid Pharmacy & Therapeutics Committee met on Thursday, March 30, 2006 from 8:45 a.m. to 3:00 p.m. in Meeting Room 6, Concourse, Empire State Plaza, Albany, New York.

A. Background Materials Provided:

The Committee was provided copies of written materials submitted by interested parties in advance of the meeting.

B. Public Comment Period:

The following speakers addressed the committee:

  1. Patel, Akshaya, Pharm D, Medical Science Specialist, Schering Plough Inc., Worcester, MA
  2. Leonard, Dana, MS, Regional Scientific Manager-Respiratory, AstraZeneca, Bedford, NH
  3. Tolat, Tejal, Pharm D, Medical Science Liaison, Kos Pharmaceuticals, Inc., Cranbury, NJ
  4. Kaiser, Fran E., MD, Executive Medical Director, Merck & Co., Dallas, TX
  5. Govaker, David, MD, Medical Director, Pfizer Inc., Arlington, VA
  6. Solomon, Henry, MD, FACC, Medical Director, Pfizer Inc., NY, NY
  7. Hunninghake, Donald B, MD, Senior Director, Medical Affairs; Field Medical Cardiovascular, AstraZeneca, Carlsbad, CA
  8. Calder, Robert, MD, Executive Medical Director, Medical & Scientific Affairs, Merck/Schering Plough, Granby, MA
  9. Zarintash, Jennifer, DO, Medical Science Liaison, First Horizon Pharmaceutical Corporation, Alpharetta, GA
  10. Vazquez, Raul, MD, Physician, Urban Family Practice, Buffalo, NY
  11. DoDoo, Benjamin, MD, Clinical Assistant Professor of Medicine, Greenburgh Health Center., White Plains, NY
  12. Shachter, Neil S., MD, Associate Professor of Clinical Medicine, Columbia University, NY, NY
  13. Pollack, Cary, MD, MD & Colonel US Army, Montefiore Medical Group, Bronx, NY
  14. Christiana, Joseph, MD, Cardiologist, Cardiology Consultants of Westchester, PC, Kingston, NY
  15. Busch, Robert, MD, Endocrinologist, The Endocrine Group, Albany, NY
  16. Frankel, Perry, MD, Merck/Schering Plough, New Hyde Park, NY
  17. deLeon, Dennis, President, Latino Health Advocacy Coalition, NY, NY
  18. Zarintash, Jennifer, DO, Medical Science Liaison, First Horizon Pharmaceutical Corporation, Alpharetta, GA
  19. Hafner, Daniel, MD, Physician, Kingston, NY
  20. Copland, Christina, PhD, Reliant Pharmaceuticals, Liberty Corner, NJ

C. Key Issues Raised by Interested Parties and Pharmacy and Therapeutics Committee Response:

Public comments:

On the topic of identification of preferred drugs in the therapeutic class of Intranasal Steroids:

  • Information regarding trial results (safety, efficacy, bioavailability, approved indications, approved dosing, side effects, use in pediatrics and pregnancy) for drugs in this category was presented.
  • The Committee was asked to consider potency, ease of use, patient and prescriber preference and acceptance in the review of this category.

On the topic of identification of preferred drugs in the therapeutic class of HMG-CoA Reductase Inhibitors (Statins):

  • Information regarding trial results (indications, safety, drug interaction profiles, efficacy with regard to effects on cholesterol and triglycerides, risk reduction, potency, dosing and compliance, and use in special populations, especially those with complex drug regimens) and general overviews of specific drugs and combination products in this class was presented.
  • The Committee was asked to consider the importance of treating patients to their goal, treating high cholesterol in the presence of high blood pressure, and the impact of Lipitor becoming non- preferred and the volume of prior authorizations that would result, due to current utilization within the Medicaid program.

On the topic of identification of preferred drugs in the therapeutic class of Triglyceride Lowering Agents:

  • Information regarding trial results (mechanism of action, bioavailability, drug delivery technology, efficacy, safety and drug interactions) for drugs in this category was presented.
  • The Committee was asked to consider new drug delivery technology, dosing with or without regard to meals and FDA approved omega-3 versus over-the-counter dietary supplements.

Pharmacy and Therapeutics Committee Response:

  • Dr. Barnes asked for clarification of Niaspan versus over-the-counter niacin. The presenter indicated that Niaspan is an extended-release tablet with fewer side effects than immediate release niacin.
  • Dr. Barnes questioned what other therapies, including other statins, may be used before going to Crestor and what are the target LDL goals? The presenter discussed the ATP III guidelines on cholesterol management including the 2004 update for LDL-c reductions for high risk and very high risk patients.
  • Dr. Martin (Chairman) questioned how the P&T Committees on which the presenter serves handled the statin issue for their hospitals. The presenter indicated that one hospital chose Lipitor and Zocor, and the other hospital has an open formulary for the statins.

D. Clinical Presentation and Discussion: Proposal to identify preferred drugs in the therapeutic class of Intranasal Steroids

Intranasal Steroids
Drugs Affected:Beconase AQ (beclomethasone dipropionate), Flonase (fluticasone propionate), flunisolide, Nasacort AQ (triamcinolone acetonide), Nasarel (flunisolide), Nasonex (mometasone furoate), Rhinocort Aqua (budesonide)

Jeanne Kennicutt, RPh, MBA, First Health Services Corporation (FHSC); Robert Correia, PharmD, NYS Department of Health, Office of Medicaid Management (DOH/OMM)

Ms. Kennicutt of First Health Services Corporation (FHSC) presented an overview of the class stating there are currently six intranasal steroids available as listed above, and two are available generically (flunisolide and fluticasone). They share common indications for the treatment of seasonal allergic rhinitis and perennial allergic rhinitis. She noted that these agents are generally well tolerated and exert local anti-inflammatory effects with minimal systemic effects. Adverse reactions are usually mild, and limited to the nasal mucosa.

Ms. Kennicutt asked the Committee to note that these products are approved for use in children 6 years of age and above, with the exception of fluticasone (dosing in children to 4 years of age) and mometasone (dosing in children to 2 years of age). She also asked that the Committee note that fluticasone should not be used with ritonavir-based regimens due to reports of adrenal insufficiency. Budesonide is pregnancy category B; the others are pregnancy category C.

Both head to head trials and indirect comparisons have shown these agents to be well tolerated with no significant benefit of one agent over another, although she noted these trials have subjective outcomes. Ms. Kennicutt concluded that a review of the literature failed to demonstrate clinical superiority of one intranasal steroid over another with regard to efficacy and that all are effective when administered once or twice daily in equipotent doses.

Dr. Martin stated that use in the pediatric population and pregnancy category appeared to be the differentiation brought forward in the product comparisons and questioned whether other products in the category were studied to this degree and failed or whether there were just no studies performed. Ms. Kennicutt indicated that no studies had been done; therefore there were no negative results.

Dr. Amodio-Groton commented on the Drug Interactions table in the FHSC Drug Class Review for this class and questioned the significance of the interactions indicated for Rhinocort Aqua. Dr. Coppola of First Health Services Corporation indicated that since there is minimal systemic bioavailability for this product, this generally is not a concern.

Dr. Correia, Office of Medicaid Management, provided the Department's recommendations regarding the clinical review for this category of drugs. He noted that all six intranasal steroids are approved for treatment of seasonal allergic rhinitis and perennial allergic rhinitis in adults and in school age children (over 6 years of age). Agents with specific labeling for finite special populations (children between 2 to 5 years of age or women during pregnancy) may be addressed in prior authorization criteria, if needed.

Dr. Correia noted that these agents demonstrate overall equivalent efficacy and safety at comparable doses for treatment of these chronic conditions, and there is currently no adequate evidence of overall clinical superiority to justify preferential availability of any one product.

E. Clinical Presentation and Discussion: Proposal to identify preferred drugs in the therapeutic class of Calcitonins

Calcitonins
Drugs Affected: Fortical (calcitonin-salmon), Miacalcin (calcitonin-salmon)

Jeanne Kennicutt, RPh, MBA, (FHSC); Robert Correia, PharmD, (DOH/OMM)

Ms. Kennicutt (FHSC) presented an overview of the class stating there are currently two calcitonin-salmon nasal products available as listed above which share the same chemical structure, and differ only in the manufacturing process. There are no head to head trials establishing differences in efficacy between the two products.

Ms. Kennicutt indicated that the primary goal in the prevention and treatment of osteoporosis is the prevention of hip and vertebral fractures. These products share the same indication for the treatment of post-menopausal osteoporosis in women greater than five years post-menopause with low bone mass relative to healthy pre-menopausal women. While calcitonin-salmon is not considered a first line agent, it provides an option for patients unwilling or unable to use other therapies.

Ms. Kennicutt confirmed Dr. Martin's statement that the two products contain the same 32 amino acids and are just manufactured differently.

Dr. Correia (DOH/OMM) indicated that both intranasal calcitonins are approved for treatment of osteoporosis in post-menopausal women, are chemically identical, and differ only in the method by which the chemical is synthesized and inert ingredients present. There is no evidence that these differences impact clinical efficacy. There are currently no head to head trials to establish relative efficacy or safety of these agents, nor is there rationale to conduct such studies. At this time, there is not adequate evidence of overall clinical superiority to justify preferential availability of either product.

At 10:15 AM, a motion was made by William Scheer, RPh, that the Triglyceride Lowering Agent clinical presentation and discussion take place in the morning session, after a 10 minute break. Dr. Johnson seconded the motion.

F. Clinical Presentation and Discussion: Proposal to identify preferred drugs in the therapeutic class of Triglyceride Lowering Agents

Triglyceride Lowering Agents
Drugs Affected: Antara (fenofibrate), fenofibrate, gemfibrozil, Lofibra (fenofibrate), Lopid (gemfibrozil), Omacor (Omega-3 acid ethyl esters), Tricor (fenofibrate), Triglide (fenofibrate)

Jeanne Kennicutt, RPh, MBA, (FHSC); Robert Correia, PharmD, (DOH/OMM)

Ms. Kennicutt (FHSC) presented an overview of the class stating there are currently two fibric acid derivatives (fibrates) and one prescription omega-3-fatty acid product available as listed above. These agents are indicated for the treatment of hypertriglyceridemia. Additionally, gemfibrozil is approved for reducing the risk of coronary heart disease (CHD), and fenofibrate is approved for treatment of hypercholesterolemia.

There are currently no large head-to-head clinical trials comparing gemfibrozil to fenofibrate without concomitant statin therapy. There is clinical trial data to support that fenofibrate and gemfibrozil lower triglycerides and raise HDL cholesterol to a similar degree. Both agents have demonstrated efficacy in lowering LDL cholesterol. Omega-3-fatty acids have demonstrated efficacy in lowering triglycerides and raising HDL cholesterol, however a head-to-head clinical trial shows gemfibrozil to be significantly more effective when compared to Omacor. Ms. Kennicutt recommended to the Committee that the agents within this category be considered therapeutic alternatives.

Dr. Barnes asked Ms. Kennicutt to comment on the drug interaction between the fibrates (gemfibrozil and fenofibrate), and the statins, with regard to the Cytochrome P450 effect. Ms. Kennicutt replied that studies indicate that interactions involving CYP3A4 and 2C9 may be additive with the fibrates and statins, and while studies show more interactions with gemfibrozil, most references do not distinguish the difference of one fibrate over another with regard to this interaction.

Dr. Johnson commented that in practice, clinicians do consider the potential for rhabdomyolysis with statins and Lopid (gemfibrozil), especially in individuals with HIV, as they have seen occurrences of rhabdomyolysis in this population. He also stated that it is possible that these occupancies are not always reported.

Dr. Martin asked if there was any difference in tolerability and efficacy of these agents when taken with or without food. Ms. Kennicutt indicated that there was no information on the effect of food from a clinical perspective.

Dr. Correia (DOH/OMM) provided the recommendations of the DOH, based on a review of current literature and research. He indicated that both fibric acid derivatives have comparable effects in lowering triglycerides and raising HDL and comparable side effect profiles, contraindications, and recommendations for monitoring liver function. Both carry cautions for increased adverse effects if used in combination with statins. It was also noted that only gemfibrozil has evidence of actual clinical outcomes, including cardiovascular and all-cause mortality, and is approved for reducing coronary heart disease risk. In a small head to head trial of HIV infected patients receiving antiretroviral therapy (70 patients), triglyceride reduction curves were nearly identical for gemfibrozil and fenofibrate over 12 months (no significant difference).

Clinical trials indicate Omacor is significantly less effective at lowering triglyceride levels than fibrates and also does not have their capacity to elevate HDL levels. One small head-to-head trial showed gemfibrozil to lower triglycerides 51.2% versus 28.9% for Omacor, and to raise HDL cholesterol 27.9% versus 1.2% for Omacor. Patients receiving omega-3-fatty acid at the prescription dose should be monitored if using anticoagulant therapy, and also for elevated liver enzymes.

Gemfibrozil is given twice a day before meals, fenofibrates once a day, and with food for Lofibra and Antara to maximize bioavailability. Omacor was given once or twice a day during meals in clinical trials.

Dr. Correia stated in conclusion that at this time there is not adequate evidence of overall clinical superiority to justify preferential availability of any one product.

Dr. Martin discussed off-label use of Omacor and the potential advantages of the FDA approved product versus the over-the-counter (OTC) products in terms of safety, potency and purity. Dr. Correia indicated that there are a wide range of OTC products, and some of these are available from reputable sources.

G. Clinical Presentation and Discussion: Proposal to identify preferred drugs in the therapeutic class of HMG-CoA Reductase Inhibitors (Statins)

HMG-CoA Reductase Inhibitors (Statins)
Drugs Affected:Advicor (lovastatin/niacin extended-release), Altoprev (lovastatin extended-release), Caduet (atorvastatin/amlodipine), Crestor (rosuvastatin), Lescol (fluvastatin), Lescol XL (fluvastatin XL), Lipitor (atorvastatin), lovastatin, Mevacor (lovastatin), Pravachol (pravastatin), Pravigard PAC (pravastatin/buffered aspirin), Vytorin (simvastatin/ezetimibe), Zocor (simvastatin)

Susan Carson, MPH, Oregon Health & Sciences University, Evidence-based Practice Center (OHSU EPC); Jeanne Kennicutt, RPh, MBA, (FHSC); Robert Correia, PharmD, (DOH/OMM)

Ms. Carson (OHSU) provided a drug class review on HMG-CoA Reductase Inhibitors (Statins). She noted that the report will be updated again later this year. Combination products containing a statin were not included in the report.

Ms. Carson summarized the evidence of the comparative effectiveness and safety profiles of the statins:

The report addressed the statins' ability to reduce LDL cholesterol (LDL-c), taking into consideration equipotent dosing and the ability to achieve National Cholesterol Education Program (NCEP) goals. Results from a large number of studies showed that when statins are provided in equipotent doses, a similar percent of LDL-c lowering can be achieved. For patients needing the highest percentages of LDL-c lowering, higher doses would likely be needed to reach goal, and higher rates of adverse events would likely occur.

On the comparison of the statins' ability to raise HDL cholesterol (HDL-c), a similar percent increase can generally be expected for statins provided in equipotent doses.

Statins were compared in their ability to reduce all-cause mortality, cardiovascular mortality, coronary heart disease (CHD) events and strokes. The report states that there are no controlled trials comparing equivalent doses of two or more statins to reduce the risk of coronary events, stroke, or death.

The report addressed differences in the effectiveness and safety of statins in different demographic groups. Benefits have been documented in women and the elderly, but almost no data exists for other ethnic groups. No data compares the efficacy or safety of different statins in women, the elderly or African Americans.

Finally, the differences in the safety of the statins in the general population, patients with diabetes, patients with HIV, transplant patients, and patients taking other medications (drug interactions) was addressed.

Dr. Martin asked Ms. Carson if she would comment on the newer Crestor (rosuvastatin) studies. Ms. Carson indicated that she had seen the study from March 2006, but because it was so new, OHSU had not been able to review the study for quality, therefore she could not comment. She also noted that if a study does not include health outcomes data such as mortality and morbidity, it may not be included in subsequent reports.

Ms. Kennicutt (FHSC) presented an overview of the FHSC comparative study of statins as well as the statin combination products. She noted that the components of the combination products are all available individually, may be combined with any of the statins, and offer no clinical superiority when compared to the single agents taken together. All statins share the common indications of treatment of primary hypercholesterolemia and mixed dyslipidemia, are generally well tolerated, and share common adverse effects. Ms. Kennicutt defined potency and indicated that statins may be categorized as low versus high potency. She asked the Committee to note that many of the studies utilize equivalent mg for mg doses, but not equipotent doses. She concluded that all statins can effectively lower LDL-c, TG, total cholesterol, and can modestly increase HDL-c, and given in equipotent doses, they have similar efficacy. It was recommended that they be considered therapeutic alternatives.

Dr. Martin confirmed with Ms. Kennicutt that high potency refers more to the strength of a statin rather than to the statin itself. She confirmed this, and referred him to the Approximate Dosage Equivalents table that was presented to the Committee in writing as part of the FHSC Drug Class Review.

Dr. Correia (DOH/OMM) provided the DOH recommendations for the category, based on a review of current literature and research. He stated that comparisons between statins are greatly impeded by the fact that in the majority of studies, they are not compared in equipotent doses. When prescribed in comparable doses, there is consistent evidence from a large number of trials that statins achieve comparable reductions in LDL-c and increases in HDL-c. Dr. Correia explained how the different statins may need to be dosed to achieve the NCEP goals, and that there is currently a lack of outcomes data with regard to safety and efficacy for long term use at highest doses. In studies long enough to demonstrate emergence of adverse events, there is evidence of increased adverse effects at the dosages needed for more than 50% reduction in LDL-c. If necessary, prior authorization criteria could be implemented to address the needs of the special population where a greater than 50% reduction in LDL-c is appropriate. There are no drugs in this class with unusual or severe problems at equivalent doses indicating access should be restricted or prohibited.

There is no equivalent comparative data between statins in terms of reducing the risk of coronary events, stroke or death. There is individual evidence of reduction for all-cause mortality (atorvastatin, pravastatin, simvastatin), cardiovascular mortality (atorvastatin, pravastatin, simvastatin) as well as reduction of CHD events and strokes (atorvastatin, lovastatin, pravastatin, simvastatin). There is no comparative data from clinical trials on differences in efficacy or safety between statins in relation to demographic groups (age, gender, or race).

Dr. Correia addressed statin combination products indicating that there is no evidence of enhanced efficacy by combining drugs in a single tablet versus taking them together as individual tablets. The drugs currently combined with the statins as combination products (niacin, ezetimibe, aspirin and a calcium channel blocker) are covered by New York Medicaid and can in fact be combined with any of the available statins.

Dr. Correia described three recent developments pertaining to this class, the ASTEROID trial, the STARSHIP trial, and new FDA labeling for Vytorin. The studies were briefly explained to the Committee, but they added no new comprehensive evidence of safety or efficacy for equivalent therapies.

Dr. Correia then stated in conclusion that at this time there is not adequate evidence of overall clinical superiority to justify preferential availability of any one product.

Janice Gay asked if the Committee was to consider the ASTERIOD and the STARSHIP trials and Dr. Correia indicated yes, all evidence presented should be considered and evaluated for quality and relevance.

H. Executive Session:

The Committee recessed the public session at 10:55 A.M. to go into executive session for review of financial information relating to the determination of preferred drugs in the following classes: Intranasal Steroids, Calcitonins and Triglyceride Lowering Agents. No official action was taken in the executive session. The executive session was recessed at 12:15 P.M.

The Committee recessed the public session at 1:05 P.M. to go into executive session for review of financial information relating to the determination of preferred drugs in the following class: HMG-CoA Reductase Inhibitors (Statins). No official action was taken in the executive session. The executive session was recessed at 1:55 P.M.

I. Recommendations of the Pharmacy and Therapeutics Committee:

The following recommendations developed by the P&T Committee are to be submitted to the Commissioner of Health for final determination.

Description of RecommendationsCommissioner's Final Decision
Proposal: Identification of preferred drugs in the category of Intranasal Steroids

A. Based on the submitted or presented clinical information and on the financial information provided during the executive session, the following drugs are recommended to be preferred. The Committee unanimously recommended the following:

Preferred Drugs
Nasacort AQ, Nasonex

Non-preferred Drugs:
Beconase AQ, Flonase, flunisolide, fluticasone, Nasarel, Rhinocort Aqua

B. The Committee unanimously recommended the following clinical questions be used as the basis for approving use of the non-preferred drug:

  • Q: Has your patient experienced treatment failure with a preferred intranasal steroid?

  • Q: Has your patient experienced an adverse drug reaction with a preferred intranasal steroid?

  • Q: Is there a documented history of successful therapeutic control with a non-preferred intranasal steroid and transition to a preferred intranasal steroid is medically contraindicated?

Approved as Recommended
Proposal: Identification of preferred drugs in the category of Calcitonins

A. Based on the submitted or presented clinical information and on the financial information provided during the executive session, the following drugs are recommended to be preferred. The Committee unanimously recommended the following:

Preferred Drug
Miacalcin

Non-preferred Drug
Fortical

B. The Committee unanimously recommended the standard clinical questions be used in the prior authorization review process.

Approved as Recommended
Proposal: Identification of preferred drugs in the category of Triglyceride Lowering Agents

A. Based on the submitted or presented clinical information and on the financial information provided during the executive session, the following drugs are recommended to be preferred. The Committee unanimously recommended the following:

Preferred Drugs
Gemfibrozil, Lofibra

Non-preferred Drugs
Antara, fenofibrate, Lopid, Omacor, Tricor, Triglide

B. The Committee unanimously recommended the standard clinical questions be used in the prior authorization review process.

Approved as Recommended
Proposal: Identification of preferred drugs in the category of HMG-CoA Reductase Inhibitors (Statins)

A. Based on the submitted or presented clinical information and on the financial information provided during the executive session, the following drugs are recommended to be preferred. The Committee unanimously recommended the following:

Preferred Drugs
Advicor, Altoprev, Crestor, Lescol, Lescol XL, Lipitor, Vytorin, Zocor

Non-preferred Drugs
Caduet, lovastatin, Mevacor, Pravachol, Pravigard PAC

B. The Committee unanimously recommended the standard clinical questions be used in the prior authorization review process.

C. In anticipation of the release of generic Zocor (simvastatin); The Committee recommends that generic Zocor (simvastatin) become preferred and brand name Zocor become non-preferred within 30 days of the NYS Department of Health being notified of generic availability by First DataBank.

Approved as Recommended

J. Additional Discussion:

During Welcome and Introductions, Dr. Martin (Chairman) made a statement to the public clarifying the role of the Committee and the information being requested during the public comment period. He indicated that all written information received by the Committee is reviewed by the members prior to the meeting, and encouraged availability of scientific information, particularly head to head trials of drugs. He also indicated that the recommendations made by the Committee are not final, but are reviewed and approved by the Commissioner of Health. Finally, he noted that the determination of preferred and non- preferred drugs does not prohibit a prescriber from obtaining any of the medications covered under Medicaid.

Ms. Desmond (DOH) also reminded the public that the purpose of the public comment is to allow representatives to provide comments regarding topics before the Committee. It was suggested that written comments be provided, and that the public comment period be used as an opportunity to summarize those comments. Ms. Desmond also emphasized that the NYS Medicaid program does not have a formulary. All drugs currently covered by Medicaid remain available under the preferred drug program.

Ms. Desmond reminded the public of the role of the P&T Committee. The Committee makes recommendations to the Commissioner of Health and these recommendations are posted on the DOH website for 30 days, allowing for additional public comment. The Commissioner makes the final determination of preferred and non-preferred drugs, and the final determination is posted on the DOH website as well.

Dr. Martin indicated that the next meeting will take place on May 5, 2006. It is anticipated that in June 2006, implementation of the actions of the Committee through the May 5th meeting will take place, with advanced education and outreach. Ms. Desmond indicated that the May 5, 2006 P&T Committee meeting agenda will be posted soon, and the final determinations from the February 2, 2006 meeting have been posted on the DOH website.

K. Old Business:

Dr. Martin requested the DOH provide a summary of the outcomes of the prior authorization program for Antihistamines at the next meeting.

The meeting adjourned at 2:00 PM.

Meeting summary posted April 7, 2006.

L. Final Determinations:
The Commissioner has determined that Medicaid will require prior authorization under the Preferred Drug Program (PDP) for non-preferred drugs, as listed above, in the following classes:
Intranasal Steroids, Calcitonins, Triglyceride Lowering Agents and HMG-CoA Reductase Inhibitors (Statins). Preferred drugs will not require prior authorization.

The impacts of this final determination are as follows:

1. State Public Health Population:

  • Minimal effects as a large majority of Medicaid patients currently utilize those drugs which have been determined to be preferred.
  • Use of prior authorization for non-preferred products encourages use of more cost effective drugs within the same therapeutic class when appropriate.

2. Program Providers:

  • Limited additional time and effort will be required by prescribers to complete the prior authorization process for non-preferred drugs.

3. Fiscal Impact to State Health Program:

  • Through the changes in utilization to more cost effective drugs, and the receipt of supplemental rebates from pharmaceutical manufacturers, annual savings for the Preferred Drug Program are estimated at $38.7M, adjusting for the implementation of Medicare Part D.

Posted May 12, 2006