National Alliance on Mental Illness Testimony Antidepressants, Other - Pristiq Aniello Marotta, PharmD MBA Pfizer

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1 The meeting started at 6:00pm Attendance Connecticut Medicaid P&T Meeting Minutes October 23, 2013 Present Members: Carl Sherter, MD Charles Thompson, MD Emmett Sullivan, RPh Cynthia Conrad, MD Manage Nissanka, MD Kevin Chamberlin, PharmD Karen McMillan, RN Jeffrey Kamradt, MD Absent Members: Mark Defrancesco, MD Angelo DeFazio, RPh Elizabeth Rodriguez, RN Andrew Lustbader, MD Hilda Slivka, MD Stella Cretella DSS: Jason Gott, RPh James Zakszewski, RPh HP/Magellan: Deborah Gallagher Jason Young, PharmD Margaret Stroczkowski Melissa Chandler Heather Kissinger, PharmD (HID) Kathy Novak, RPh (Magellan) Opening remarks: Dr. Carl Sherter thanked the attendees for coming and called meeting to order at 6:00 pm. The minutes from the previous meeting, held May 8, 2013, were unanimously approved by the committee members present. Public Presentations: CT Psychiatric Society Testimony National Alliance on Mental Illness Testimony Antidepressants, Other Paul Desan, MD, PhD Daniela Giordano, MSW - Pristiq Aniello Marotta, PharmD MBA Pfizer

2 - Viibryd Bassam Awwa, M.D. Anticonvulsants - Vimpat Amy Dalsania, PharmD UCB COPD Agents - Tudorza and Daliresp Morris Papernik, MD FACP Cytokine and CAM Antagonists - Xeljanz Aniello Marotta, PharmD MBA Pfizer - Cimzia Amy Dalsania, PharmD UCB Intranasal Rhinitis Agents - QNASL Kristen Kau, MBA, PhD Teva Oncology Agents, Oral - Sutent, Bosulif, Inlyta, Xalkori Aniello Marotta, PharmD MBA Pfizer The rest of the scheduled speakers waived their right to speak because their product was recommended as preferred on the PDL. Therapeutic Class Reviews: Note: Brand name drugs listed in bold font. Antidepressants, Other Dr. Paul Desan and Daniela Giordano provided public testimony, on behalf of CT Psychiatric Society and NAMI respectively, for open access to mental health drugs. Aniello Marotta testified to the committee for the inclusion of Pristiq, and Dr. Bassam Awwa spoke on behalf of Viibryd. Cynthia Conrad motioned to accept the recommendations of Magellan, along with the addition of Pristiq and Viibryd, as preferred. Charles Thompson seconded this motion, and it passed unanimously. ON Medicaid PDL: BUPROPION (ORAL), BUPROPION SR (ORAL), BUPROPION XL (ORAL), MARPLAN (ORAL), MIRTAZAPINE ODT (ORAL), MIRTAZAPINE TABLET (ORAL), PARNATE (ORAL), PHENELZINE (ORAL), PRISTIQ (ORAL), TRAZODONE (ORAL), VENLAFAXINE ER CAPSULES (ORAL), VIIBRYD (ORAL), VIIBRYD DOSE PACK (ORAL) OFF Medicaid PDL: APLENZIN (ORAL), DESVENLAFAXINE ER (ORAL), EFFEXOR XR (ORAL), EMSAM (TRANSDERMAL), FORFIVO XL (ORAL), NARDIL (ORAL),

3 NEFAZODONE (ORAL), OLEPTRO ER (ORAL), REMERON ODT (ORAL), REMERON TABLET (ORAL), TRANYLCYPROMINE SULFATE (ORAL), VENLAFAXINE (ORAL), VENLAFAXINE ER TABLETS (GENERIC) (ORAL), VENLAFAXINE ER TABLETS (SCHWARZ) (ORAL), VENLAFAXINE ER TABLETS (UPSTATE) (ORAL), WELLBUTRIN (ORAL), WELLBUTRIN SR (ORAL), WELLBUTRIN XL (ORAL) Antipsychotics Carl Sherter reminded the committee of their decision last year to have open access for this class of medications. Cynthia Conrad motioned to make all drugs in this class preferred, and her motion was seconded and passed unanimously by the committee. ON Medicaid PDL: ABILIFY (INTRAMUSC), ABILIFY DISCMELT (ORAL), ABILIFY MAINTENA (INTRAMUSC.), ABILIFY SOLUTION (ORAL), ABILIFY TABLET (ORAL), AMITRIPTYLINE / PERPHENAZINE (ORAL), CHLORPROMAZINE (ORAL), CLOZAPINE (ORAL), CLOZAPINE ODT (ORAL), CLOZARIL (ORAL), FANAPT TABLET (ORAL), FANAPT TITRATION PACK (ORAL), FAZACLO (ORAL), FLUPHENAZINE DECANOATE (INJECTION), FLUPHENAZINE ELIXIR/SOLN (ORAL), FLUPHENAZINE TABLET (ORAL), GEODON (INTRAMUSC), GEODON (ORAL), HALDOL (INJECTION), HALDOL DECANOATE (INTRAMUSC), HALOPERIDOL (ORAL), HALOPERIDOL DECANOATE (INJECTION), HALOPERIDOL LACTATE (INJECTION), HALOPERIDOL LACTATE CONC (ORAL), INVEGA (ORAL), INVEGA SUSTENNA (INTRAMUSC), LATUDA (ORAL), LOXAPINE (ORAL), OLANZAPINE (INTRAMUSC), OLANZAPINE ODT (ORAL), OLANZAPINE TABLET (ORAL), OLANZAPINE/FLUOXETINE (ORAL), ORAP (ORAL), PERPHENAZINE (ORAL), QUETIAPINE TABLETS (ORAL), RISPERDAL CONSTA (INTRAMUSC.), RISPERDAL ODT (ORAL), RISPERDAL SOLUTION (ORAL), RISPERDAL TABLET (ORAL), RISPERIDONE ODT (ORAL), RISPERIDONE SOLUTION (ORAL), RISPERIDONE TABLET (ORAL), SAPHRIS (SUBLINGUAL), SEROQUEL (ORAL), SEROQUEL XR (ORAL), SYMBYAX (ORAL), THIORIDAZINE (ORAL), THIOTHIXENE (ORAL), TRIFLUOPERAZINE (ORAL), ZIPRASIDONE CAPSULE (ORAL), ZYPREXA (INTRAMUSC), ZYPREXA (ORAL), ZYPREXA RELPREVV (INTRAMUSC), ZYPREXA ZYDIS (ORAL) OFF Medicaid PDL: NONE Anticonvulsants Amy Dalsania provided public testimony for the inclusion of Vimpat on the PDL. Emmett Sullivan motioned to accept the recommendations as presented by Magellan. Cynthia Conrad seconded, and the committee passed the motion unanimously.

4 ON Medicaid PDL: CARBAMAZEPINE CHEWABLE TABLET (ORAL), CARBAMAZEPINE ER (GENERIC CARBATROL) (ORAL), CARBAMAZEPINE SUSPENSION (ORAL), CARBAMAZEPINE TABLET (ORAL), CARBAMAZEPINE XR (ORAL), CARBATROL (ORAL), CELONTIN (ORAL), CLONAZEPAM (ORAL), DIASTAT (RECTAL), DIASTAT ACUDIAL (RECTAL), DILANTIN INFATAB (ORAL), DIVALPROEX ER (ORAL), DIVALPROEX SPRINKLE (ORAL), DIVALPROEX TABLET (ORAL), ETHOSUXIMIDE SYRUP (ORAL), FELBAMATE SUSPENSION (ORAL), GABITRIL (ORAL), LAMOTRIGINE TABLET (ORAL), LAMOTRIGINE TABLET DOSE PACK (ORAL), LEVETIRACETAM SOLUTION (ORAL), LEVETIRACETAM TABLETS (ORAL), OXCARBAZEPINE SUSPENSION (ORAL), OXCARBAZEPINE TABLETS (ORAL), PEGANONE (ORAL), PHENOBARBITAL ELIXIR (ORAL), PHENOBARBITAL TABLET (ORAL), PHENYTOIN CAPSULE (ORAL), PHENYTOIN EXT CAPSULE (GENERIC PHENYTEK) (ORAL), PHENYTOIN SUSPENSION (ORAL), PRIMIDONE (ORAL), TOPIRAMATE SPRINKLE (ORAL), TOPIRAMATE TABLETS (ORAL), VALPROATE SYRUP (ORAL), VALPROIC ACID (ORAL), VIMPAT SOLUTION (ORAL), VIMPAT TABLET (ORAL), ZONISAMIDE (ORAL) OFF Medicaid PDL: BANZEL SUSPENSION (ORAL), BANZEL TABLET (ORAL), CLONAZEPAM ODT (ORAL), DEPAKENE CAPSULE (ORAL), DEPAKENE SYRUP (ORAL), DEPAKOTE (ORAL), DEPAKOTE ER (ORAL), DEPAKOTE SPRINKLE (ORAL), DIAZEPAM (RECTAL), DIAZEPAM DEVICE (RECTAL), DILANTIN (ORAL), DILANTIN 30 MG CAPSULE (ORAL), DILANTIN SUSPENSION (ORAL), EQUETRO (ORAL) ETHOSUXIMIDE CAPSULE (ORAL), FELBAMATE TABLET (ORAL), FELBATOL SUSPENSION (ORAL), FELBATOL TABLET (ORAL), KEPPRA SOLUTION (ORAL), KEPPRA TABLETS (ORAL), KEPPRA XR (ORAL), KLONOPIN TABLET (ORAL), LAMICTAL ODT (ORAL), LAMICTAL ODT DOSE PACK (ORAL), LAMICTAL TABLET (ORAL), LAMICTAL TABLET DOSE PACK (ORAL), LAMICTAL XR (ORAL), LAMICTAL XR DOSE PACK (ORAL), LAMOTRIGINE XR (ORAL), LEVETIRACETAM ER (ORAL), MYSOLINE (ORAL), ONFI SUSPENSION (ORAL), ONFI TABLET (ORAL), OXTELLAR XR (ORAL), PHENYTEK (ORAL), PHENYTOIN CHEWABLE TABLET (ORAL), POTIGA (ORAL), SABRIL POWDER PACK (ORAL), SABRIL TABLET (ORAL), STAVZOR (ORAL), TEGRETOL SUSPENSION (ORAL), TEGRETOL TABLET (ORAL), TEGRETOL XR (ORAL), TIAGABINE (ORAL), TOPAMAX SPRINKLE (ORAL), TOPAMAX TABLETS (ORAL), TRILEPTAL SUSPENSION (ORAL), TRILEPTAL TABLETS (ORAL), TROKENDI XR (ORAL), ZARONTIN CAPSULE (ORAL), ZARONTIN SYRUP (ORAL), ZONEGRAN (ORAL) Botulinum Toxins Kevin Chamberlin motioned to accept the recommendations as presented for this class, and his motion was seconded by Charles Thompson. The motion passed unanimously. ON Medicaid PDL: BOTOX (INTRAMUSC)

5 OFF Medicaid PDL: BOTOX COSMETIC (INTRAMUSC), DYSPORT (INTRAMUSC), MYOBLOC (INTRAMUSC), XEOMIN (INTRAMUSC) COPD Agents Morris Papernik provided testimony for the inclusion of Tudorza and Daliresp on the PDL. Carl Sherter noted the benefits of Daliresp. Carl Sherter motioned to accept the recommendations as presented, along with the addition of Daliresp to the PDL. His motion was seconded and passed unanimously by the committee. ON Medicaid PDL: ATROVENT HFA (INHALATION), COMBIVENT RESPIMAT (INHALATION), DALIRESP (ORAL), DUONEB (INHALATION), IPRATROPIUM / ALBUTEROL (INHALATION), IPRATROPIUM NEBULIZER (INHALATION), SPIRIVA (INHALATION) OFF Medicaid PDL: COMBIVENT (INHALATION), TUDORZA PRESSAIR (INHALATION) Cytokine and CAM Antagonists Aniello Marotta provided public testimony in support of Xeljanz, and Amy Dalsania spoke in support of Cimzia. Kevin Chamberlin motioned to accept the recommendations as presented by Magellan. His motion was seconded by Emmett Sullivan and the motion passed unanimously. ON Medicaid PDL: ENBREL KIT (INJECTION), ENBREL PEN (INJECTION), ENBREL SYRINGE (INJECTION), HUMIRA KIT (INJECTION), HUMIRA PEN KIT (INJECTION) OFF Medicaid PDL: ACTEMRA (INJECTION), CIMZIA KIT (INJECTION), CIMZIA SYRINGE KIT (INJECTION), KINERET (INJECTION), ORENCIA SYRINGE (SUBCUT.), ORENCIA VIAL (INJECTION), REMICADE (INJECTION), SIMPONI ARIA VIAL (INTRAVEN.), SIMPONI PEN INJECTER (INJECTION), SIMPONI SYRINGE (INJECTION), STELARA SYRINGE (INJECTION), XELJANZ (ORAL) Epinephrine, Self-Injected Kathy Novak introduced Auvi-Q as a new medication to this class. Charles Thompson questioned how including Auvi-Q on the PDL would affect cost savings, and Kathy noted there would be a negative savings in the scenario. Cynthia Conrad motioned to accept the recommendations as presented, and her motion was seconded and passed unanimously by the committee.

6 ON Medicaid PDL: EPIPEN (INTRAMUSC), EPIPEN JR (INTRAMUSC) OFF Medicaid PDL: AUVI-Q (INTRAMUSC), EPINEPHRINE (INJECTION) Glucocorticoids, Inhaled Kevin Chamberlin motioned to accept the recommendations as presented for this class. His motion was seconded by Manage Nissanka and passed unanimously by the committee. ON Medicaid PDL: ADVAIR DISKUS (INHALATION), ADVAIR HFA (INHALATION), ASMANEX (INHALATION), DULERA (INHALATION), FLOVENT DISKUS (INHALATION), FLOVENT HFA (INHALATION), PULMICORT 0.25, 0.5 MG RESPULES (INHALATION), PULMICORT FLEXHALER (INHALATION), QVAR (INHALATION), SYMBICORT (INHALATION) OFF Medicaid PDL: ALVESCO (INHALATION), BUDESONIDE 0.25, 0.5 MG RESPULES (INHALATION), PULMICORT 1 MG RESPULES (INHALATION) Intranasal Rhinitis Agents Kristen Kau provided public testimony for the inclusion of QNASL on the PDL. Kevin Chamberlin motioned to accept the recommendations as presented, and was seconded by Charles Thompson. The motion passed unanimously. ON Medicaid PDL: ASTELIN (NASAL), ASTEPRO (NASAL), FLUNISOLIDE (NASAL), FLUTICASONE (NASAL), IPRATROPIUM (NASAL), NASONEX (NASAL), PATANASE (NASAL) OFF Medicaid PDL: ATROVENT (NASAL), AZELASTINE (NASAL), BECONASE AQ (NASAL), DYMISTA (NASAL), FLONASE (NASAL), NASACORT AQ (NASAL), OMNARIS (NASAL), QNASL (NASAL), RHINOCORT AQUA (NASAL), TRIAMCINOLONE (NASAL), VERAMYST (NASAL), ZETONNA (NASAL) Neuropathic Pain Agents Cynthia Conrad motioned to accept the recommendations as presented for this class. Emmett Sullivan seconded her motion, and it was passed unanimously by the committee. ON Medicaid PDL: CYMBALTA (ORAL), GABAPENTIN CAPSULE (ORAL), LIDODERM (TOPICAL), LYRICA CAPSULE (ORAL)

7 OFF Medicaid PDL: GABAPENTIN SOLUTION (ORAL), GABAPENTIN TABLET (ORAL), GRALISE (ORAL), HORIZANT (ORAL), LYRICA SOLUTION (ORAL), NEURONTIN CAPSULE (ORAL), NEURONTIN SOLUTION (ORAL), NEURONTIN TABLET (ORAL), QUTENZA KIT (TOPICAL), SAVELLA (ORAL), SAVELLA DOSE PACK (ORAL) NSAIDs Kevin Chamberlin motioned to accept the recommendations as presented for this class. Manage Nissanka seconded the motion, and the committee passed it unanimously. ON Medicaid PDL: ETODOLAC TAB SR (ORAL), FLECTOR (TOPICAL), FLURBIPROFEN (ORAL), IBUPROFEN SUSPENSION (ORAL), IBUPROFEN TABLET (ORAL), INDOCIN SUSPENSION (ORAL), INDOMETHACIN (ORAL/RECTAL), INDOMETHACIN CAPSULE (ORAL), KETOPROFEN (ORAL), KETOROLAC (ORAL), MELOXICAM SUSPENSION (ORAL), MELOXICAM TABLET (ORAL), MOBIC SUSPENSION (ORAL), NABUMETONE (ORAL), NAPROXEN SODIUM (ORAL), NAPROXEN SUSPENSION (ORAL), NAPROXEN TABLET (ORAL), PIROXICAM (ORAL), SULINDAC (ORAL), VOLTAREN (TOPICAL) OFF Medicaid PDL: ADVIL MIGRAINE CAPSULE OTC (ORAL), ADVIL OTC (ORAL), ADVIL TAB CHEW OTC (ORAL), ALEVE CAPSULE OTC (ORAL), ALEVE TABLET OTC (ORAL), ANAPROX (ORAL), ARTHROTEC (ORAL), CATAFLAM TABLET (ORAL), CELEBREX (ORAL), CHILDREN'S MOTRIN ORAL SUSP OTC (ORAL), DAYPRO (ORAL), DICLOFENAC POTASSIUM (ORAL), DICLOFENAC SODIUM (ORAL), DICLOFENAC SODIUM/MISOPROSTOL (ORAL), DICLOFENAC SR (ORAL), DIFLUNISAL (ORAL), DUEXIS (ORAL), ETODOLAC (ORAL), FENOPROFEN (ORAL), IBUPROFEN CAPSULE OTC (ORAL), IBUPROFEN DROPS SUSPENSION OTC (ORAL), IBUPROFEN SUSPENSION OTC (ORAL), IBUPROFEN TAB CHEW OTC (ORAL), IBUPROFEN TABLET OTC (ORAL), INDOCIN (RECTAL), INDOMETHACIN CAPSULE ER (ORAL), INFANT'S MOTRIN DROPS SUSP OTC (ORAL), KETOPROFEN ER (ORAL), MECLOFENAMATE (ORAL), MEFENAMIC ACID (ORAL), MIDOL TABLET OTC (ORAL), MOBIC TABLET (ORAL), MOTRIN TABLET OTC (ORAL), NALFON (ORAL), NAPRELAN (ORAL), NAPROSYN EC (ORAL), NAPROSYN SUSPENSION (ORAL), NAPROSYN TABLET (ORAL), NAPROXEN EC (ORAL), NAPROXEN SODIUM OTC (ORAL), OXAPROZIN (ORAL), PENNSAID (TOPICAL), PONSTEL (ORAL), SPRIX (NASAL), TOLMETIN SODIUM CAPSULE (ORAL), TOLMETIN SODIUM TABLET (ORAL), VIMOVO (ORAL), ZIPSOR (ORAL) Oncology Agents, Oral Aniello Marotta provided testimony for open access to all drugs in this therapeutic category. The committee agreed that none of the chemical entities in this class should be subject to prior authorization. Kathy Novak noted the higher cost for generic of Temodar, and suggested that the

8 committee allow all chemical entities to be preferred, and allow the state to determine if brand or generic is preferred based on cost. At this time, the brand Temodar will be preferred and the generic non-preferred. Cynthia motioned to make all entities preferred, with the lower cost of either brand or generic for each entity being preferred. Kevin Chamberlin seconded and the committee passed the motion unanimously. ON Medicaid PDL: AFINITOR (ORAL), AFINITOR DISPERZ (ORAL), ALKERAN (ORAL), BOSULIF (ORAL), CAPRELSA (ORAL), COMETRIQ (ORAL), ERIVEDGE (ORAL), FLUTAMIDE (ORAL), GILOTRIF (ORAL), GLEEVEC (ORAL), HYDREA (ORAL), HYDROXYUREA (ORAL), ICLUSIG (ORAL), INLYTA (ORAL), JAKAFI (ORAL), MEKINIST (ORAL), MERCAPTOPURINE (ORAL), NEXAVAR (ORAL), SPRYCEL (ORAL), STIVARGA (ORAL), SUTENT (ORAL), TAFINLAR (ORAL), TARCEVA (ORAL), TASIGNA (ORAL), TEMODAR (ORAL), TYKERB (ORAL), VOTRIENT (ORAL), XALKORI (ORAL), XELODA (ORAL), XTANDI (ORAL), ZELBORAF (ORAL), ZOLINZA (ORAL), ZYTIGA (ORAL) OFF Medicaid PDL: TEMOZOLOMIDE (AG) (ORAL), TEMOZOLOMIDE (ORAL) Smoking Cessation Kevin Chamberlin motioned to accept the recommendations as presented for this class. Charles Thompson seconded the motion, and it was passed unanimously. ON Medicaid PDL: BUPROPION SR (ORAL), CHANTIX (ORAL), CHANTIX DOSE PACK (ORAL), NICOTINE GUM OTC (BUCCAL), NICOTINE LOZENGE OTC (BUCCAL), NICOTINE PATCH OTC (TRANSDERMAL) OFF Medicaid PDL: NICODERM CQ (TRANSDERMAL), NICORETTE GUM OTC (BUCCAL), NICORETTE LOZENGE OTC (BUCCAL), NICOTROL (INHALATION), NICOTROL NS (NASAL), ZYBAN (ORAL) Stimulants and Related Agents Charles Thompson acknowledged the need for a liquid dosage form in this class for pediatric populations. He motioned to accept the recommendations as presented, along with the addition of Methylin solution to the PDL. His motion was seconded by Cynthia Conrad and passed unanimously. ON Medicaid PDL: ADDERALL XR (ORAL), AMPHETAMINE SALT COMBO (ORAL), DAYTRANA (TRANSDERMAL), DEXMETHYLPHENIDATE (ORAL), DEXTROAMPHETAMINE TABLET (ORAL), FOCALIN (ORAL), FOCALIN XR (ORAL), INTUNIV (ORAL), METADATE CD (ORAL), METHYLIN SOLUTION (ORAL), METHYLPHENIDATE (ORAL), METHYLPHENIDATE ER (CONCERTA) (ORAL),

9 METHYLPHENIDATE ER (ORAL), MODAFINIL (ORAL), PROCENTRA (ORAL), QUILLIVANT XR (ORAL), STRATTERA (ORAL), VYVANSE (ORAL) OFF Medicaid PDL: ADDERALL (ORAL), AMPHETAMINE SALT COMBO ER (ORAL), AMPHETAMINE SALT COMBO ER (TEVA, GLOBAL) (ORAL), CONCERTA (ORAL), DESOXYN (ORAL), DEXEDRINE SPANSULE (ORAL), DEXTROAMPHETAMINE CAPSULE ER (ORAL), DEXTROAMPHETAMINE SOLUTION (ORAL), KAPVAY (ORAL), KAPVAY DOSE PACK (ORAL), METHAMPHETAMINE (ORAL), METHYLIN CHEWABLE TABLETS (ORAL), METHYLPHENIDATE CD (AG) (ORAL), METHYLPHENIDATE CD (ORAL), METHYLPHENIDATE ER (GEN RITALIN LA) (ORAL), METHYLPHENIDATE SOLUTION (ORAL), NUVIGIL (ORAL), PROVIGIL (ORAL), RITALIN (ORAL), RITALIN LA (ORAL), RITALIN LA 10 MG CAPSULE (ORAL), RITALIN SR (ORAL), ZENZEDI (ORAL) Alzheimer s Agents Kathy Novak introduced Namenda XR as a new drug to the class, and that Exelon is available in a new strength. Kevin Chamberlin motioned to accept the recommendations as presented by Magellan, and Emmett Sullivan seconded. The motion was passed unanimously. ON Medicaid PDL: DONEPEZIL ODT (ORAL), DONEPEZIL TABLET (ORAL), EXELON (TRANSDERM.), EXELON CAPSULES (ORAL), NAMENDA SOLUTION (ORAL), NAMENDA TABLET (ORAL), NAMENDA TABLET DOSE PACK (ORAL) OFF Medicaid PDL: ARICEPT (ORAL), ARICEPT 23 MG (ORAL), ARICEPT ODT (ORAL), DONEPEZIL 23 MG (ORAL), EXELON SOLUTION (ORAL), GALANTAMINE ER (ORAL), GALANTAMINE SOLUTION (ORAL), GALANTAMINE TABLET (ORAL), NAMENDA XR (ORAL), RIVASTIGMINE CAPSULES (ORAL) Antidepressants, SSRIs Emmett Sullivan motioned to accept the recommendations as presented for this class. Cynthia Conrad seconded the motion and it was passed unanimously by the committee. ON Medicaid PDL: CITALOPRAM SOLUTION (ORAL), CITALOPRAM TABLET (ORAL), ESCITALOPRAM TABLET (ORAL), FLUOXETINE CAPSULE (ORAL), FLUOXETINE SOLUTION (ORAL), FLUOXETINE TABLET (ORAL), FLUVOXAMINE (ORAL), LEXAPRO SOLUTION (ORAL), PAROXETINE TABLET (ORAL), SERTRALINE CONC (ORAL), SERTRALINE TABLET (ORAL) OFF Medicaid PDL: BRISDELLE (ORAL), CELEXA TABLET (ORAL), ESCITALOPRAM SOLUTION (ORAL), FLUOXETINE 60 MG (ORAL), FLUOXETINE

10 CAPSULE DR (ORAL), FLUVOXAMINE ER (ORAL), LEXAPRO TABLET (ORAL), LUVOX CR (ORAL), PAROXETINE CR (ORAL), PAXIL (ORAL), PAXIL CR (ORAL), PAXIL SUSPENSION (ORAL), PEXEVA (ORAL), PROZAC CAPSULE (ORAL), PROZAC WEEKLY (ORAL), SARAFEM (ORAL), ZOLOFT CONC (ORAL), ZOLOFT TABLET (ORAL) Antihistamines, minimally sedating Emmett Sullivan motioned to accept the recommendations as presented for this class. His motion was seconded by Manage Nissanka, and was passed unanimously by the committee. ON Medicaid PDL: CETIRIZINE SOLUTION (ORAL), CETIRIZINE SOLUTION 5MG/5ML OTC, CETIRIZINE SOLUTION OTC (ORAL), CETIRIZINE-D OTC (ORAL), FEXOFENADINE 60, 180 MG OTC (ORAL), FEXOFENADINE D 12-HOUR OTC (ORAL), FEXOFENADINE D 24-HOUR OTC (ORAL),, LORATADINE ODT OTC (ORAL), LORATADINE SOLUTION OTC (ORAL), LORATADINE TABLETS OTC (ORAL), LORATADINE-D OTC (ORAL) OFF Medicaid PDL: ALLEGRA ALLERGY OTC (ORAL), ALLEGRA ALLERGY SUSPENSION OTC (ORAL), ALLEGRA ODT (ORAL), ALLEGRA-D 12 HOUR OTC (ORAL), ALLEGRA-D 24 HOUR OTC (ORAL), ALLEGRA-D 24-HOUR (ORAL), CETIRIZINE CAPSULE OTC (ORAL), CETIRIZINE CHEWABLE OTC (ORAL), CETIRIZINE TABLETS OTC (ORAL), CLARINEX SYRUP (ORAL), CLARINEX TABLET (ORAL), CLARINEX-D 12 HOUR (ORAL), CLARINEX-D 24 HOUR (ORAL), CLARITIN CAPSULE OTC (ORAL), CLARITIN CHEW OTC (ORAL), CLARITIN ODT OTC (ORAL), CLARITIN SOLUTION OTC (ORAL), CLARITIN TABLET OTC (ORAL), CLARITIN-D 12 HOUR OTC (ORAL), CLARITIN-D 24 HOUR OTC (ORAL), DESLORATADINE (ORAL), DESLORATADINE ODT (ORAL), FEXOFENADINE 30 MG (ORAL), FEXOFENADINE 30 MG OTC (ORAL), FEXOFENADINE 60, 180 MG (ORAL), FEXOFENADINE ODT OTC (ORAL), FEXOFENADINE-D 24-HOUR (ORAL), LEVOCETIRIZINE SOLUTION (ORAL), LEVOCETIRIZINE TABLETS (ORAL), SEMPREX-D (ORAL), XYZAL SOLUTION (ORAL), XYZAL TABLET (ORAL), ZYRTEC (ORAL), ZYRTEC CHEWABLET TABLET OTC (ORAL), ZYRTEC OTC (ORAL), ZYRTEC SOLUTION OTC (ORAL), ZYRTEC-D OTC (ORAL) Antihypertensives, sympatholytic Emmett Sullivan motioned to accept the recommendations as presented for this class. His motion was seconded by Manage Nissanka and passed unanimously by the committee. ON Medicaid PDL: CATAPRES-TTS (TRANSDERM), CLONIDINE (ORAL), GUANFACINE (ORAL), METHYLDOPA (ORAL), METHYLDOPA/ HYDROCHLOROTHIAZIDE (ORAL)

11 OFF Medicaid PDL: CATAPRES (ORAL), CLONIDINE (TRANSDERM), CLORPRES (ORAL), METHYLDOPATE HCL (INTRAVEN), RESERPINE (ORAL), TENEX (ORAL) Antihyperuricemics, Oral Kevin Chamberlin motioned to accept the recommendations as presented for this class. Emmett Sullivan seconded the motion and the committee passed it unanimously. ON Medicaid PDL: ALLOPURINOL (ORAL), PROBENECID (ORAL), PROBENECID / COLCHICINE (ORAL) OFF Medicaid PDL: (ORAL) COLCRYS (ORAL), KRYSTEXXA (INTRAVEN), ULORIC Antiparkinson s Agents Cynthia Conrad motioned to accept this class as recommended by Magellan. Her motion was seconded by Kevin Chamberlin and passed unanimously by the committee. ON Medicaid PDL: BENZTROPINE (ORAL), BROMOCRIPTINE (ORAL), CARBIDOPA / LEVODOPA (ORAL), CARBIDOPA / LEVODOPA ER (ORAL), CARBIDOPA / LEVODOPA ODT (ORAL), CARBIDOPA/LEVODOPA/ENTACAPONE (ORAL), PRAMIPEXOLE (ORAL), ROPINIROLE (ORAL), SELEGILINE CAPSULE (ORAL), SELEGILINE TABLET (ORAL), TRIHEXYPHENIDYL ELIXIR (ORAL), TRIHEXYPHENIDYL TABLET (ORAL) OFF Medicaid PDL: AZILECT (ORAL), COMTAN (ORAL), ENTACAPONE (ORAL), LODOSYN (ORAL), MIRAPEX (ORAL), MIRAPEX ER (ORAL), NEUPRO (TRANSDERM), PARCOPA (ORAL), PARLODEL CAPSULE (ORAL), REQUIP (ORAL), REQUIP XL (ORAL), ROPINIROLE ER (ORAL), SINEMET (ORAL), SINEMET CR (ORAL), STALEVO (ORAL), TASMAR (ORAL), ZELAPAR (ORAL) Antipsoriatics, Oral Kathy Novak introduced this as a new category for the Connecticut PDL. Kathy explained that cost savings derive from using the lower cost brand medications in this class. Cynthia Conrad motioned to accept the recommendations as presented, and Kevin Chamberlin seconded the motion. The committee unanimously approved the motion. ON Medicaid PDL: OXSORALEN-ULTRA (ORAL), SORIATANE (ORAL) OFF Medicaid PDL: 8-MOP (ORAL), ACITRETIN (AG) (ORAL), ACITRETIN (ORAL)

12 Antipsoriatics, Topical Kevin Chamberlin motioned to accept the recommendations as presented for this class. The motion was seconded by Charles Thompson and passed unanimously by the committee. ON Medicaid PDL: CALCIPOTRIENE CREAM (TOPICAL), CALCIPOTRIENE OINTMENT (TOPICAL), CALCIPOTRIENE SOLUTION (TOPICAL), CALCITRIOL OINTMENT (TOPICAL), DOVONEX CREAM (TOPICAL) OFF Medicaid PDL: CALCITRENE (TOPICAL), SORILUX (TOPICAL), TACLONEX OINTMENT (TOPICAL), TACLONEX SCALP (TOPICAL), VECTICAL (TOPICAL) Anxiolytics Kathy Novak introduced this as a new class for the Connecticut PDL. She informed the committee that all chemical entities were represented in their recommendations. Emmett Sullivan suggested the addition of the lorazepam intensol dosage form for hospice settings. He motioned to accept the recommendations as presented, along with the addition of lorazepam intensol. The motion was seconded by Cynthia Conrad and passed unanimously by the committee. ON Medicaid PDL: ALPRAZOLAM TABLET (ORAL), BUSPIRONE (ORAL), CHLORDIAZEPOXIDE (ORAL), CLORAZEPATE (ORAL), DIAZEPAM SOLUTION (ORAL), DIAZEPAM TABLET (ORAL), LORAZEPAM INTENSOL (ORAL), LORAZEPAM TABLET (ORAL) OFF Medicaid PDL: ALPRAZOLAM ER (ORAL), ALPRAZOLAM INTENSOL (ORAL), ALPRAZOLAM ODT (ORAL), ATIVAN TABLET (ORAL), DIAZEPAM INTENSOL (ORAL), DIAZEPAM SYRINGE (INJECTION), DIAZEPAM VIAL (INJECTION), MEPROBAMATE (ORAL), NIRAVAM (ORAL), OXAZEPAM (ORAL), TRANXENE T- TAB (ORAL), VALIUM TABLET (ORAL), XANAX TABLET (ORAL), XANAX XR (ORAL) Bile Salts Kevin Chamberlin motioned to accept the recommendations as presented for this class. The motion was seconded by Jeffrey Kamradt and passed unanimously by the committee. ON Medicaid PDL: URSODIOL 300 MG CAPSULE (ORAL) OFF Medicaid PDL: ACTIGALL (ORAL), CHENODAL (ORAL), URSO/URSO FORTE TABLET (ORAL), URSODIOL TABLET (ORAL)

13 Bronchodilators, Beta Agonists Kathy Novak informed the committee there were no changes to this class from the previous review. Kevin Chamberlin motioned to accept the recommendations as presented. The motion was seconded by Emmett Sullivan and passed unanimously by the committee. ON Medicaid PDL: ALBUTEROL NEB SOLN 0.63, 1.25 MG (INHALATION), ALBUTEROL NEB SOLN 100 MG/20 ML (INHALATION), ALBUTEROL NEB SOLN 2.5 MG/3 ML (INHALATION), ALBUTEROL SYRUP (ORAL), ALBUTEROL TABLET (ORAL), PROAIR HFA (INHALATION), PROVENTIL HFA (INHALATION), TERBUTALINE (ORAL) OFF Medicaid PDL: ACCUNEB (INHALATION), ALBUTEROL ER (ORAL), ALBUTEROL NEB SOLN 2.5 MG/0.5 ML (INHALATION), ARCAPTA NEOHALER (INHALATION), BROVANA (INHALATION), FORADIL (INHALATION), LEVALBUTEROL NEB SOLN (INHALATION), LEVALBUTEROL NEB SOLN CONC (INHALATION), MAXAIR (INHALATION), METAPROTERENOL SYRUP (ORAL), METAPROTERENOL TABLET (ORAL), PERFOROMIST (INHALATION), SEREVENT (INHALATION), VENTOLIN HFA (INHALATION), VOSPIRE ER (ORAL), XOPENEX HFA (INHALATION), XOPENEX NEB SOLN (INHALATION), XOPENEX NEB SOLN CONC (INHALATION) Emollients Kathy Novak informed committee of two new products to this class. Cynthia Conrad motioned to accept the recommendations as presented, and her motion was seconded by Kevin Chamberlin. The motion was passed unanimously by the committee. ON Medicaid PDL: AMMONIUM LACTATE CREAM/LOTION (TOPICAL), LACTIC ACID CREAM/LOTION (TOPICAL) OFF Medicaid PDL: ATOPICLAIR (TOPICAL), BIAFINE (TOPICAL), ELETONE (TOPICAL), EMOLLIENT COMBINATION NO.10 (TOPICAL), EMOLLIENT COMBINATION NO.32 (TOPICAL), EMOLLIENT COMBO 35 CREAM (TOPICAL), EMOLLIENT FOAM (TOPICAL), EMOLLIENT FOAM PLUS (TOPICAL), EPICERAM (TOPICAL), HPR PLUS (TOPICAL), HPR PLUS-MB HYROGEL (TOPICAL), HYLATOPIC (TOPICAL), HYLATOPIC PLUS (TOPICAL), LAC-HYDRIN CREAM/LOTION (TOPICAL), MB HYDROGEL (TOPICAL), PRUCLAIR (TOPICAL), TL TRISEB (TOPICAL), TROPAZONE CREAM (TOPICAL), TROPAZONE LOTION (TOPICAL)

14 Histamine II Receptor Blockers Kathy Novak introduced this as a new class to the Connecticut PDL. Charles Thompson motioned to accept as recommended along with the addition of ranitidine syrup and Pepcid suspension as they are needed for use in pediatric populations. Karen McMillan seconded the motion and the committee passed it unanimously. ON Medicaid PDL: CIMETIDINE TABLET (ORAL), CIMETIDINE TABLET OTC (ORAL), FAMOTIDINE TABLET (ORAL), FAMOTIDINE TABLET OTC (ORAL), PEPCID SUSPENSION (ORAL), RANITIDINE SYRUP (ORAL), RANITIDINE TABLET (ORAL), RANITIDINE TABLET OTC (ORAL) OFF Medicaid PDL: AXID SOLUTION (ORAL), CIMETIDINE SOLUTION (ORAL), FAMOTIDINE (INTRAVEN), FAMOTIDINE PIGGYBACK (INJECTION), FAMOTIDINE SUSPENSION (ORAL), FAMOTIDINE VIAL (INJECTION), NIZATIDINE CAPSULE (ORAL), NIZATIDINE SOLUTION (ORAL), PEPCID AC TABLET OTC (ORAL), PEPCID TABLET (ORAL), RANITIDINE (INJECTION), RANITIDINE CAPSULE (ORAL), ZANTAC (INJECTION), ZANTAC 25 (ORAL), ZANTAC 75 TABLET OTC (ORAL), ZANTAC SYRUP (ORAL), ZANTAC TABLET (ORAL), ZANTAC TABLET OTC (ORAL) Immunomodulators, Atopic Dermatitis Jeffrey Kamradt motioned to accept the recommendations as presented for this class. Cynthia Conrad seconded, and the motion was passed unanimously. ON Medicaid PDL: ELIDEL (TOPICAL) OFF Medicaid PDL: PROTOPIC (TOPICAL) Immunomodulators, Topical Kathy Novak introduced this as a new category for the Connecticut PDL. Kathy stated all agents are the same active ingredient and cost savings are derived by pushing to the specific branded product Aldara. Kevin Chamberlin motioned to approve the recommendations as presented. The motion was seconded and passed unanimously by the committee. ON Medicaid PDL: ALDARA (TOPICAL)

15 OFF Medicaid PDL: IMIQUIMOD (TOPICAL), ZYCLARA (TOPICAL) Iron, Oral Kathy Novak introduced this as a new category for the Connecticut PDL. Cynthia Conrad motioned to accept the recommendations as presented. Charles Thompson seconded the motion and it was passed unanimously by the committee. ON Medicaid PDL: CENTRATEX (ORAL), FE C OTC (ORAL), FE FUMARATE/VIT C/B12-IF/FA (ORAL), FEOSOL OTC (ORAL), FERATE OTC (ORAL), FERRALET 90 DUAL-IRON (ORAL), FERRAPLUS 90 (ORAL), FERRIMIN 150 OTC (ORAL), FERROCITE PLUS (ORAL), FERROUS GLUCONATE OTC (ORAL), FERROUS SULFATE 65 MG TABLET OTC (ORAL), FERROUS SULFATE OTC (ORAL), FERROUS SULFATE SOLUTION OTC (ORAL), FOLITAB 500 OTC (ORAL), FOLIVANE-F (ORAL), FOLIVANE-PLUS (ORAL), HEMATOGEN (ORAL), HEMATOGEN FA (ORAL), HEMOCYTE PLUS (ORAL), HEMOCYTE-F (ORAL), IFEREX 150 FORTE (ORAL), INTEGRA F (ORAL), INTEGRA OTC (ORAL), INTEGRA PLUS (ORAL), IRON 45 MG TABLET OTC (ORAL), IRON POLYSACCHARIDES COMPLEX OTC (ORAL), IRON PS CMPLX/VIT B12/FA (ORAL), IRON,CARBONYL/ASCORBIC ACID OTC (ORAL), MV COMB18/FEFM-FEPOL CB1/FA (ORAL), NEPHRON FA (ORAL), NOVAFERRUM 50 CAPSULE OTC (ORAL), NOVAFERRUM DROPS OTC (ORAL), SE-TAN PLUS (ORAL), SLOW RELEASE IRON (ORAL), TANDEM DUAL ACTION OTC (ORAL), TANDEM PLUS (ORAL), TARON FORTE (ORAL), TL-FOL 500 (ORAL), TL-HEM 150 (ORAL), VITRON-C OTC (ORAL) OFF Medicaid PDL: ACTIVE FE (ORAL), BIFERA RX (ORAL), CHROMAGEN (ORAL), CORVITA 150 (ORAL), CORVITE 150 (ORAL), CORVITE FE (ORAL), DUOFER (ORAL), FE FUMARATE/VIT C/VIT B12/FA (ORAL), FERIVA (ORAL), FERREX 150 PLUS OTC (ORAL), FERREX 28 (ORAL), FERROFLEX 150 FORTE (ORAL), FUSION PLUS (ORAL), HEMETAB (ORAL), ICAR-C OTC (ORAL), IROSPAN (ORAL), MAXARON FORTE (ORAL), MULTIGEN (ORAL), MULTIGEN FOLIC (ORAL), MULTIGEN PLUS (ORAL), NATALVIRT FLT (ORAL), NIRON KOMPLETE (ORAL), NOVAFERRUM (ORAL), NOVAFERRUM LIQUID OTC (ORAL), VITAFOL (ORAL) Leukotriene Modifiers Kathy Novak advised that the montelukast chewable tablets could be crushed, and such the granules were not recommended as preferred. Carl Sherter motioned to accept the recommendations as presented. Charles Thompson seconded the motion and it was passed unanimously by the committee. ON Medicaid PDL: ACCOLATE (ORAL), MONTELUKAST CHEWABLE TABLET (ORAL), MONTELUKAST TABLET (ORAL)

16 OFF Medicaid PDL: MONTELUKAST GRANULES (ORAL), SINGULAIR CHEWABLE TABLET (ORAL), SINGULAIR GRANULES (ORAL), SINGULAIR TABLET (ORAL), ZAFIRLUKAST (ORAL), ZYFLO (ORAL), ZYFLO CR (ORAL) Oncology Agents, Breast Cancer Cynthia Conrad motioned to accept the recommendations as presented for this class. Kevin Chamberlin seconded the motion and the committee passed it unanimously. ON Medicaid PDL: ARIMIDEX (ORAL), EXEMESTANE (ORAL), LETROZOLE (ORAL), TAMOXIFEN CITRATE (ORAL) OFF Medicaid PDL: ANASTROZOLE (ORAL), AROMASIN (ORAL), FARESTON (ORAL), FEMARA (ORAL) Ophthalmic Antibiotics The committee unanimously voted to accept the recommendations as presented for this drug category. ON Medicaid PDL: BACITRACIN/POLYMYXIN B SULFATE OINT. (OPHTHALMIC), CIPROFLOXACIN SOLUTION (OPHTHALMIC), ERYTHROMYCIN (OPHTHALMIC), GENTAMICIN DROPS (OPHTHALMIC), GENTAMICIN OINT. (OPHTHALMIC), LEVOFLOXACIN (OPHTHALMIC), MOXEZA (OPHTHALMIC), NEOMYCIN- POLYMYXIN-GRAMICIDIN (OPHTHALMIC), OFLOXACIN (OPHTHALMIC), POLYMYXIN/TRIMETHOPRIM (OPHTHALMIC), SULFACETAMIDE SOLUTION (OPHTHALMIC), TOBRAMYCIN (OPHTHALMIC), TOBREX OINTMENT (OPHTHALMIC), VIGAMOX (OPHTHALMIC) OFF Medicaid PDL: AZASITE (OPHTHALMIC), BACITRACIN (OPHTHALMIC), BESIVANCE (OPHTHALMIC), BLEPH-10 (OPHTHALMIC), CILOXAN DROPS (OPHTHALMIC), CILOXAN OINTMENT (OPHTHALMIC), GARAMYCIN DROPS (OPHTHALMIC), GARAMYCIN OINT. (OPHTHALMIC), NATACYN (OPHTHALMIC), NEOMYCIN/BACITRACIN/POLYMYXIN OINT (OPHTHALMIC), POLYTRIM (OPHTHALMIC), SULFACETAMIDE OINTMENT (OPHTHALMIC), TOBREX DROPS (OPHTHALMIC), ZYMAR (OPHTHALMIC), ZYMAXID (OPHTHALMIC) Ophthalmic Antibiotic/Steroid Combinations

17 Kathy Novak advised there were no changes to this drug category from previous review. Charles Thompson motioned to accept the recommendations as presented. Kevin Chamberlin seconded the motion and it was passed unanimously. ON Medicaid PDL: BLEPHAMIDE (OPHTHALMIC), BLEPHAMIDE S.O.P. (OPHTHALMIC), NEOMYCIN/BACITRACIN/POLY/HC (OPHTHALMIC), NEOMYCIN/POLYMYXIN/DEXAMETHASONE (OPHTHALMIC), PRED-G DROPS SUSP (OPHTHALMIC), PRED-G OINT. (OPHTHALMIC), SULFACETAMIDE / PREDNISOLONE (OPHTHALMIC), TOBRADEX OINTMENT (OPHTHALMIC), TOBRADEX SUSPENSION (OPHTHALMIC) OFF Medicaid PDL: MAXITROL DROPS SUSP (OPHTHALMIC), MAXITROL OINT. (OPHTHALMIC), NEOMYCIN/POLYMYXIN/HC (OPHTHALMIC), TOBRADEX ST (OPHTHALMIC), TOBRAMYCIN / DEXAMETHASONE SUSPENSION (OPHTHALMIC), ZYLET (OPHTHALMIC) Ophthalmics for Allergic Conjunctivitis The committee voted unanimously to accept the recommendations as presented for this category. ON Medicaid PDL: ALREX (OPHTHALMIC), CROMOLYN SODIUM (OPHTHALMIC), PATADAY (OPHTHALMIC) OFF Medicaid PDL: ALAMAST (OPHTHALMIC), ALOCRIL (OPHTHALMIC), ALOMIDE (OPHTHALMIC), AZELASTINE (OPHTHALMIC), BEPREVE (OPHTHALMIC), ELESTAT (OPHTHALMIC), EMADINE (OPHTHALMIC), EPINASTINE (OPHTHALMIC), KETOTIFEN OTC (OPHTHALMIC), LASTACAFT (OPHTHALMIC), OPTIVAR (OPHTHALMIC), PATANOL (OPHTHALMIC), ZADITOR OTC (OPHTHALMIC) Ophthalmic Anti-inflammatories Cynthia Conrad motioned to accept the recommendations as presented for this category. Kevin Chamberlin seconded the motion and it was passed unanimously. ON Medicaid PDL: DEXAMETHASONE (OPHTHALMIC), DICLOFENAC (OPHTHALMIC), DUREZOL (OPHTHALMIC), FLAREX (OPHTHALMIC), FLUOROMETHOLONE (OPHTHALMIC), FLURBIPROFEN (OPHTHALMIC), FML FORTE (OPHTHALMIC), FML S.O.P. (OPHTHALMIC), LOTEMAX DROPS (OPHTHALMIC), MAXIDEX (OPHTHALMIC), PRED MILD (OPHTHALMIC), PREDNISOLONE ACETATE (OPHTHALMIC), PREDNISOLONE SOD PHOSPHATE (OPHTHALMIC)

18 OFF Medicaid PDL: ACULAR (OPHTHALMIC), ACULAR LS (OPHTHALMIC), ACUVAIL (OPHTHALMIC), BROMDAY (OPHTHALMIC), BROMFENAC (OPHTHALMIC), FML (OPHTHALMIC) ILEVRO (OPHTHALMIC), KETOROLAC (OPHTHALMIC), KETOROLAC LS (OPHTHALMIC), LOTEMAX GEL (OPHTHALMIC), LOTEMAX OINTMENT (OPHTHALMIC), NEVANAC (OPHTHALMIC), OMNIPRED (OPHTHALMIC), OZURDEX (INTRAOCULR), PRED FORTE (OPHTHALMIC), PROLENSA (OPHTHALMIC), RETISERT (INTRAOCULR), TRIESENCE (INTRAOCULR), VEXOL (OPHTHALMIC) Ophthalmic Glaucoma Agents Cynthia Conrad motioned to accept the recommendations as presented for this category. Charles Thompson seconded the motion and it was passed unanimously by the committee. ON Medicaid PDL: ALPHAGAN P 0.15% (OPHTHALMIC), AZOPT (OPHTHALMIC), BETAXOLOL (OPHTHALMIC), BETIMOL (OPHTHALMIC), BETOPTIC S (OPHTHALMIC), BRIMONIDINE (OPHTHALMIC), CARTEOLOL (OPHTHALMIC), DORZOLAMIDE (OPHTHALMIC), DORZOLAMIDE / TIMOLOL (OPHTHALMIC), ISTALOL (OPHTHALMIC), LATANOPROST 2.5 ML (OPHTHALMIC), LEVOBUNOLOL (OPHTHALMIC), METIPRANOLOL (OPHTHALMIC), PILOCARPINE (OPHTHALMIC), SIMBRINZA (OPHTHALMIC), TIMOLOL (OPHTHALMIC), TRAVATAN Z 2.5 ML (OPHTHALMIC), TRAVATAN Z 5 ML (OPHTHALMIC) OFF Medicaid PDL: ALPHAGAN P 0.1% (OPHTHALMIC), APRACLONIDINE (OPHTHALMIC), BETAGAN (OPHTHALMIC), BRIMONIDINE P 0.15% (OPHTHALMIC), COMBIGAN (OPHTHALMIC), COSOPT (OPHTHALMIC), COSOPT PF (OPHTHALMIC), IOPIDINE (OPHTHALMIC), LUMIGAN 2.5ML (OPHTHALMIC), LUMIGAN 5ML (OPHTHALMIC), LUMIGAN 7.5ML (OPHTHALMIC), PILOPINE HS (OPHTHALMIC), RESCULA (OPHTHALMIC), TIMOPTIC (OPHTHALMIC), TIMOPTIC OCUDOSE (OPHTHALMIC), TIMOPTIC- XE (OPHTHALMIC), TRAVOPROST 2.5 ML (OPHTHALMIC), TRAVOPROST 5 ML (OPHTHALMIC), TRUSOPT (OPHTHALMIC), XALATAN 2.5 ML (OPHTHALMIC), ZIOPTAN (OPHTHALMIC) Otic Antibiotics Kevin Chamberlin motioned to accept the recommendations as presented for this category. Manage Nissanka seconded the motion and it was passed unanimously by the committee. ON Medicaid PDL: CIPRODEX (OTIC), CORTISPORIN SOLUTION (OTIC), NEOMYCIN/POLYMYXIN/HC SOLN/SUSP (OTIC), OFLOXACIN (OTIC)

19 OFF Medicaid PDL: CIPRO HC (OTIC), CIPROFLOXACIN (OTIC), COLY-MYCIN S (OTIC), CORTISPORIN-TC (OTIC) Otic Anti-infectives & Anesthetics Karen McMillan motioned to accept the recommendations as presented for this class. Cynthia Conrad seconded the motion and it was passed unanimously by the committee. ON Medicaid PDL: ACETIC ACID (OTIC), ACETIC ACID/ALUMINUM (OTIC), ANTIPYRINE / BENZOCAINE (OTIC) OFF Medicaid PDL: ACETIC ACID HC (OTIC), AURAX (OTIC), MYOXIN (OTIC), OTIC CARE (OTIC), OTO-END 10 (OTIC), OTOZIN (OTIC), PINNACAINE (OTIC), PRAMOXINE-HC (OTIC), VOSOL HC (OTIC) Sedative Hypnotics Kathy Novak advised there were no changes to the recommendations from last review for this category. She informed the committee of the updated dosing recommendations for zolpidem use in female patients. Manage Nissanka motioned to accept the recommendations as presented. Kevin Chamberlin seconded the motion and it was passed unanimously by the committee. ON Medicaid PDL: FLURAZEPAM (ORAL), TEMAZEPAM (ORAL), ZOLPIDEM (ORAL) OFF Medicaid PDL: AMBIEN (ORAL), AMBIEN CR (ORAL), EDLUAR (SUBLINGUAL), ESTAZOLAM (ORAL), INTERMEZZO (SUBLINGUAL), LUNESTA (ORAL), RESTORIL (ORAL), ROZEREM (ORAL), SILENOR (ORAL), SONATA (ORAL), TEMAZEPAM 22.5 MG (ORAL), TEMAZEPAM 7.5 MG (ORAL), TRIAZOLAM (ORAL), ZALEPLON (ORAL), ZOLPIDEM ER (ORAL), ZOLPIMIST (ORAL) Steroids, Topical Low Emmett Sullivan motioned to accept the recommendations as presented for this class. Charles Thompson seconded the motion and it was passed unanimously by the committee. ON Medicaid PDL: CAPEX SHAMPOO (TOPICAL), DESONIDE CREAM (TOPICAL), DESONIDE LOTION (TOPICAL), DESONIDE OINTMENT (TOPICAL), DESOWEN LOTION (TOPICAL), FLUOCINOLONE 0.01% OIL (TOPICAL), HYDROCORTISONE / MIN OIL / PET OINTMENT (TOPICAL), HYDROCORTISONE CREAM (TOPICAL), HYDROCORTISONE GEL (TOPICAL), HYDROCORTISONE OINTMENT (TOPICAL) OFF Medicaid PDL: ALCLOMETASONE DIPROPIONATE CREAM (TOPICAL), ALCLOMETASONE DIPROPIONATE OINTMENT (TOPICAL), AQUA GLYCOLIC HC

20 (TOPICAL), DERMA-SMOOTHE-FS (TOPICAL), DESONATE GEL (TOPICAL), HYDROCORTISONE ACETATE / UREA (TOPICAL), HYDROCORTISONE LOTION (TOPICAL), HYDROCORTISONE/ALOE GEL (TOPICAL), PEDIADERM HC (TOPICAL), PEDIADERM TA (TOPICAL), TEXACORT (TOPICAL), VERDESO (TOPICAL) Steroids, Topical Medium The committee voted unanimously to accept the recommendations as presented for this category. ON Medicaid PDL: FLUOCINOLONE ACETONIDE CREAM (TOPICAL), FLUOCINOLONE ACETONIDE OINTMENT (TOPICAL), FLUOCINOLONE ACETONIDE SOLUTION (TOPICAL), FLUTICASONE PROPIONATE CREAM (TOPICAL), FLUTICASONE PROPIONATE OINTMENT (TOPICAL), HYDROCORTISONE BUTYRATE CREAM (TOPICAL), HYDROCORTISONE BUTYRATE CREAM BRAND (TOPICAL), HYDROCORTISONE BUTYRATE OINTMENT (TOPICAL), HYDROCORTISONE BUTYRATE OINTMENT BRAND (TOPICAL), HYDROCORTISONE BUTYRATE SOLUTION (TOPICAL), HYDROCORTISONE BUTYRATE SOLUTION BRAND (TOPICAL), HYDROCORTISONE VALERATE CREAM (TOPICAL), HYDROCORTISONE VALERATE OINTMENT (TOPICAL), MOMETASONE FUROATE CREAM (TOPICAL), MOMETASONE FUROATE OINTMENT (TOPICAL), MOMETASONE FUROATE SOLUTION (TOPICAL), PREDNICARBATE CREAM (TOPICAL), PREDNICARBATE OINTMENT (TOPICAL) OFF Medicaid PDL: BETAMETHASONE VALERATE FOAM (TOPICAL), CLODERM (TOPICAL), CORDRAN TAPE (TOPICAL), CUTIVATE CREAM (TOPICAL), CUTIVATE LOTION (TOPICAL), DERMATOP OINTMENT (TOPICAL), ELOCON CREAM (TOPICAL), ELOCON OINTMENT (TOPICAL), ELOCON SOLUTION (TOPICAL), FLUTICASONE PROPIONATE LOTION (TOPICAL), LUXIQ (TOPICAL), MOMEXIN (TOPICAL), PANDEL (TOPICAL), SYNALAR CREAM (TOPICAL), SYNALAR CREAM KIT (TOPICAL), SYNALAR OINTMENT (TOPICAL), SYNALAR OINTMENT KIT (TOPICAL), SYNALAR SOLUTION (TOPICAL), SYNALAR TS KIT (TOPICAL) Steroids, Topical High Cynthia Conrad motioned to accept the recommendations as presented for this category. Manage Nissanka seconded the motion and it was passed unanimously by the committee. ON Medicaid PDL: BETAMETHASONE DIPROPIONATE CREAM (TOPICAL), BETAMETHASONE DIPROPIONATE LOTION (TOPICAL), BETAMETHASONE VALERATE CREAM (TOPICAL), BETAMETHASONE VALERATE OINTMENT (TOPICAL), BETA-VAL CREAM (TOPICAL), FLUOCINONIDE CREAM (TOPICAL), FLUOCINONIDE EMOLLIENT (TOPICAL), FLUOCINONIDE SOLUTION (TOPICAL), TRIAMCINOLONE ACETONIDE CREAM (TOPICAL), TRIAMCINOLONE ACETONIDE LOTION (TOPICAL), TRIAMCINOLONE ACETONIDE OINTMENT (TOPICAL), TRIANEX OINTMENT (TOPICAL)

21 OFF Medicaid PDL: AMCINONIDE CREAM (TOPICAL), AMCINONIDE LOTION (TOPICAL), AMCINONIDE OINTMENT (TOPICAL), BETAMET DIPROP / PROP GLY CREAM (TOPICAL), BETAMET DIPROP / PROP GLY LOTION (TOPICAL), BETAMET DIPROP / PROP GLY OINTMENT (TOPICAL), BETAMETHASONE DIPROPIONATE GEL (TOPICAL), BETAMETHASONE DIPROPIONATE OINTMENT (TOPICAL), BETAMETHASONE VALERATE LOTION (TOPICAL), DESOXIMETASONE CREAM (TOPICAL), DESOXIMETASONE GEL (TOPICAL), DESOXIMETASONE OINTMENT (TOPICAL), DIFLORASONE DIACETATE CREAM (TOPICAL), DIFLORASONE DIACETATE OINTMENT (TOPICAL), DIPROLENE AF CREAM (TOPICAL), DIPROLENE LOTION (TOPICAL), DIPROLENE OINTMENT (TOPICAL), FLUOCINONIDE GEL (TOPICAL), FLUOCINONIDE OINTMENT (TOPICAL), HALOG CREAM (TOPICAL), HALOG OINTMENT (TOPICAL), KENALOG AEROSOL (TOPICAL), TOPICORT CREAM (TOPICAL), TOPICORT LP CREAM (TOPICAL), TOPICORT OINTMENT (TOPICAL), TOPICORT SPRAY (TOPICAL), VANOS (TOPICAL) Steroids, Topical Very High Cynthia Conrad motioned to accept the recommendations as presented for this category. Manage Nissanka seconded the motion and it was passed unanimously by the committee. ON Medicaid PDL: CLOBETASOL EMOLLIENT (TOPICAL), CLOBETASOL PROPIONATE CREAM (TOPICAL), CLOBETASOL PROPIONATE GEL (TOPICAL), CLOBETASOL PROPIONATE OINTMENT (TOPICAL), CLOBETASOL PROPIONATE SOLUTION (TOPICAL), CLOBEX SHAMPOO (TOPICAL), HALOBETASOL PROPIONATE CREAM (TOPICAL), HALOBETASOL PROPIONATE OINTMENT (TOPICAL) OFF Medicaid PDL: APEXICON E (TOPICAL), CLOBETASOL LOTION (TOPICAL), CLOBETASOL PROPIONATE FOAM (TOPICAL), CLOBETASOL SHAMPOO (TOPICAL), CLOBEX LOTION (TOPICAL), CLOBEX SPRAY (TOPICAL), HALAC (TOPICAL), HALONATE (TOPICAL), OLUX (TOPICAL), OLUX-E (TOPICAL), ULTRAVATE CREAM (TOPICAL), ULTRAVATE OINTMENT (TOPICAL), ULTRAVATE X PAC CREAM (TOPICAL), ULTRAVATE X PAC OINTMENT (TOPICAL) Recommendations for next class reviews: Magellan recommended the following classes be reviewed at the May P&T meeting: ACNE AGENTS, TOPICAL ANALGESICS, NARCOTICS LONG ANALGESICS, NARCOTICS SHORT ANDROGENIC AGENTS ANGIOTENSIN MODULATOR COMBINATIONS

22 ANGIOTENSIN MODULATORS ANTIBIOTICS, GI ANTIBIOTICS, INHALED ANTIBIOTICS, TOPICAL ANTIBIOTICS, VAGINAL ANTICOAGULANTS ANTIEMETIC/ANTIVERTIGO AGENTS ANTIFUNGALS, ORAL ANTIFUNGALS, TOPICAL ANTIMIGRAINE AGENTS ANTIPARASITICS, TOPICAL ANTIVIRALS, ORAL ANTIVIRALS, TOPICAL BETA-BLOCKERS BLADDER RELAXANT PREPARATIONS BONE RESORPTION SUPPRESSION AND RELATED AGENTS BPH TREATMENTS CALCIUM CHANNEL BLOCKERS CEPHALOSPORINS AND RELATED ANTIBIOTICS COLONY STIMULATING FACTORS CONTRACEPTIVES, ORAL ERYTHROPOIESIS STIMULATING PROTEINS FLUOROQUINOLONES, ORAL GROWTH FACTORS GROWTH HORMONE H. PYLORI TREATMENT HEPATITIS C AGENTS HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS HYPOGLYCEMICS, INSULIN AND RELATED AGENTS HYPOGLYCEMICS, MEGLITINIDES HYPOGLYCEMICS, TZD IMMUNOSUPPRESSIVES, ORAL IRRITABLE BOWEL SYNDROME LIPOTROPICS, OTHER LIPOTROPICS, STATINS MACROLIDES/KETOLIDES MULTIPLE SCLEROSIS AGENTS OPIATE DEPENDENCE TREATMENTS PAH AGENTS, ORAL AND INHALED PANCREATIC ENZYMES PHOSPHATE BINDERS PITUITARY SUPPRESSIVE AGENTS, LHRH PLATELET AGGREGATION INHIBITORS PRENATAL VITAMINS

23 PROTON PUMP INHIBITORS SKELETAL MUSCLE RELAXANTS TETRACYCLINES ULCERATIVE COLITIS AGENTS VASODILATORS, CORONARY New Generics: Kathy Novak presented to the committee members the following new generic products which would be non-preferred on the Medicaid formulary: SULFACETAMIDE SHAMPOO (TOPICAL) DONEPEZIL 23 MG (ORAL) CANDESARTAN (ORAL) MUPIROCIN CREAM (TOPICAL) GRISEOFULVIN ULTRAMICROSIZE (ORAL) VORICONAZOLE SUSPENSION (ORAL) ZOLMITRIPTAN TABLET (ORAL) ZOLMITRIPTAN ODT (ORAL) ACITRETIN (ORAL) CALCIPOTRIENE CREAM (TOPICAL) ACYCLOVIR OINTMENT (TOPICAL) ALENDRONATE SOLUTION LANSOPRAZOLE/AMOXICILLIN/CLARITHROMYCIN (ORAL) REPAGLINIDE (ORAL) PIOGLITAZONE/GLIMEPIRIDE (ORAL) NIACIN ER (ORAL) FENOFIBRIC ACID (TRILIPIX) (ORAL) LIDOCAINE (TOPICAL) TEMOZOLOMIDE (ORAL) GATIFLOXACIN (OPHTHALMIC) BUPRENORPHINE/NALOXONE TAB (SUBLINGUAL) QUAZEPAM HYDROCORTISONE BUTYRATE DEXTROAMPHETAMINE SOLUTION (ORAL) DOXYCYCLINE MONOHYDRATE SUSPENSION (ORAL) Schedule next meeting: Committee members suggested that a set of available dates be ed to committee members for review. The first week of May was suggested to be avoided due to a conflicting conference for some committee members. Available dates will be sent to the committee by Jason Young.

24 Meeting adjourned at 7:21pm