Connecticut Medicaid P&T Meeting Minutes November 14, 2012

Connecticut Medicaid P&T Meeting Minutes November 14, 2012 The meeting started at 6:10 pm Attendance Present Members: Carl Sherter, MD Charles Thompson, MD Emmett Sullivan, RPh Stella Cretella Hilda Slivka, MD Cynthia Conrad, MD Manage Nissanka, MD Elizabeth Rodriguez, RN Eric Einstein, MD Kevin Chamberlin, PharmD Andrew Lustbader, MD Absent Members: Mark Defrancesco, MD Rick Carbray Jr Rph Angelo DeFazio, RPh DSS: Jason Gott, RPh HP/Provider Synergies: Chris Andrews, Pharm D Deborah Gallagher Kathy Novak, RPh Mark Synol, RPh Michael Stinchon RPh Tim Melechensky Melissa Chandler Opening remarks: Dr. Carl Sherter thanked the attendees for coming and called meeting to order. Dr. Sherter had both Kevin Chamberlin, PharmD and Andrew Lustbader, MD introduce themselves as new members to the Committee. They briefly spoke regarding their professional experience. Approval of minutes: Committee members approved the meeting minutes from the May 9, 2012 meeting. Public Presentations: Growth Hormone Growth Hormone- Genotropin Growth Hormone- Norditropin Oncology Agents, Oral Oncology Agents, Oral- Sutent, Inlyta, Xalkori Oncology Agents, Oral- Votrient Oncology Agents, Oral- Afinitor, Gleevac, Tasigna Oncology Agents, Breast Cancer Antipsychotics M Gatzak,RN P Palma Sisto,MD CCMC Neil Marotta, PharmD Pfizer Chuck Dipaula Novo Nordisk Dawn Holcombe CT Oncology Assoc. Neil Marotta, PharmD Pfizer J Salpeter, PharmD GSK Chris Sugg, PharmD Dawn Holcombe CT Oncology Assoc. C. Drazinic, MD CT Psychiatric Society

Public Presentations cont.: Antipsychotics Antipsychotics- Abilify Antipsychotics- Saphris Antipsychotics Antipsychotics- Fanapt Antipsychotics- Seroquel XR Antidepressants, Other Antidepressants, Other- Viibryd Antidepressants, Other- Pristiq Antidepressants, SSRI Stimulants and Related Agents Stimulants and Related Agents- Intuiv and Vyvanse Anticonvulsants - Potiga Botulinum Toxins- Botox Botulinum Toxins- Dyport Bronchodilators, Beta Agonist- ProAir COPD Agents- Combivent Respimat Cytokine and CAM Antagonists- Orencia Cytokine and CAM Antagonists- Cimzia Epinephrine, Self-Injected- Epipen Glucocorticoids, Inhaled- Pulmicort Flexhaler, Symbicort Immunomodulators, Atopic Dermatitis- P rotopic Intranasal Rhinitis Agents- QNASL Neuropathic Pain Neuropathic Pain- Gralise Neuropathic pain- Lyrica NSAIDs- Celebrex Smoking Cessation- Chantix Sara Frankel NAMI Kimberly Largay, MD Otsuka Pharm G. Sardinas, APRN Elysa Doherty, APRN Tanner Odom, PharmD Novartis P. Sachdeva, PharmD Astrazeneca C. Drazinic, MD CT Psychiatric Society L. Wratchford, NP Neil Marrotta, PharmD Pfizer C. Drazinic, MD CT Psychiatric Society C. Drazinic, MD CT Psychiatric Society Adam Kopp Shire Barry Patel, PharmD GSK Alicia Mark, PharmD Allergan John Bruins Ipsen Philip Buck, PhD Teva M. Dugandzic, PharmD BI Payal Patel, PharmD Bristol Myers Tim Phalen, PharmD UCB Joe Harper, PharmD Mylan Mary Brown, PharmD AZ Linda Posta, PharmD Astellas Philip Buck, PhD Teva Wendy Berggren Foster US Pain Found Kalpana Patel, PharmD DepoMed Neil Marotta, PharmD Pfizer Neil Marotta, PharmD Pfizer Neil Marotta, PharmD Pfizer New Generics: Chris Andrews informed the committee members regarding the following new generic products: Non-preferred Dilaudid liquid Diovan HCT Gabitril Natroba Detrol (IR) Sanctura XR Actos Actoplus Met Revatio The Committee motioned to approve and accept Provider Synergies recommendations. The motion was passed unanimously.

Therapeutic Class Reviews: GROWTH HORMONE Chris Andrews presented the evaluation and recommendation for this class. He noted there are no new clinical updates from May when this class was initially reviewed. Dr. Paola Palma Sisto and Marlene Gatzak, RN from Connecticut Children s Hospital gave public testimony. They answered questions from the Committee on which products they most often use and if they would feel comfortable switching a stabilized patient to another growth hormone. They stated they would most likely continue with the current therapies if the patient was stable. The speakers stated the prior authorization process was very easy to navigate and they had no issues with it. The Committee discussed several drug combination possibilities. Chris Andrews explained to the Committee the financial impact of different scenarios. Dr. Hilda Slivka motioned to keep the current preferred status with respect to this class for the Medicaid PDL with Dr. Cynthia Conrad seconding. The motion was passed unanimously. ON Medicaid PDL: GENOTROPIN CARTRIDGE (INJECTION), GENOTROPIN DISP SYRIN (INJECTION), NORDITROPIN PEN (INJECTION), NUTROPIN AQ CARTRIDGE (INJECTION), NUTROPIN AQ VIAL (INJECTION), NUTROPIN VIAL (INJECTION) OFF Medicaid PDL: HUMATROPE CARTRIDGE (INJECTION), HUMATROPE VIAL (INJECTION), OMNITROPE CARTRIDGE (INJECTION), OMNITROPE VIAL (INJECTION), SAIZEN CARTRIDGE (INJECTION), SAIZEN (VIAL), SEROSTIM VIAL (INJECTION) TEV-TROPIN VIAL (INJECTION), ZORBATIVE VIAL (INJECTION) Oncology, Oral Agents Chris Andrews presented the evaluation and recommendation for this class. He noted no new clinical updates for this class. Dawn Holcombe from the Connecticut Oncology Association gave public testimony. She stated their organization strongly recommended to not have this class reviewed and to leave these medications as open access. She noted if the Committee decided to review them that their recommendation is to have them all listed as preferred. She cited the many different mechanisms of action the reviewed products have and the fact each patient has therapy tailored to their disease. Dr. Cynthia Conrad motioned to have all the medications in this class listed as preferred on the Medicaid PDL with Stella Cretella seconding. The motion was passed unanimously. ON Medicaid PDL: AFINITOR (ORAL), CAPRELSA (ORAL), ERIVEDGE (ORAL), GLEEVEC (ORAL), INLYTA (ORAL), JAKAFI (ORAL), NEXAVAR (ORAL), SPRYCEL (ORAL), SUTENT (ORAL), TARCEVA (ORAL), TASIGNA (ORAL), TYKERB (ORAL), VOTRIENT (ORAL), XALKORI (ORAL), XELODA (ORAL), ZELBORAF (ORAL), ZYTIGA (ORAL) OFF Medicaid PDL: NONE

Oncology Agents, Breast Cancer Chris Andrews presented the evaluation and recommendation for this class. He noted no new clinical updates in this class. Dawn Holcombe again reiterated her stance that these medications should not be reviewed or all be listed as preferred. The Committee discussed the difference in efficacy between brand and generic medications. The recommendations provided by Magellan included a brand medication to be preferred instead of the generic counterpart. Dr. Eric Einstein motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL with Stella Cretella seconding. The motion was opposed by Dr. Charles Thompson, Dr. Hilda Slivka, Dr. Cynthia Conrad and Elizabeth Rodriguez, RN. The motion was passed 7 to 4. ON Medicaid PDL: (ORAL) ARIMIDEX (ORAL), EXEMESTANE (ORAL), LETROZOLE (ORAL), TAMOXIFEM OFF Medicaid PDL: ANASTROZOLE (ORAL), AROMASIN (ORAL), FARESTON (ORAL), FEMARA (ORAL) Antipsychotics Chris Andrews presented the evaluation and recommendation for this class. He noted Seroquel, Geodon, and Symbyax are now available as generics. Dr. Carolyn Drazinic from the Connecticut psychiatric Society gave public testimony. She discussed the challenges of these patients and the need for broad access to antipsychotics. The Committee discussed several possible preferred drug combinations taking into account dosage forms and routes of administration. Stella Cretella discussed the need for broad access due to problems with therapy changes. The possibility of grandfathering in patients stable on current antipsychotics that would become non-preferred was discussed with HP and DSS. Hilda Slivka motioned to have all medications in this class as preferred for the Medicaid PDL with Cynthia Conrad seconding. Kevin Chamberlin abstained. The motion was passed. ON Medicaid PDL: ABILIFY (INTRAMUSC), ABILIFY DISCMELT (ORAL), ABILIFY SOLUTION (ORAL), ABILIFY TABLET (ORAL), AMITRIPTYLINE / PERPHENAZINE (ORAL), CHLORPROMAZINE (ORAL), CLOZAPINE (ORAL), CLOZARIL (ORAL), FANAPT TITRATION PK (ORAL), FANAPT TABLET (ORAL), FAZACLO (ORAL), FLUPHENAZINE DECANOATE (INJECTION), FLUPHENAZINE ELIXIR/SOLN (ORAL), FLUPHENAZINE TABLET (ORAL), GEODON (INTRAMUSC), GEODON (ORAL), HALDOL DECANOATE (INTRAMUSC), HALOPERIDOL (ORAL), HALOPERIDOL DECANOATE (INJECTION) HALOPERIDOL LACTATE CONC (ORAL), HALOPERIDOL LACTATE (INJECTION), INVEGA (ORAL), INVEGA SUSTENNA (INTRAMUS), LATUDA (ORAL), LOXAPINE (ORAL), MOBAN (ORAL), OLANZAPINE ODT (ORAL), OLANZAPINE TABLET (ORAL), OLANZAPINE (INTRAMUS), 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 CAPSULES (ORAL), ZYPREXA (ORAL), ZYPREXA RELPREVV (INTRAMUSC), ZYPREXA ZYDIS (ORAL) OFF Medicaid PDL: NONE

Antidepressants, Other Chris Andrews presented the evaluation and recommendation for this class. He noted Aplenzin ER (bupropion Hbr) is now indicated for prevention of seasonal major depressive episodes. Dr. Carolyn Drazinic spoke about the benefits of broad access and specifically the benefit of Viibryd. Dr. Cynthia Conrad started a Committee discussion on having all extended release venlafaxine products available on the PDL. The medication Pristiq and how it is metabolized was discussed. It was discussed as a potential addition to the PDL. Dr. Cynthia Conrad motioned to approve and accept Provider Synergies recommendations as presented with the addition of Pristiq, Viibryd and venlafaxine ER tablets for the Medicaid PDL with Dr. Hilda Slivka seconding. The motion was passed unanimously. ON Medicaid PDL: BUPROPION (ORAL), BUPROPION SR (ORAL), BUPROPION XL (ORAL), MARPLAN (ORAL), MIRTAZAPINE (ORAL), MIRTAZAPINE ODT (ORAL), NARDIL (ORAL), PARNATE (ORAL), PRISTIQ (ORAL), TRAZODONE (ORAL), VENLAFAXINE ER CAPSULES (ORAL), VENLAFAXINE ER TABLETS (GENERIC) (SCHWARTZ) (UPSTATE) (ORAL), VIIBRYD (ORAL), VIIBRYD TAB DS PK (ORAL) OFF Medicaid PDL: APLENZIN (ORAL), EFFEXOR XR (ORAL), EMSAM (TRANSDERMAL), NEFAZODONE (ORAL), OLEPTRO ER (ORAL), PHENELZINE (ORAL), REMERON (ORAL), REMERON ODT (ORAL), TRANYLCYPROMINE SULFATE (ORAL), VENLAFAXINE (ORAL), WELLBUTRIN (ORAL), WELLBUTRIN SR (ORAL), WELLBUTRIN XL (ORAL) Antidepressants, SSRIs Chris Andrews presented the evaluation and recommendation for this class. It was noted that Lexapro tablets and suspension are now available as generics. Also, fluoxetine 60mg is now available from Egdemont Pharmaceuticals. Dr. Slivka discussed the pediatric advantages of making Lexapro solution and citalopram solution preferred. Dr. Cynthia Conrad motioned to approve and accept Provider Synergies recommendations as presented with the addition of Lexapro and citalopram solutions for the Medicaid PDL with Dr. Hilda Slivka seconding. The motion was passed unanimously. ON Medicaid PDL: CITALOPRAM SOLUTION (ORAL), CITALOPRAM TABLET (ORAL), FLUOXETINE TABLET (ORAL), ESCITALOPRAM TABLET (ORAL), FLUOXETINE CAPSULE (ORAL), FLUOXETINE SOLUTION (ORAL), FLUVOXAMINE (ORAL), LEXAPRO SOLUTION (ORAL), PAROXETINE TABLET (ORAL), SERTRALINE CONC (ORAL), SERTRALINE TABLET (ORAL) OFF Medicaid PDL: CELEXA (ORAL), ESCITALOPRAM SOLUTION (ORAL), FLUOXETINE 20 MG TABLET (ORAL), FLUOXETINE 60MG (ORAL), FLUOXETINE CAPSULE DR (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)

Stimulants and Related Agents Chris Andrews presented the evaluation and recommendation for this class. It was noted there are no new clinical updates. Dr. Carolyn Drazinic again spoke of the benefits of broad access. She specifically spoke to the benefits of the extended release formulations. Dr Andrew Lustbader discussed the benefits of having Modafinil added to the PDL. Emmett Sullivan motioned to approve and accept Provider Synergies recommendations with the addition of Modafinil for the Medicaid PDL with Dr. Manage Nissanka seconding. The motion was passed unanimously. ON Medicaid PDL: ADDERALL XR (ORAL), AMPHETAMINE SALT COMBO (ORAL), DAYTRANA (TRANSDERMAL), DEXTROAMPHETAMINE TABLET (ORAL), DEXMETHYLPHENIDATE (ORAL), FOCALIN (ORAL), FOCALIN XR (ORAL), INTUNIV (ORAL), METADATE CD (ORAL), METHYLIN CHEWABLE TABLETS (ORAL), METHYLIN SOLUTION (ORAL), METHYLPHENIDATE (ORAL), METHYLPHENIDATE ER (CONCERTA), METHYLPHENIDATE ER (ORAL), MODAFINIL (ORAL), STRATTERA (ORAL), VYVANSE (ORAL) OFF Medicaid PDL: ADDERALL (ORAL), AMPHETAMINE SALT COMBO ER (GLOBAL, TEVA) (ORAL), CONCERTA (ORAL), DEXEDRINE SPANSULE (ORAL), DESOXYN (ORAL), DEXTROAMPHETAMINE CAPSULE ER (ORAL), KAPVAY (ORAL), METHAMPHETAMINE (ORAL), METHYLPHENIDATE SOLUTION (ORAL), METHYLPHENIDATE ER (GEN RITALIN LA) (ORAL), NUVIGIL (ORAL), PROCENTRA (ORAL), PROVIGIL (ORAL), RITALIN (ORAL), RITALIN LA (ORAL), RITALIN LA 10MG CAP (ORAL), RITALIN SR (ORAL) Alzheimer s Agents Chris Andrews presented the evaluation and recommendation for this class. He noted no new clinical updates. Dr. Hilda Slivka motioned to approve and accept recommendations of Provider Synergies as presented for the Medicaid PDL with Kevin Chamberlin seconding. The motion was passed unanimously. ON Medicaid PDL: DONEPEZIL (ORAL), DONEPEZIL ODT (ORAL), EXELON (TRANSDERM), EXELON CAPSULES (ORAL), NAMENDA SOLUTION (ORAL), NAMENDA TAB DS PK (ORAL), NAMENDA TABLET (ORAL) OFF Medicaid PDL: ARICEPT (ORAL), ARICEPT 23 MG (ORAL), EXELON SOLUTION (ORAL), GALANTAMINE ER (ORAL), GALANTAMINE SOLUTION (ORAL), GALANTAMINE TABLET (ORAL), RIVASTIGMINE CAPSULES (ORAL) Anticonvulsants Chris Andrews presented the evaluation and recommendation for this class. He noted Onfi (clobazam) is indicated as adjunctive therapy in the treatment of Lennox-Gastaut syndrome (LGS) for patients two years and older. Potiga (ezogabine) is a potassium channel opener indicated as adjunctive therapy in the treatment of partial-onset seizures in adults. Kevin Chamberlin motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Charles Thompson seconding. The motion was passed unanimously. ON Medicaid PDL: CARBAMAZEPINE SUSPENSION (ORAL), CARBAMAZEPINE TAB CHEW (ORAL), CARBAMAZEPINE TABLET (ORAL), CARBAMAZEPINE ER (GEN CARBATROL), CARBAMAZEPINE XR, CARBATROL (ORAL), CELONTIN (ORAL), CLONAZEPAM (ORAL), DIAZEPAM (RECTAL), DILANTIN INFATAB (ORAL), DIVALPROEX ER (ORAL), DIVALPROEX TABLET (ORAL), DIVALPROEX SPRINKLE (ORAL), ETHOSUXIMIDE SYRUP (ORAL), FELBAMATE SUSPENSION (ORAL),GABITRIL (ORAL), LAMOTRIGINE (ORAL), LAMOTRIGINE TAB DS PK (ORAL), LEVETIRACETAM SOLUTION (ORAL), LEVETIRACETAM TABLETS (ORAL),

OXCARBAZEPINE SUSPENSION (ORAL), OXCARBAZEPINE TABLETS (ORAL), PEGANONE (ORAL), PHENOBARBITAL ELIXIR (ORAL), PHENOBARBITAL TABLET (ORAL), PHENYTOIN (ORAL), PHENYTOIN EXT CAPSULE (GENERIC PHENYTEK), PHENYTOIN SUSPENSION (ORAL), PRIMIDONE (ORAL), TOPIRAMATE SPRINKLE (ORAL), TOPIRAMATE TABLETS (ORAL), VALPROATE SYRUP (ORAL), VALPROIC ACID (ORAL), ZONISAMIDE (ORAL) OFF Medicaid PDL: BANZEL SUSPENSION (ORAL), BANZEL TABLET (ORAL), CLONAZEPAM ODT (ORAL), DEPAKENE SYRUP (ORAL), DEPAKOTE (ORAL), DEPAKOTE ER (ORAL), DEPAKOTE SPRINKLE (ORAL), DIASTAT (RECTAL), DILANTIN (ORAL), DILANTIN 30MG, DILANTIN SUSPENSION, EQUETRO (ORAL), ETHOSUXIMIDE CAPSULE (ORAL), FELBATOL SUSPENSION (ORAL), FELBAMATE TABLET (ORAL), FELBATOL TABLET (ORAL), KEPPRA SOLUTION (ORAL), KEPPRA TABLETS (ORAL), KEPPRA XR (ORAL), KLONOPIN TABLET (ORAL), LAMICTAL (ORAL), LAMICTAL ODT (ORAL), LAMICTAL ODT DS PK (ORAL), LAMICTAL TAB DS PK (ORAL), LAMICTAL XR (ORAL), LAMICTAL XR DS PK (ORAL), LEVETIRACETAM ER (ORAL), ONFI (ORAL), PHENYTEK (ORAL), POTIGA (ORAL), SABRIL POWDER PACK (ORAL), SABRIL TABLET (ORAL), STAVZOR (ORAL), TEGRETOL SUSPENSION (ORAL), TEGRETOL TAB CHEW (ORAL), TEGRETOL TABLET (ORAL), TEGRETOL XR (ORAL), TOPAMAX SPRINKLE (ORAL), TOPAMAX TABLETS (ORAL), TRILEPTAL SUSPENSION (ORAL), TRILEPTAL TABLETS (ORAL), VIMPAT (ORAL), VIMPAT SOLUTION (ORAL) ZARONTIN CAPSULE (ORAL), ZARONTIN SYRUP (ORAL), ZONEGRAN (ORAL) Antihistamines, Minimally Sedating Chris Andrews presented the evaluation and recommendation for this class. It was noted Xyzal tablets are now available as a generic. Stella Cretella motioned to approve and accept the recommendations of Provider Synergies as presented for the Medicaid PDL, with Kevin Chamberlin seconding. The motion was passed unanimously. 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 (ORAL), ALLEGRA ALLERGY OTC (ORAL), ALLEGRA ODT (ORAL), ALLEGRA SUSPENSION (ORAL), ALLEGRA-D 12-HOUR OTC (ORAL), ALLEGRA-D 12- HOUR (ORAL), ALLEGRA-D 24-HOUR OTC (ORAL), ALLEGRA-D 24-HOUR (ORAL), CETIRIZINE CHEWABLE OTC (ORAL), CETIRIZINE TABLETS OTC (ORAL), CHILDREN S ALLERGA ALLERGY ORAL SUSP OTC (ORAL), CHILDREN S ALLERGA ALLERGY OTC (ORAL), CHILDREN S ALLERGA ALLERGY OTC RAPIDS OTC (ORAL), CHILDREN S ZYRTEC OTC (ORAL), CLARINEX ODT (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), FEXOFENADINE 30 MG (ORAL), FEXOFENADINE 60, 180 MG (ORAL), FEXOFENADINE-D 12-HOUR (ORAL), FEXOFENADINE-D 24-HOUR (ORAL), LEVOCETIRIZINE SOLUTION (ORAL), LEVOCETIRIZINE TABLETS (ORAL), SEMPREX-D (ORAL), XYZAL SOLUTION (ORAL), XYZAL TABLET (ORAL), ZYRTEC OTC (ORAL), ZYRTEC-D OTC (ORAL)

Antihypertensive, Sympatholytics Chris Andrews presented the evaluation and recommendation for this class. He noted no new clinical information for this class. Dr. Cynthia Conrad motioned to approve and accept Provider Synergies recommendations for the Medicaid PDL, with Dr. Hilda Slivka seconding. The motion was passed unanimously. ON Medicaid PDL: CATAPRES-TTS (TRANSDERM), CLONIDINE (ORAL), GUANFACINE (ORAL), METHYLDOPA (ORAL), METHYLDOPA/HYDROCHLOROTHIAZIDE (ORAL) OFF Medicaid PDL: CATAPRES (ORAL), CLONIDINE (TRANSDERM), CLORPRES (ORAL), METHYLDOPATE HCL (INTRAVEN), NEXICLON XR SUSPENSION (ORAL), NEXICLON XR TABLETS (ORAL), RESERPINE (ORAL), TENEX (ORAL) Antihyperuricemics Chris Andrews presented the evaluation and recommendation for this class. It was noted that there has been no new significant clinical updates to this class. Dr. Eric Einstein motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Andrew Lustbader seconding. The motion was passed unanimously. ON Medicaid PDL: (ORAL) ALLOPURINOL (ORAL), PROBENECID (ORAL), PROBENECID / COLCHICINE OFF Medicaid PDL: COLCRYS (ORAL), KRYSTEXXA (INTRAVEN), ULORIC (ORAL) Antiparkinson s Agents Chris Andrews presented the evaluation and recommendation for this class. He noted Requip XL, Stalevo and Comtan are now available as generics. Neupro has been reformulated and was relaunched in July. It is FDA approved to treat the signs and symptoms of moderate to severe primary Restless Legs Syndrome (RLS), advanced Parkinson s disease and early-stage idiopathic Parkinson's disease. Kevin Chamberlin motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Andrew Lustbader seconding. The motion was passed unanimously. 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), MIRAPEX (ORAL), MIRAPEX ER (ORAL), NEUPRO (TRANSDERM), REQUIP (ORAL), REQUIP XL (ORAL), ROPINIROLE ER (ORAL), SINEMET (ORAL), SINEMET (ORAL), STALEVO (ORAL), TASMAR (ORAL), ZELAPAR (ORAL)

Antipsoriatics, Topical Chris Andrews presented the evaluation and recommendation for this class. He noted this was a new class for review. Emmett Sullivan motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Charles Thompson seconding. The motion was passed unanimously. ON Medicaid PDL: CALCPOTRIENE CREAM (TOPICAL), CALCPOTRIENE OINTMENT (TOPICAL), CALCPOTRIENE SOLUTION (TOPICAL), CALCITROL OINTMENT (TOPICAL), DOVONEX CREAM (TOPICAL) OFF Medicaid PDL: CALCITRENE (TOPICAL), SORILUX (TOPICAL), TACLONEX OINTMENT (TOPICAL), TACLONEX SCALP (TOPICAL), VECTICAL (TOPICAL) Bile Salts Chris Andrews presented the evaluation and recommendation for this class. It was noted that there are no new clinical updates for this class. Dr. Cynthia Conrad motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Manage Nissanka seconding. The motion was passed unanimously. ON Medicaid PDL: : URSODIOL 300MG CAPSULE (ORAL) OFF Medicaid PDL: ACTIGALL (ORAL), CHENODAL (ORAL), URSODIOL TABLET (ORAL) Botulinum Toxins Chris Andrews presented the evaluation and recommendation for this class. It was noted that there has been no new significant clinical updates to this class. Stella Cretella motioned to approve and accept Provider Synergies recommendations with Dr. Hilda Slivka seconding. The motion was passed unanimously. ON Medicaid PDL: BOTOX (INTRAMUSC), DYSPORT (INTRAMUSC) OFF Medicaid PDL: MYOBLOC (INTRAMUSC), XEOMIN (INTRAMUSC) Bronchodilators, Beta Agonists Chris Andrews presented the evaluation and recommendation for this class. It was noted there were no significant changes to GINA or GOLD in the 2011 updates that affect PDL decisions. Dr. Conrad motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Andrew Lustbader seconding. The motion was passed unanimously.

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 CONC (INHALATION), MAXAIR (INHALATION), METAPROTERENOL SYRUP (ORAL), METAPROTERENOL TABLET (ORAL), PERFOROMIST (INHALATION), SEREVENT (INHALATION), VENTOLIN HFA (INHALATION), XOPENEX HFA (INHALATION), XOPENEX NEB SOLN (INHALATION), XOPENEX NEB SOLN CONC (INHALATION) COPD Agents Chris Andrews presented the evaluation and recommendation for this class. A new product, Combivent Respimat, is a CFC-free formulation and addition to the Combivent line. Combivent MDI will be discontinued in May of 2013 and once supplies are exhausted the Respimat form will be the only version available. The Committee discussed the possibility of making the Respimat formulation preferred when the MDI supply is exhausted. This was discussed with both DSS and HP who assured the Committee this type of situation could be accommodated. Chris Andrews stated Magellan would notify HP when the MDI supply was exhausted. The Committee agreed to the recommendations as presented with the stipulation that the Respimat would be moved to preferred when the MDI is no longer available. Dr. Cynthia Conrad motioned to approve and accept Provider Synergies recommendations as presented, with Dr. Charles Thompson seconding. The motion was passed unanimously. ON Medicaid PDL: ATROVENT HFA (INHALATION), COMBIVENT (INHALATION), DUONEB (INHALATION), IPRATROPIUM NEBULIZER (INHALATION), SPIRIVA (INHALATION) OFF Medicaid PDL: COMBIVENT RESPIMAT (INHALATION), DALIRESP (ORAL), IPRATROPIUM / ALBUTEROL (INHALATION) Cytokine and CAM antagonists Chris Andrews presented the evaluation and recommendation for this class. It was noted Adalimumab (Humira) is now indicated for inducing and sustaining clinical remission in adult patients with moderately to severely active ulcerative colitis who have had an inadequate response to immunosuppressants such as corticosteroids, AZA, or 6MP. Tocilizumab (Actemra) is now indicated for systemic juvenile idiopathic arthritis in children ages two years and older. American College of Rheumatology (ACR) updated their guidelines in 2012 for management of Rheumatoid Arthritis (RA). There were no changes that impact PDL decisions. The 2011 update to the International Annual Workshop on Advances in Targeted Therapies generally states that there is no evidence to support any TNF antagonist over another. As of November 2011, the FDA is requiring manufacturers of TNF blockers to perform enhanced safety surveillance on these products. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Kevin Chamberlin seconding. The motion was passed unanimously. ON Medicaid PDL: ENBREL DISP SYRINGE (INJECTION), ENBREL KIT (INJECTION), ENBREL PEN (INJECTION), HUMIRA KIT (INJECTION), HUMIRA PEN IJ KIT (INJECTION)

OFF Medicaid PDL: ACTEMRA (INJECTION), CIMZIA KIT (INJECTION), CIMZIA SYRINGE KIT (INJECTION), KINERET (INJECTION), ORENCIA (INJECTION), ORENCIA (SUB-Q), REMICADE (INJECTION), SIMPONI DISP SYRINGE (INJECTION), SIMPONI PEN INJECTER (INJECTION), STELARA DISP SYRINGE (INJECTION) Emollients Chris Andrews presented the evaluation and recommendation for this class. It was noted there are no new clinical updates for this class. Dr. Hilda Slivka motioned to approve and accept Provider Synergies recommendations, with Dr. Andrew Lustbader seconding. The motion was passed unanimously. ON Medicaid PDL: AMMONIUM LACTATE CREAM/LOTION (TOPICAL), LACTIC ACID CREAM/LOTION (TOPICAL) OFF Medicaid PDL: ATOPICLAIR (TOPICAL), AURSTAT (TOPICAL), BIAFINE (TOPICAL), ELETONE (TOPICAL), EMOLLIENT COMBINATION NO. 10, EMOLLIENT COMBINATION NO.32, EMOLLIENT COMBO 35 CREAM (TOPICAL), EMOLLIENT FOAM (TOPICAL), EMOLLIENT FOAM PLUS (TOPICAL), EPICERAM (TOPICAL), HPR PLUS (TOPICAL), HYLATOPIC (TOPICAL), HYLATOPIC PLUS (TOPICAL), HYLATOPIC PLUS-AURSTAT KIT (TOPICAL), LAC-HYDRIN CREAM/LOTION (TOPICAL), MIMYX Epinephrine, Self-Injected Chris Andrews presented the evaluation and recommendation for this class. He noted that the only product in the class currently is Epipen and Epipen Jr. Dr. Hilda Slivka motioned to approve and accept Provider Synergies recommendations, with Dr. Charles Thompson seconding. The motion was passed unanimously. ON Medicaid PDL: EPIPEN (INTRAMUSC), EPIPEN JR (INTRAMUSC) OFF Medicaid PDL: NONE Glucocortocoids, Inhaled Chris Andrews presented the evaluation and recommendation for this class. He noted no new clinical updates for this class. Chris Andrews explained a late financial model made Brand Pulmicort.25/.5mg the preferred products and had the Committee make note on the Cost Sheets. The Committee had a discussion around the Pulmicort 1mg strength and if that should be added to the PDL. Dr. Slivka thought this should be strongly considered. Dr. Sherter explained this medication is usually not covered on most insurance due to pricing and a prior authorization is usually required. Stella Cretella motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Andrew Lustbader seconding. The motion was opposed by Charles Thompson and Hilda Slivka. The motion was passed 9 to 2. 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) Immunomodulators, Atopic Dermatitis Chris Andrews presented the evaluation and recommendation for this class. He noted that there is no new clinical information for this class. Dr. Slivka discussed the merits of Protopic. Dr. Hilda Slivka motioned to approve and accept Provider Synergies recommendations as presented with the addition of Protopic for the Medicaid PDL, with Stella Cretella seconding. The motion was passed unanimously. ON Medicaid PDL: ELIDEL (TOPICAL), PROTOPIC (TOPICAL) OFF Medicaid PDL: NONE Intranasal Rhinitis Agents Chris Andrews presented the evaluation and recommendation for this class. He noted Qnasal is a beclomethasone non-aqueous nasal aerosol (with built-in dose counter) indicated for the treatment of nasal symptoms associated with seasonal and perennial allergic rhinitis in adults and adolescents 12 years of age and older. Zetonna is a ciclesonide nasal aerosol indicated for treatment of symptoms associated with seasonal and perennial allergic rhinitis in adults and adolescents 12 years of age and older. Dymista is a azelastine hydrochloride and fluticasone propionate combo indicated for the relief of symptoms of seasonal allergic rhinitis in patients 12 years of age and older who require treatment with both agents for symptomatic relief. Dr. Andrew Lustbader motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Manage Nissanka seconding. The motion was passed unanimously ON Medicaid PDL: ASTELIN (NASAL), ASTEPRO (NASAL), FLUNISOLIDE (NASAL), FLUTICASONE (NASAL), IPRATROPIUM (NASAL), NASACORT AQ (NASAL), NASONEX (NASAL), PATANASE (NASAL) OFF Medicaid PDL: AZELASTINE (NASAL), BECONASE AQ (NASAL), DYMISTA (NASAL), FLONASE (NASAL), OMNARIS (NASAL), QNASL (NASAL), RHINOCORT AQUA (NASAL), TRIAMCINOLONE (NASAL), VERAMYST (NASAL), ZETONNA (NASAL) Leukotriene Modifiers Chris Andrews presented the evaluation and recommendation for this class. He noted Singulair formulations are now available as generics. It was pointed out by Chris Andrews and Michael Stinchon that the generic formulations are currently preferred although not reflected on the cost sheet. Dr. Hilda Slivka motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Thompson seconding. The motion was passed unanimously.

ON Medicaid PDL: ACCOLATE (ORAL), MONTELUKAST TAB CHEW (ORAL), MONTELUKAST TABLET (ORAL), MONTELUKAST GRAN PACK (ORAL) OFF Medicaid PDL: SINGULAIR GRAN PACK (ORAL), SINGULAIR TAB CHEW (ORAL), SINGULAIR TABLET (ORAL), ZAFIRLUKAST (ORAL), ZYFLO (ORAL), ZYFLO CR (ORAL) Neuropathic Pain Chris Andrews presented the evaluation and recommendation for this class. He discussed the new class and how it was constructed. Lyrica (pregabalin) received approval for an indication of neuropathic pain associated with spinal cord injury. Cymbalta is indicated for the treatment of chronic musculoskeletal pain Dr. Thompson opened a discussion regarding the labeling of Lyrica and use in Fibromyalgia. Dr. Charles Thompson motioned to approve and accept Provider Synergies recommendations as presented with the addition of Lyrica for the Medicaid PDL, with Dr. Hilda Slivka seconding. The motion and addition of Lyrica was opposed by Kevin Chamberlin and Andrew Lustbader. The motion was passed 9 to 2. ON Medicaid PDL: CYMBALTA (ORAL), GABAPENTIN CAPSULE (ORAL), GABAPENTIN SOLUTION (ORAL), GABAPENTIN TABLET (ORAL), LIDODERM (TOPICAL), LYRICA (ORAL), SAVELLA (ORAL), SAVELLA DS (ORAL) OFF Medicaid PDL: SINGULAIR GRAN PACK (ORAL), SINGULAIR TAB CHEW (ORAL), SINGULAIR TABLET (ORAL), ZAFIRLUKAST (ORAL), ZYFLO (ORAL), ZYFLO CR (ORAL) NSAIDs Chris Andrews presented the evaluation and recommendation for this class. He noted that Pennsaid and Flector are now contained in this class. Elizabeth Rodrigues motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Hilda Slivka seconding. The motion was passed 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), VIMOVO (ORAL), VOLTAREN (TOPICAL) OFF Medicaid PDL: ARTHROTEC (ORAL), CELEBREX (ORAL), DAYPRO (ORAL), DICLOFENAC POTASSIUM (ORAL), DICLOFENAC SODIUM (ORAL), DICLOFENAC SR (ORAL), DIFLUNISAL (ORAL), DUEXIS (ORAL), ETODOLAC (ORAL), FENOPROFEN (ORAL), INDOCIN (RECTAL), INDOMETHACIN CAPSULE ER (ORAL), KETOPROFEN ER (ORAL), MECLOFENAMATE (ORAL),

MEFENAMIC ACID (ORAL), MOBIC TABLET (ORAL), NALFON (ORAL), NAPRELAN (ORAL), NAPROSYN SUSPENSION (ORAL), NAPROSYN TABLET (ORAL), NAPROXEN EC (ORAL), OXAPROZIN (ORAL), PENNSAID (TOPICAL), PONSTEL (ORAL), SPRIX (NASAL), TOLMETIN SODIUM CAPSULE (ORAL), TOLMETIN SODIUM TABLET (ORAL), ZIPSOR (ORAL) Ophthalmic Antibiotic- Steroid Combinations Chris Andrews presented the evaluation and recommendation for this class. He noted no clinical updates for the class. Dr. Hilda Slivka motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Andrew Lustbader seconding. The motion 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: NEOMYCIN/POLYMYXIN/HC (OPHTHALMIC), TOBRADEX ST (OPHTHALMIC), TOBRAMYCIN / DEXAMETHASONE SUSPENSION (OPHTHALMIC), ZYLET (OPHTHALMIC) Ophthalmic Antibiotics Chris Andrews presented the evaluation and recommendation for this class. He also noted there are no clinical updates for this class. Dr. Lustbader motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Emmett Sullivan seconding. The motion was passed unanimously. 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 OINTMENT (OPHTHALMIC), GARAMYCIN OINT. (OPHTHALMIC), ILOTYCIN (OPHTHALMIC), NATACYN (OPHTHALMIC), NEOMYCIN/BACITRACIN/POLYMYXIN OINT (OPHTHALMIC), OCUFLOX (OPHTHALMIC), QUIXIN (OPHTHALMIC), SULFACETAMIDE OINTMENT (OPHTHALMIC), ZYMAR (OPHTHALMIC), ZYMAXID (OPHTHALMIC) Ophthalmic Anti-Inflammatories Chris Andrews presented the evaluation and recommendation for this class. He noted Durezol is now approved for treatment of endogenous anterior uveitis. Stella Cretella motioned to approve and accept

Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Hilda Slivka seconding. The motion was passed unanimously. ON Medicaid PDL: DEXAMETHASONE (OPHTHALMIC), DICLOFENAC (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) OFF Medicaid PDL: ACULAR (OPHTHALMIC), ACULAR LS (OPHTHALMIC), ACUVAIL (OPHTHALMIC), BROMDAY (OPHTHALMIC), BROMFENAC (OPHTHALMIC), DUREZOL (OPHTHALMIC), FML (OPHTHALMIC), KETOROLAC (OPHTHALMIC), KETOROLAC LS (OPHTHALMIC), LOTEMAX OINTMENT (OPHTHALMIC), NEVANAC (OPHTHALMIC), OZURDEX (INTRAOCULR), PRED FORTE (OPHTHALMIC), RETISERT (INTRAOCULR), TRIESENCE (INTRAOCULR), VEXOL (OPHTHALMIC), VOLTAREN (OPHTHALMIC), XIBROM (OPHTHALMIC) Ophthalmics for Allergic Conjunctivitis Chris Andrews presented the evaluation and recommendation for this class. He noted. Dr. Hilda Slivka motioned to approve and accept Provider Synergies recommendations as recommended to the Medicaid PDL. Dr. Manage Nissanka seconded the motion. The motion was passed unanimously. ON Medicaid PDL: ALREX (OPHTHALMIC), CROMOLYN SODIUM (OPHTHALMIC), PATADAY (OPHTHALMIC), PATANOL (OPHTHALMIC) OFF Medicaid PDL: ALAMAST (OPHTHALMIC), ALOCRIL (OPHTHALMIC), ALOMIDE (OPHTHALMIC), AZELASTINE (OPHTHALMIC), BEPREVE (OPHTHALMIC), ELESTAT (OPHTHALMIC), EMADINE (OPHTHALMIC), EPINASTINE (OPHTHALMIC), LASTACAFT (OPHTHALMIC), OPTIVAR (OPHTHALMIC) Ophthalmics, Glaucoma Agents Chris Andrews presented the evaluation and recommendation for this class. He also noted Cosopt PF is now available. It is available in single-dose vials. Zioptan is indicated for reducing elevated intraocular pressure in patients with open angle glaucoma or ocular hypertension. Dr. Slivka motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Charles Thompson seconding. The motion was passed unanimously. ON Medicaid PDL: ALPHAGAN P 0.15% (OPHTHALMIC), AZOPT (OPHTHALMIC), BETAXOLOL (OPHTHALMIC), BETIMOL (OPHTHALMIC), BETOPTIC S (OPHTHALMIC), BRIMONIDINE (OPHTHALMIC), CARTEOLOL (OPHTHALMIC), COMBIGAN (OPHTHALMIC), DORZOLAMIDE (OPHTHALMIC), DORZOLAMIDE / TIMOLOL (OPHTHALMIC), ISTALOL (OPHTHALMIC), LATANOPROST 2.5 ML (OPHTHALMIC), LEVOBUNOLOL (OPHTHALMIC), METIPRANOLOL (OPHTHALMIC), PILOCARPINE (OPHTHALMIC), TIMOLOL (OPHTHALMIC), TRAVATAN / TRAVATAN Z 2.5 ML (OPHTHALMIC), TRAVATAN / TRAVATAN Z 5 ML (OPHTHALMIC) OFF Medicaid PDL: ALPHAGAN P 0.1% (OPHTHALMIC), APRACLONIDINE (OPHTHALMIC), BRIMONIDINE P 0.15% (OPHTHALMIC), COSOPT (OPHTHALMIC), COSOPT PF (OPHTHALMIC)),

LUMIGAN 2.5ML (OPHTHALMIC), LUMIGAN 5ML (OPHTHALMIC), LUMIGAN 7.5ML (OPHTHALMIC), TIMOPTIC (OPHTHALMIC), TRUSOPT (OPHTHALMIC), XALATAN 2.5ML (OPHTHALMIC) ZIOPTAN (OPHTHALMIC) OTIC Antibiotics Chris Andrews presented the evaluation and recommendation for this class. He also noted Dr. Andrew Lustbader motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Hilda Slivka seconding. The motion was passed unanimously. ON Medicaid PDL: CIPRODEX (OTIC), NEOMYCIN/POLYMYXIN/HC SOLN/SUSP (OTIC), OFLOXACIN (OTIC) OFF Medicaid PDL: CETRAXAL (OTIC), CIPRO HC (OTIC), COLY-MYCIN S (OTIC), CORTISPORIN- TC (OTIC) OTIC Anti-Infectivies & Anesthetics Chris Andrews presented the evaluation and recommendation for this class. He noted no clinical updates in this class. Dr. Manage Nissanka motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Emmett Sullivan seconding. The motion was passed unanimously. ON Medicaid PDL: ACETIC ACID (OTIC), ACETIC ACID/ALUMINUM (OTIC), ANTIPYRINE / BENZOCAINE (OTIC) OFF Medicaid PDL: ACETIC ACID HC (OTIC), AURAX (OTIC), MYOXIN (OTIC), NEOTIC (OTIC), OTIC CARE (OTIC), OTO-END 10 (OTIC), OTOZIN (OTIC), PINNACAINE (OTIC), PRAMOXINE HC (OTIC), TREAGAN OTIC (OTIC), TRIOXIN (OTIC) Sedative Hypnotics Chris Andrews presented the evaluation and recommendation for this class. He noted Intermezzo is a sublingual tablet formulation of zolpidem tartrate, available in 1.75 and 3.5 mg strengths, indicated for treating patients as needed with insomnia characterized by waking in the middle-of-the-night with difficulty or inability to return to sleep.. Dr. Cynthia Conrad motioned to approve and accept Provider Synergies recommendations as presented with the addition of nateglinide for the Medicaid PDL, with Kevin Chamberlin seconding. The motion was passed unanimously.

ON Medicaid PDL: CHLORAL HYDRATE SYRUP (ORAL), FLURAZEPAM (ORAL), TEMAZEPAM 15MG/30MG (ORAL), ZOLPIDEM TARTRATE (ORAL) OFF Medicaid PDL: AMBIEN (ORAL), AMBIEN CR (ORAL), DORAL (ORAL), EDLUAR (SUBLINGUAL), ESTAZOLAM (ORAL), INTERMEZZA (SUBLINGUAL), LUNESTA (ORAL), RESTORIL 22.5 MG (ORAL), RESTORIL 7.5 MG (ORAL), ROZEREM (ORAL), SILENOR (ORAL), SOMNOTE (ORAL), SONATA (ORAL), TEMAZEPAM 22.5 MG (ORAL), TEMAZEPAM 7.5 MG (ORAL), TRIAZOLAM (ORAL), ZALEPLON (ORAL), ZOLPIDEM ER (ORAL), ZOLPIMIST (ORAL) Smoking Cessation Chris Andrews presented the evaluation and recommendation for this class. He also noted that there has been no new significant information pertaining to this class. Dr. Cynthia Conrad motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Manage Nissanka seconding. The motion was passed unanimously. ON Medicaid PDL: BUPROPION SR (ORAL), CHANTIX TAB DS PK (ORAL), CHANTIX TABLET (ORAL), NICOTINE GUM OTC (BUCCAL), NICOTINE LOZENGE OTC (BUCCAL), NICOTINE LOZENGE OTC (MUCOUS MEM), NICOTINE PATCH OTC (TRANSDERMAL) OFF Medicaid PDL: NICODERM CQ (TRANSDERMAL), NICORETTE GUM OTC (BUCCAL), NICORETTE LOZENGE OTC (BUCCAL), NICOTROL (INHALATION), NICOTROL NS (NASAL) Steroids, Topical High Potency Chris Andrews presented the evaluation and recommendation for this class. He also noted that there has been no new significant information pertaining to this class. Dr. Cynthia Conrad motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Manage Nissanka seconding. The motion was passed unanimously. ON Medicaid PDL: BETAMETHASONE DIPROPIONATE CREAM (TOPICAL), BETAMETHASONE DIPROPIONATE LOTION (TOPICAL), BETAMETHASONE VALERATE CREAM (TOPICAL), BETAMETHASONE VALERATE LOTION (TOPICAL), BETAMETHASONE VALERATE OINT. (TOPICAL), BETA-VAL CREAM (TOPICAL), BETA-VAL LOTION (TOPICAL), FLUOCINONIDE CREAM (TOPICAL), FLUOCINONIDE EMOLLIENT (TOPICAL), FLUOCINONIDE SOLUTION (TOPICAL), TRIAMCINOLONE ACETONIDE CREAM (TOPICAL), TRIAMCINOLONE ACETONIDE LOTION (TOPICAL), TRIAMCINOLONE ACETONIDE OINT. (TOPICAL) OFF Medicaid PDL: AMCINONIDE CREAM (TOPICAL), AMCINONIDE LOTION (TOPICAL), AMCINONIDE OINT. (TOPICAL), BETAMET DIPROP / PROP GLY CREAM (TOPICAL), BETAMET DIPROP / PROP GLY LOTION (TOPICAL), BETAMET DIPROP / PROP GLY OINT. (TOPICAL), BETAMETHASONE DIPROPIONATE GEL (TOPICAL), BETAMETHASONE DIPROPIONATE OINT. (TOPICAL), DESOXIMETASONE CREAM (TOPICAL), DESOXIMETASONE GEL (TOPICAL), DESOXIMETASONE OINT. (TOPICAL), DIFLORASONE DIACETATE CREAM (TOPICAL), DIFLORASONE DIACETATE OINT. (TOPICAL), DIPROLENE AF CREAM (TOPICAL), DIPROLENE OINT. (TOPICAL), FLUOCINONIDE GEL (TOPICAL), FLUOCINONIDE OINT. (TOPICAL), HALOG CREAM (TOPICAL), HALOG OINT. (TOPICAL), KENALOG AEROSOL (TOPICAL), TOPICORT LP CREAM (TOPICAL),TOPICORT OINT. (TOPICAL), VANOS (TOPICAL)

Steroids, Topical Low Chris Andrews presented the evaluation and recommendation for this class. He also noted that there has been no new significant information pertaining to this class. He then noted a switch in the status on Derma-smooth FS to preferred and the generic equivalent to be non-preferred. Dr. Cynthia Conrad motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Manage Nissanka seconding. The motion was passed unanimously. ON Medicaid PDL: ALCLOMETASONE DIPROPIONATE CREAM (TOPICAL), ALCLOMETASONE DIPROPIONATE OINT. (TOPICAL), CAPEX SHAMPOO (TOPICAL),DERMA-SMOOTHE-FS (TOPICAL), DESONIDE CREAM (TOPICAL), DESONIDE OINT. (TOPICAL), DESOWEN LOTION (TOPICAL), HYDROCORTISONE / MIN OIL / PET OINT. (TOPICAL), HYDROCORTISONE ACETATE / UREA (TOPICAL), HYDROCORTISONE CREAM (TOPICAL), HYDROCORTISONE LOTION (TOPICAL), HYDROCORTISONE OINT. (TOPICAL), HYDROCORTISONE / ALOE GEL (TOPICAL) OFF Medicaid PDL: AQUA GLYCOLIC HC (TOPICAL), DESONATE GEL (TOPICAL), DESONIDE LOTION (TOPICAL), FLUOCINOLONE 0.01% OIL (TOPICAL), PEDIADERM HC (TOPICAL), PEDIADERM TA (TOPICAL), TEXACORT (TOPICAL), VERDESO (TOPICAL) Steroids, Topical Medium Chris Andrews presented the evaluation and recommendation for this class. He also noted that there has been no new significant information pertaining to this class. Dr. Cynthia Conrad motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Manage Nissanka seconding. The motion was passed unanimously. ON Medicaid PDL: FLUOCINOLONE ACETONIDE CREAM (TOPICAL), FLUOCINOLONE ACETONIDE OINT. (TOPICAL), FLUOCINOLONE ACETONIDE SOLUTION (TOPICAL), FLUTICASONE PROPIONATE CREAM (TOPICAL), FLUTICASONE PROPIONATE OINT. (TOPICAL), HYDROCORTISONE BUTYRATE CREAM (TOPICAL), HYDROCORTISONE BUTYRATE CREAM BRAND (TOPICAL), HYDROCORTISONE BUTYRATE OINT. (TOPICAL), HYDROCORTISONE BUTYRATE OINT. BRAND (TOPICAL), HYDROCORTISONE BUTYRATE SOLUTION (TOPICAL), HYDROCORTISONE BUTYRATE SOLUTION BRAND (TOPICAL), HYDROCORTISONE VALERATE CREAM (TOPICAL), HYDROCORTISONE VALERATE OINT. (TOPICAL), MOMETASONE FUROATE CREAM (TOPICAL), MOMETASONE FUROATE OINT. (TOPICAL), MOMETASONE FUROATE SOLUTION (TOPICAL), PREDNICARBATE CREAM (TOPICAL), PREDNICARBATE OINT. (TOPICAL) OFF Medicaid PDL: CLODERM (TOPICAL), CORDRAN TAPE (TOPICAL), CUTIVATE CREAM (TOPICAL), CUTIVATE LOTION (TOPICAL), DERMATOP OINT. (TOPICAL), ELOCON CREAM (TOPICAL), FLUTICASONE PROPIONATE LOTION (TOPICAL), LUXIQ (TOPICAL), MOMEXIN (TOPICAL), PANDEL (TOPICAL)

Steroids, Topical Very High Chris Andrews presented the evaluation and recommendation for this class. He also noted that there has been no new significant information pertaining to this class. Dr. Cynthia Conrad motioned to approve and accept Provider Synergies recommendations as presented for the Medicaid PDL, with Dr. Manage Nissanka seconding. The motion was passed unanimously. ON Medicaid PDL: CLOBETASOL EMOLLIENT (TOPICAL), CLOBETASOL PROPIONATE CREAM (TOPICAL), CLOBETASOL PROPIONATE GEL (TOPICAL), CLOBETASOL PROPIONATE OINT. (TOPICAL), CLOBETASOL PROPIONATE SOLUTION (TOPICAL), HALOBETASOL PROPIONATE CREAM (TOPICAL), HALOBETASOL PROPIONATE OINT. (TOPICAL) OFF Medicaid PDL: APEXICON E (TOPICAL), CLOBETASOL PROPIONATE FOAM (TOPICAL), CLOBETASOL LOTION (AG) (TOPICAL), CLOBETASOL SHAMPOO (AG) (TOPICAL) CLOBEX LOTION (TOPICAL), CLOBEX SHAMPOO (TOPICAL), CLOBEX SPRAY (TOPICAL), HALAC (TOPICAL), HALONATE (TOPICAL), OLUX-E (TOPICAL), TEMOVATE OINT. (TOPICAL), ULTRAVATE PAC CREAM (TOPICAL), ULTRAVATE X PAC CREAM (TOPICAL), ULTRAVATE X PAC OINT. (TOPICAL) Committee Discussion Topics: Dr. Sherter mentioned the voting for Chair happens in odd numbered years. Dr. Charles Thompson asked HP if any fail first methodology for the Preferred Drug List was to be enacted. HP was not aware of any changes to the current process. Recommendations for next class reviews: Provider Synergies recommended the following classes be reviewed at the next P&T meeting: ACNE AGENTS, TOPICAL ANALGESICS, NARCOTICS LONG ANALGESICS, NARCOTICS SHORT ANDROGENIC AGENTS ANGIOTENSIN MODULATOR COMBINATIONS ANGIOTENSIN MODULATORS ANTIBIOTICS, GI ANTIBIOTICS, INHALED ANTIBIOTICS, TOPICAL ANTIBIOTICS, VAGINAL ANTICOAGULANTS ANTIEMETICS / ANTIVERTIGO ANTIFUNGALS, ORAL ANTIFUNGALS, TOPICAL ANTIMIGRAINE AGENTS, TRIPTANS ANTIPARASITICS, TOPICAL ANTIVIRALS, ORAL ANTIVIRALS, TOPICAL BETA-BLOCKERS BLADDER RELAXANT PREPARATIONS

BONE RESORPTION SUPPRESSION BPH TREATMENTS CALCIUM CHANNEL BLOCKERS CEPHALOSPORINS AND RELATED ANTIBIOTICS COLONY STIMULATING FACTORS CONTRACEPTIVES, ORAL DIABETIC SUPPLIES ERYTHROPOIESIS STIMULATING PROTEINS FLUOROQUINOLONES, ORAL GROWTH HORMONE H. PYLORI AGENTS HEPATITIS C AGENTS HIV/AIDS HYPOGLYCEMICS, INCRETIN MIMETICS/ENHANCERS HYPOGLYCEMICS, INSULIN HYPOGLYCEMICS, MEGLITINIDES HYPOGLYCEMICS, TZD IMMUNOSUPPRESSANTS LIPOTROPICS, OTHER LIPOTROPICS, STATINS MACROLIDES/KETOLIDES MULTIPLE SCLEROSIS AGENTS OPIATE DEPENDENCE PAH AGENTS, ORAL PANCREATIC ENZYMES PHOSPHATE BINDERS PLATELET AGGREGATION INHIBITORS PRENATAL VITAMINS PROTON PUMP INHIBITORS SKELETAL MUSCLE RELAXANTS TETRACYCLINES, ORAL ULCERATIVE COLITIS AGENTS Schedule next meeting: Committee members will discuss the appropriate time for the next P & T meeting in the coming days. Meeting adjourned at 9:15 pm