1. AHCCCS Pharmacy and Therapeutics Committee October 20, 2015 1 Reaching across Arizona to provide comprehensive quality health care for those in need

2. Introductions 2

3. 3 1. MRPDL History and Purpose 2. AzAHP Feedback on MRPDL 3. Next Steps with MRPDL 4. Committee Name and Purpose 5. Committee Operational Policy Draft Review Goals of Today’s Meeting Reaching across Arizona to provide comprehensive quality health care for those in need

4. AHCCCS Coverage: Medications 1.Medically necessary 2.Cost effective 3.Federally reimbursable 4 Reaching across Arizona to provide comprehensive quality health care for those in need

5. Name of drug list MRPDL Drug List Preferred Drug List Formulary 5 Reaching across Arizona to provide comprehensive quality health care for those in need

6. 6 Developed due to provider feedback Evaluated utilization trend across contractors All therapeutic classes and individual drugs reviewed Consensus based recommendations: 1 vote per health plan MRPDL History: Recap Reaching across Arizona to provide comprehensive quality health care for those in need

7. 7 MRPDL History: Recap Reaching across Arizona to provide comprehensive quality health care for those in need ACUTE# Drugs 10-1-12621 1-1-13740 10-20-15749 ALTCS# Drugs 10-1-12640 1-1-13760 10-20-15769

8. 1-1-13 MRPDL Additions 1.Anthelmintics 2.Pediculosides/Scabicides 3.Antimalarials 4.Antineoplastic and Misc. agents for Prostate 5.Ophthalmic Agents for Glaucoma 6.Blood Modifiers 7.Antidiarrheal Agents 8.Cardiovascular Agents – Angina, atrial fibrillation 9.Women’s Health – progesterone 8 Reaching across Arizona to provide comprehensive quality health care for those in need

9. MRPDL: Current Functions Assist providers when selecting clinically appropriate medications for AHCCCS members Specifies which drugs: o Are preferred agents (HCV) o Require step therapy o Require PA to ensure clinically appropriate medication use o Have quantity limits (QL) Meds not listed on the MRPDL available through Prior Authorization 9 Reaching across Arizona to provide comprehensive quality health care for those in need

10. MRPDL: Current AHCCCS Process for Changes Submit a written request to AHCCCS pharmacy department Requests must include the following information: (1) Medication requested (2) Dosage forms, strengths and corresponding costs of the medication requested; (3) Average daily dosage; (4) FDA indication and accepted off–label use; (5) Advantages or disadvantages of the medication over currently available products on the MRPDL; (6) Adverse effects reported with the medication; (7) Specific monitoring requirements and costs associated with these requirements; and (8) Detailed clinical summary. 10 Reaching across Arizona to provide comprehensive quality health care for those in need

11. AzAHP Feedback 9-14-15: MRPDL Most therapeutic categories require coverage of most, if not all, meds in class Request a standardized process that provides flexibility and transparency 11 Reaching across Arizona to provide comprehensive quality health care for those in need

12. CDC: Most Frequently Prescribed Therapeutic Classes Analgesics Antihyperlipidemic agents Antidepressants 12 Reaching across Arizona to provide comprehensive quality health care for those in need http://www.cdc.gov/nchs/fastats/drug-use-therapeutic.htm

13. 13 MRPDL 1.Atorvastatin 2.Lovastatin 3.Pravastatin 4.Simvastatin Available 1.Atorvastatin 2.Lovastatin 3.Pravastatin 4.Simvastatin 5.Fluvastatin 6.Pitavastatin 7.Rosuvastatin Antihyperlipidemic Agents: Statins Reaching across Arizona to provide comprehensive quality health care for those in need

14. AzAHP Feedback 9-14-15: MRPDL Most therapeutic categories require coverage of most, if not all, meds in class AHCCCS position: MRPDL needs to be re- evaluated in its entirety based on significant changes since 10-1-12 14 Reaching across Arizona to provide comprehensive quality health care for those in need

15. AzAHP Feedback 9-14-15: MRPDL Request a standardized process that provides flexibility and transparency AHCCCS position: agree that standardization, flexibility, and transparency are required at all levels of system (provider, MCO/RBHA, and AHCCCS) 15 Reaching across Arizona to provide comprehensive quality health care for those in need

16. AzAHP Feedback: Benzos All benzos QL 120 tablets per month No consideration of various strengths (safety issue) Not clear if ER dosage forms covered AHCCCS position: Agree that benzodiazepine needs to be reevaluated in its entirety 16 Reaching across Arizona to provide comprehensive quality health care for those in need

17. MRPDL: Benzodiazepines 17 Reaching across Arizona to provide comprehensive quality health care for those in need

18. AzAHP Feedback Narcotic Cough Preparations Current QL=480ml Recommend lower limit =240ml AHCCCS position: agree with recommendation 18 Reaching across Arizona to provide comprehensive quality health care for those in need

19. MRPDL: Narcotic Cough Preparations 19 Reaching across Arizona to provide comprehensive quality health care for those in need

20. AzAHP Feedback Recommend remove pantoprazole from MRPDL due to cost AHCCCS position: need to evaluate further before making decision Pantoprazole is inexpensive (priced at less than $10 per month) Pantoprazole is used by many providers due to other PPI side effect profiles (i.e. omeprazole diarrhea) 20 Reaching across Arizona to provide comprehensive quality health care for those in need

21. MRPDL Recommend one preferred agent in following categories: o Corticosteroid inhalers o Combination inhalers o Anticholinergic inhalers AHCCCS position: need to re-evaluate in its entirety 21 Reaching across Arizona to provide comprehensive quality health care for those in need

22. AzAHP Feedback 22 Reaching across Arizona to provide comprehensive quality health care for those in need

23. AzAHP Feedback: GH Recommend health plans select one Growth Hormone as a preferred agent AHCCCS position: Request denied as GH is one class that AHCCCS is seeking supplemental rebate http://www.azahcccs.gov/commercial/pharmacyupdates.aspx 23 Reaching across Arizona to provide comprehensive quality health care for those in need

24. Other AzAHP Feedback PAH Agents o Make sildenafil the preferred agent Gout agents o Remove Uloric o Remove or place QL on Colcrys ARB o Remove Benicar Remove Ciprodex Otic Remove or use PA or step therapy for Lidocaine Ointment Remove Qualaquin or restrict use for tx of malaria Remove Nystatin/Triamcinolone combination product 24 Reaching across Arizona to provide comprehensive quality health care for those in need

25. Next Steps with MRPDL: Discussion “Start from scratch” vs. use current MRPDL as starting point Who to review? o Development/update of MRPDL by P&T— committee review up next 25 Reaching across Arizona to provide comprehensive quality health care for those in need

26. BREAK 26 Reaching across Arizona to provide comprehensive quality health care for those in need

27. Committee Name and Purpose Drug Utilization Review Board (DURB) o Sec 1927 SS Act o AHCCCS waived in State PlanState Plan o Drug rebate program req. for MCO/FFS Pharmacy and Therapeutics Committee 27 Reaching across Arizona to provide comprehensive quality health care for those in need

28. Committee Functions Core Functions of DURPCurrent level where addressed 1. Developing and submitting recommendations for drug list AHCCCS, DBHS 2. Suggest clinical prior authorizations on outpatient prescription drugs DBHS, MCO Exceptions: AHCCCS- HCV, Tobacco Cessation 3. Recommend educational interventions for Medicaid providers MCO, RBHA 4. Review drug utilizationMCO, RBHA 28 Reaching across Arizona to provide comprehensive quality health care for those in need

29. Committee operational draft policy review 29 Reaching across Arizona to provide comprehensive quality health care for those in need