Pharmacy Utilization Management Program Updates Effective July 2, 2012
The State Health Plan continues to monitor and update pharmacy programs to ensure appropriate medication utilization, address safety concerns and maintain an affordable benefit. The following programs will be implemented July 2, 2012, to help with this ongoing effort.
Prior Authorization Programs
Duexis® (Ibuprofen/famotidine), a medication indicated to relieve the signs and symptoms of osteoarthritis and rheumatoid arthritis and to decrease the risk of developing ulcers in patients who are taking ibuprofen for those indications, will require a prior authorization. The rationale for the prior authorization is to provide coverage for Duexis in situations where the use of traditional nonsteroidal anti-inflammatories may contribute to the likelihood of adverse gastrointestinal side effects.
Dificid™ (Fidaxomicin), is an antibiotic indicated for the treatment of Clostridium difficile-associated diarrhea in adults 18 years of age and older. The rationale for the prior authorization is to ensure the appropriate use of Dificid for the treatment of Clostridium difficile-associated diarrhea when the use of other antibiotics are ineffective or not tolerated.
Kalydeco® (Ivacaftor), is indicated for the treatment of cystic fibrosis and will require prior authorization for all patients. The prior authorization will ensure the appropriate use of Kalydeco for the treatment of cystic fibrosis in patients who have a specific positive gene mutation.
Step Therapy Programs
The State Health Plan will implement new step therapy programs for:
To request a coverage review, providers may call Medco toll-free at 800-417-1764, from 8 a.m. to 9 p.m. Eastern Time, Monday through Friday.