PharmaCare Newsletter


00-007
June 7, 2000

    Compounded Prescriptions Update

    This information is to clarify the eligibility of compounded prescriptions for PharmaCare coverage.
    PharmaCare recognizes compounded prescriptions as rational combinations of active ingredients requiring professional judgement and technical skill in their preparation. The practice of including prescription items with non-prescription items, in an attempt to secure reimbursement, is inappropriate practice.

    The following examples of compounds would NOT be eligible for coverage:
    1. Preparations containing hydrocortisone or betamethasone compounded with non-benefit or over-the-counter products such as Nix® (permethrin) or Eurax® (crotamiton) cream, or an over-the-counter medicated base
    2. Clindamycin in Reversa®, or any other OTC medicated base (exception-clindamycin in Duonalc® is eligible for coverage)
    3. Topical NSAIDs
    4. Topical hormone products - these include progesterone creams, testosterone cream, triple estrogen cream
    5. Compounded estrogen capsules for oral use
    At the present time, there are no randomized controlled trials to support the clinical use of topical NSAIDs and hormones and therefore such compounds are not eligible for PharmaCare coverage.
    Note: All compounded preparations containing retinoic acid would only be a benefit if the physician had obtained a Special Authority for coverage of retinoic acid for the patient.

    Compounds not eligible for coverage:

    • Please use the non-benefit PIN # 66123252

    Compounds eligible for coverage: use one of the following benefit compound PIN #s:

    • 921297 - Compounded Mixture
    • 842435 - Compounded Ointment/Cream
    • 842443 - Compounded Lotion

    Should you have any questions concerning the eligibility of compounded prescriptions, please contact the PharmaNet Help Desk for clarification.
    Please note that claims for non-benefit compounds which are submitted using any of the compound benefit PINs, will be subject to recovery upon audit.

    Methadone - Reminder

    Please ensure all claims for methadone maintenance are submitted as Methadone 1mg/ml, using PIN #999792, with no fee for Plans A and C.
    When dispensing methadone prescriptions for pain management, submit claims under narcotic compounds, PIN #999776, and follow the normal billing practice for drug cost and fee.
    PharmaCare will monitor the use of both PINs. Any methadone claims that are submitted using an inappropriate PIN will be subject to recovery.

    Ipratropium 21 mcg Aerosol Nasal Spray

    The following LCA items should be entered by number of doses, ie. 345, and NOT by ml.

    • Alti-Ipratropium 21 mcg Nasal Spray DIN 2240072
    • PMS-Ipratropium 21 mcg Nasal Spray DIN 2239627
    • Atrovent® 21 mcg Nasal Spray DIN 2240072

Correction : Newsletter 00-01

Page #3, New Products Categorized to LCA and/or RDP:
DIN 2240682 should read " PMS- Fluvoxamine (fluvoxamine maleate) tabs 50 mg ", not

"PMS-Fluoxetine HCl 50mg"

LCA Update

Status Change: MORPHINE SR 30 mg and 60 mg ( M.O.S.® SR Tablets ICN )
Based on the recent price reduction, please be advised that effective August 1, 2000, M.O.S. SR tablets 30mg and 60mg will also be designated as full benefits.

    PRODUCT and DIN

    BENEFIT STATUS

    M.O.S.® SR 30 mg Tablets din 776181

    F

    M.O.S.® SR 60 mg Tablets din 776203

    F

    BENEFITS

    The following new drugs have been included
    as eligible PharmaCare benefits on Plans A, B, C, E and F (criteria follows)

    DIN

    MAN

    DRUG NAME

    Short Term

    Long Term

    Plan G Eligible

    2240334

    KNR

    Alti-Tryptophan (tryptophan) caps 500mg

    		 

    Y

    Y

    2241887

    TAR

    Taro-Desoximetasone (desoximetasone) gel 0.05%

    		  

    Y

    		  

    2240295

    LIL

    Humalog® Mix25 (Pen)

    		  

    Y

    		  

    2241283

    LIL

    Humalog® Pen

    		  

    Y

    		  

    2239713

    RXP

    Rhoxal-Valproic (valproic acid) caps 500mg EC

    		  

    Y

    Y

    2239714

    RXP

    Rhoxal-Valproic (valproic acid) caps 250mg

    		  

    Y

    Y

    Humalog® Pens
    Effective immediately, PharmaCare will provide partial coverage for Humalog® Pen and Humalog® Mix 25 Pen. Coverage for these products will be provided up to the average PharmaCare claimed price of human biosynthetic regular (short-acting) insulin, subject to the usual plan eligibility requirements and deductibles. Patients will be required to pay the difference in cost between the current PharmaCare maximum price (currently $1.9625 per ml) and the claimed price for Humalog® Pen and Humalog Mix 25® Pen.

    NEW PRODUCTS CATEGORIZED TO LCA and/or RDP

    The following new products will be included as benefits
    under the LCA/RDP Program for Benefit Groups A, B, C, E, & F

    DIN

    MAN

    DRUG NAME

    FULL/
    PARTIAL

    LCA/RDP Price

    Short Term

    Long Term

    Plan G Eligible

    2241704

    NOP

    Novo-Gemfibrozil (gemfibrozil) caps 300mg

    P

    0.3545

    		  

    Y

    		  

    2241575

    APX

    APO-Levobunolol (levobunolol HCl) sol 0.25%

    P

    1.2399

    		  

    Y

    		  

    2241574

    APX

    APO-Levobunolol (levobunolol HCl) sol 0.5%

    P

    1.6113

    		  

    Y

    		  

    2241224

    SIL

    Sab-Diclofenac (diclofenac sodium) supp 50mg

    P

    0.6800

    		  

    Y

    		  

    2241225

    SIL

    Sab-Diclofenac (diclofenac sodium) supp 100mg

    P

    0.9408

    		  

    Y

    		  

       

    LCA and/or RDP (cont'd)

    		          

    DIN

    MAN

    DRUG NAME

    FULL/
    PARTIAL

    LCA/RDP Price

    Short Term

    Long Term

    Plan G Eligible

    2231327

    NOP

    Novo-Naprox SR (naproxen) tab SR 24h 750mg

    P

    0.8763

    		  

    Y

    		  

    2241826

    YMG

    Schein Amoxicillin (amoxicillin trihydrate) caps 250mg

    P

    0.1065

    Y

    		    

    2241827

    YMG

    Schein Amoxicillin (amoxicillin trihydrate) caps 500mg

    P

    0.2072

    Y

    		    

    2242177

    YMG

    Scheinpharm Fluoxetine caps 10mg

    P

    1.1502

    		  

    Y

    Y

    2242178

    YMG

    Scheinpharm Fluoxetine caps 20mg

    P

    1.0718

    		  

    Y

    Y

    RESTRICTED BENEFITS

    Special Authority Only (criteria follows)

    DIN

    MAN

    DRUG NAME

    Short Term

    Long Term

    2241007

    FRS

    Hyzaar® DS (losartan potassium/hctz) tabs 100-25mg

    		  

    Y

    2241818

    SFY

    Avalide® (irbesartan/hydrochlorothiazide) tabs 150/12.5mg

    		  

    Y

    2241819

    SFY

    Avalide® (irbesartan/hydrochlorothiazide) tabs 300/12.5mg

    		  

    Y

    2240867

    NOP

    Novo-Nabumetone (nabumetone) tabs 500mg

    		  

    Y

    Hyzaar® DS (losartan potassium/ hydrochlorothiazide) & Avalide® (irbesartan/hydrochlorothiazide)

    • for the treatment of hypertension for patients who have experienced a cough with ACE inhibitors and who also require a diuretic.

    Advair® (salmeterol+fluticasone), revised criteria

    Coverage for Advair® (salmeterol+fluticasone) is currently available as a restricted benefit for the treatment of asthma for patients who require both corticosteroid and long-acting beta agonist therapy and have been previously stabilized on the above products for a period of time. Patients are required to have met the initial criteria for coverage of salmeterol.
    Coverage for salmeterol is currently provided for patients experiencing breakthrough symptoms when given optimal corticosteroid and short-acting beta agonist therapy.
    Based on the recommendations of PharmaCare's Drug Benefit Committee (DBC), the following changes will be in effect as of June 1, 2000:
    1. Respirologists and allergists will be exempt from the special authority process, similar to the exemption for salmeterol. Written or verbal requests from these specialists groups will no longer be required for coverage of Advair®
    2. PharmaCare will accept requests for Advair® coverage from pharmacists for patients who already have a current special authority approval for salmeterol and who are also receiving concomitant corticosteroid therapy.

    NON-BENEFITS

    PharmaCare's Drug Benefit Committee (DBC) recently completed the review of the following
    products and recommended that these products not be added as a benefit
    under the program (criteria follows)

    DIN

    MAN

    DRUG NAME

    2218488

    UNK

    Merrem® PWS IV (meropenem) vial 500mg

    2218496

    UNK

    Merrem® PWS IV (meropenem) vial 1g

    2219018

    UNK

    Merrem® add-vantage (meropenem) vial 500mg

    2219026

    UNK

    Merrem® add-vantage (meropenem) vial 1g

    2240863

    GOW

    Relenza® (zanamivir) 5mg

    Merrem® (meropenem) IV solution

    • currently intravenous therapy administered at home falls under the jurisdiction of the regional health boards and not under the mandate of PharmaCare.

    Relenza® (zanamivir) 5mg

    • PharmaCare's Drug Benefit Committee (DBC) has completed the review of zanamivir and concluded that there is insufficient evidence from published randomized controlled trials to assess whether zanamivir provides a therapeutic advantage over placebo in the treatment of influenza.
    • there is no evidence that zanamivir prevents any of the complications of influenza, ongoing morbidity as a result of an influenza episode, or mortality. The DBC noted concerns about the very low number of high-risk patients who participated in the studies and about the induction of bronchospasm in patients with asthma or other respiratory disease.

    Cipro® IV Solutions: Change in benefit status

    Currently intravenous therapy adminstered at home falls under the mandate of the Regional Health Boards and not under the mandate of the PharmaCare Program. Effective June 1, 2000, Cipro® IV solutions (DIN 2155982) will no longer be available as a benefit under this Program.

DRUGS UNDER REVIEW

    The following drug submissions are currently under review by the Therapeutics Initiative, Pharmacoeconomics Initiative and the Drug Benefit Committee of PharmaCare.

    ancestim (STEMGEN®)
    alendronate (FOSAMAX®), resubmission
    azithromycin (ZITHROMAX®), resubmission
    bisoprolol (MONOCOR®)
    celecoxib (CELEBREX®), resubmission
    diazepam rectal gel (DIASTAT®)
    epoprostenol (FLOLAN®), new indication
    erythropoeitin (EPREX®), resubmission
    filgrastim (NEUPOGEN®), new indication
    fosfomycin tromethamine (MONUROL®)
    imiquimod cream 5% (ALDARA®)
    interferon alfacon-1 (INFERGEN®)
    leflunomide (ARAVA®)
    levonorgestrel (Plan B)
    modafinil (ALERTEC®)
    quetiapine (SEROQUEL®), resubmission
    raloxifene HCl (EVISTA®), resubmission
    risedronate sodium (ACTONEL®)
    rizatriptan benzoate (MAXALT®)
    rofecoxib (VIOXX®)
    ropinirole HCl (REQUIP®), resubmission
    rosiglitazone (AVANDIA®)
    salmon-calcitonin 2000IU (MIACALCIN®)
    tamsulosin (FLOMAX®), resubmission
    zafirlukast (ACCOLATE®), resubmission
    tizanadine (ZANAFLEX®)