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    Pharmacy & Therapeutics Committee Meeting Minutes — Coverage Criteria

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    Minutes and decisions from the Executive Office of Health and Human Services Pharmacy & Therapeutics Committee meeting on December 12, 2018, documenting therapeutic class reviews, public testimony, committee votes, and recommendations affecting pharmacy coverage and prior authorization practices.

    Policy Summary
    PayerExecutive Office of Health and Human Services
    PolicyPharmacy & Therapeutics Committee Meeting Minutes — Coverage Criteria
    Policy CodePolicy N/A
    Change TypeCommittee minutes — coverage recommendations
    Effective DateN/A
    Next Review DateApr 9, 2019
    Key ActionSubmit prior authorization requests for PCSK9 agents (Repatha) per the PA process.
    SourceLink
    POLICY UPDATE CHANGES

    No material clinical or coverage changes in this revision.

    1meeting held on
    17review items
    2019committee officers
    42019 meetings

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    9:40 AMadjourned

    Therapeutic Class Recommendations & Coverage Decisions

    Therapeutic Class Recommendations

    Committee decisions by therapeutic class (motions generally accepted unless noted):

    Antianginal Modulators & Combinations: Recommendations accepted; recalls/market availability (e.g., valsartan) were considered

    Motion accepted

    Antianginal & anti-ischemics: Recommendations accepted

    Motion accepted

    Anticoagulants: Recommend switching from Lovenox to enoxaparin; recommendations accepted

    Motion accepted

    Anticonvulsants: Flip Dilantin chewables to phenytoin chewable; noted new product Epidiolex (new to federal rebate program) with indication for Lennox-Gastaut; RI PA process applies to new-to-market items; request DUR follow-up for long-term use

    Motion accepted

    Antidepressants, other: Add fluvoxamine oral (non-extended release) without a fail-first; motion passed 6:1

    Partial dissent recorded

    Antidepressants, SSRIs: Add citalopram solution; recommendations accepted

    Motion accepted

    Beta Blockers: New extended-release metoprolol formulation accepted

    Motion accepted

    Bile Salts: No changes; recommendations accepted

    Motion accepted

    Calcium Channel Blockers: No changes; recommendations accepted

    Motion accepted

    Lipotropics, Other: Updated indication for Repatha; PCSK9 agents available with prior authorization; removal of niacin products (including OTC niacin ER, Niaspan, Slo-niacin) approved

    Motion accepted

    Lipotropics, Statins: No new information; recommendations accepted

    Motion accepted

    Neuropathic Pain: Lyrica (pregabalin) indication updated to include patients down to 4 years; addition of gabapentin tablets; recommendations accepted

    Motion accepted

    NSAIDS: Recommendations accepted

    Motion accepted

    PAH Agents: Recommendations accepted

    Motion accepted

    Platelet Inhibitors: Recommendations updated to include prasugrel and remove ticlopidine due to no utilization

    Motion accepted

    Progestins for Cachexia: Recommendations accepted

    Motion accepted

    Rosacea Agents: Recommendations accepted; compliance concerns noted

    Motion accepted

    The committee voted to remove several niacin products from the formulary recommendations. Specifically, the motion accepted removal of OTC niacin ER, Niaspan, and Slo‑niacin from the Lipotropics (Other) class recommendations.

    Prior Authorization, Step Therapy, and DUR Actions

    Prior Authorization

    Prior authorization required for PCSK9 agent (Repatha)

    PCSK9 agents (Repatha/evolocumab) are subject to prior authorization; providers must submit a PA request when seeking coverage for these drugs.

    Step Therapy

    Selective exemption from fail‑first for fluvoxamine (oral, non‑ER)

    The committee approved adding fluvoxamine oral (non–extended release) without a fail‑first requirement; providers may prescribe this formulation without completing step‑therapy first.

    • Motion passed 6:1 to add fluvoxamine oral (non‑extended release) without a fail‑first.

    Committee Purpose and Scope

    The Pharmacy & Therapeutics Committee conducts regular reviews of therapeutic classes, new formulations, and new‑to‑market drugs. During these reviews the committee considers updated indications and public testimony, and makes recommendations regarding formulary placement, prior authorization, and utilization management. Committee motions recorded in the minutes reflect these routine responsibilities and decisions.

    Key Terms and Abbreviations

    prior authorization (PA)
    AbbreviationPA
    TermPrior authorization
    DefinitionA Rhode Island process requiring approval before coverage for certain new-to-market or specific medications; used to manage utilization and ensure appropriate use
    Context from minutesRI has PA process in place for new-to-market items; PCSK9 agents (Repatha) are available with prior authorization
    drug utilization review (DUR)
    AbbreviationDUR
    Term

    Initial Therapy Adjustments and Decisions

    Initial therapy adjustments

    Selected initial-therapy related decisions noted by the committee:

    Fluvoxamine: Added oral (non-extended release) without a fail-first requirement

    Motion passed 6:1

    Citalopram solution: Added to recommendations

    Motion accepted

    Step Therapy Exceptions and Tabled Items

    Agent / TherapyStep-therapy requirementNotes
    Fluvoxamine (oral, non-extended release)
    No fail-first required
    Committee voted to add fluvoxamine oral (non-extended release) without a fail‑first requirement; motion passed 6:1.
    Policy Summary
    PayerExecutive Office of Health and Human Services
    PolicyPharmacy & Therapeutics Committee Meeting Minutes — Coverage Criteria
    Policy CodePolicy N/A
    Change TypeCommittee minutes — coverage recommendations
    Effective DateN/A
    Next Review DateApr 9, 2019
    Key ActionSubmit prior authorization requests for PCSK9 agents (Repatha) per the PA process.
    SourceLink
    On This Page
    Therapeutic Class Recommendations & Coverage DecisionsPrior Authorization, Step Therapy, and DUR ActionsCommittee Purpose and ScopeKey Terms and AbbreviationsInitial Therapy Adjustments and DecisionsStep Therapy Exceptions and Tabled Items
    Documentation Required

    DUR follow‑up and monitoring for new agents

    The committee requested that DUR follow up on long‑term use of certain new products (for example, new antiepileptic agents) and report findings to the DUR committee; providers should expect DUR monitoring of these agents.

    • Request that DUR follow up on patients using new products long‑term and report to the DUR committee.
    • Concerns about long‑term use were specifically noted for new anticonvulsant products (Epidiolex).
    Denial Risk

    New‑to‑market drugs may require prior authorization

    Rhode Island maintains a PA process for new‑to‑market items; newly introduced products (e.g., Epidiolex) may be subject to prior authorization and subsequent DUR follow‑up.

    • RI has a PA process in place for new‑to‑market items.
    • New products may be subject to both PA and DUR monitoring.
    Drug utilization review
    DefinitionCommittee-led monitoring and follow-up of medication use (e.g., long-term use of new antiepileptic products) to ensure appropriate therapy and report findings to the DUR committee
    Context from minutesConcerns regarding long term use of new products; request that DUR follow up on each of these patients and report to the DUR committee