A PUBLICATION TO SUPPORT OUR NETWORK OF PHARMACY PROFESSIONALS

FALL 2013 • VOLUME 6 • ISSUE 4

New commercial products and drug formularies for 2014 Beginning in 2014, Independent Health will be offering a number of new small group and individual products as a result of the Affordable Care Act. We have added many new products to our product portfolio that will be available directly from Independent Health and through the NY State of Health: The Official Health Plan Marketplace. You can view a complete list of our Small Group products at http://bit.ly/SmallGroupProducts. Since we are adding additional products to our portfolio for 2014, we have also expanded our pharmacy offerings to include three commercial drug formularies. Drug Formulary I: For large groups; small groups through their 2014 renewal date Drug Formulary II: For Individual plans, on and off the NY State of Health; small groups on the NY State of Health Drug Formulary III: For small groups off the NY State of Health Drug Formulary I is our current commercial drug formulary. Drug Formularies II and III will include non-preferred generics on Tier 2. In addition, brand-name drugs that have generic equivalents will be non-formulary (not covered) on Formularies II and III. You may view the formularies on independenthealth.com by clicking on “Drug Covered” under “Tools, Forms & More” on the homepage.

Independent Health offers tablet splitting program As you are aware, rising prescription drug costs make patient adherence challenging. However, studies show medications that maximize cost-effectiveness, while providing the desired outcome, will minimize unnecessary treatment costs and potentially improve patient adherence. Independent Health’s tablet splitting program is a voluntary program designed to save patients money. When a patient and their doctor agree, patients are able to save half of their copayment (copayments vary by plan) when they split a higher dose tablet in half to achieve the prescribed dose. Listed below are the medications that may be dispensed through Independent Health’s tablet splitting program. To assist our members in splitting their medications as accurately as possible, one tablet splitter is available at no cost to the member if they are taking a tablet splitting program medication. Tablet splitters may be adjudicated directly to Independent Health via our online claims processing system. Value of tablet splitter not to exceed $5.00. • Abilify® 5 mg, 10 mg, 15 mg • Atorvastatin Calcium (Lipitor®) 10 mg, 20 mg, 40 mg • Bisoprolol (Zebeta®) 5 mg • Citalopram (Celexa®) 10 mg, 20 mg • Crestor® 5 mg, 10 mg, 20 mg • Diovan® 40 mg, 80 mg, 160 mg • Enalapril (Vasotec®) 2.5 mg, 5 mg, 10 mg • Enalapril/htcz (Vaseretic®) 5/12.5 mg • Fosinopril (Monopril®) 10 mg, 20 mg • Irbesartan (Avapro®) 75 mg, 150 mg

• Irbesartan /htcz (Avalide®) 150/12.5 mg • Januvia® 25 mg, 50 mg • Escitalopram (Lexapro®) 5 mg, 10 mg • Lisinopril (Prinivil®, Zestril®) 2.5 mg, 5 mg, 10 mg • Lisinopril/htcz (Prinzide®, Zestoretic®) 10/12.5 mg • Lovastatin (Mevacor®) 10 mg, 20 mg • Onglyza® 2.5 mg • Paroxetine (Paxil®) 10 mg, 20 mg • Perindopril (Aceon®) 2 mg, 4 mg

• Pravastatin (Pravachol®) 10 mg, 20 mg • Quinapril (Accupril®) 5 mg, 10 mg, 20 mg • Quinapril/htcz (Accuretic®) 10/12.5 mg • Sertraline (Zoloft®) 25 mg, 50 mg • Simvastatin (Zocor®) 5 mg, 10 mg, 20 mg, 40 mg • Trandolapril (Mavik®) 1 mg, 2 mg • Valsartan/htcz (Diovan HCT) 80/12.5 mg, 160/12.5 mg

PHARMACY HELP DESK If you have question regarding any of the information in the issue, please call our Pharmacy Help Desk at (716) 631-2927 or 1-800-993-9898, Monday through Friday from 8 a.m. to 11 p.m. and Saturday and Sunday from 8 a.m. to 8 p.m. Additional information regarding when the Help Desk is closed can be found on page 2.

Fraud Prevention Health care fraud can cost the government millions of dollars annually and increase the cost of health care nationwide. Examples of health care fraud range from an individual using someone else’s coverage or insurance card to a health care provider billing for services that were not provided. If you become aware of any potentially fraudulent or illegal activity, please contact Independent Health’s Integrity Help Line toll-free at 1-877-229-4916.

What to do when you get a rejection and the help desk is closed Our claim processing statistics indicate that our help desk is currently open when approximately 95 percent of Independent Health prescriptions are filled. The normal hours of operation for our help desk are Monday through Friday from 8 a.m. to 11 p.m. and Saturday and Sunday from 8 a.m. to 8 p.m. Unfortunately, there will be some rejects occurring for medically necessary drugs when our help desk is not open. Here’s what to do when… 1. A claim rejects because the drug is non-formulary, requires prior authorization, and 2. The prescription is urgent, and the patient cannot reasonably wait until the next time the help desk is open to obtain and begin taking the medication, and 3. You are confident of the member’s eligibility with Independent Health.

Has Your Provider Information Changed? Independent Health is continuously updating its pharmacy information to ensure the most accurate and complete information possible is available for published directory listings, as well as for service remittance addresses, phone and fax numbers, state identification, status and billing. If any of the above listed or any related items should change in your pharmacy, please let us know in writing at: Independent Health Attn.: Pharmacy Department 511 Farber Lakes Drive Buffalo, New York 14221

Read Script on the Internet Read Script online at: independenthealth.com. Accessible in the Providers section under “Publications for Providers.”

A. You can dispense up to a five-day supply of medication to Independent Health members with prescription coverage. You will need to call the next time the help desk is open to obtain an override for the dispensed amount and to determine how to obtain coverage for the remaining amount. Independent Health will honor your decision for the five-day supply, provided you have made your best effort to confirm that the member is an active member (i.e., holding a valid Independent Health identification card). OR B. You can call our 24-Hour Medical Help Line at (716) 631-8701 or 1-800-501-3439, and press two. A nurse is available 24 hours a day/7 days a week and will be able to page a staff pharmacist or medical director to determine if an override can be given. While you’re posting phone numbers by your phone, our 24-Hour Medical Help Line number is a good one to add. If a claim rejects for eligibility reasons, your best option is to have the member pay cash for part or all of the prescription and work out the eligibility issues with our Member Services Department and/or their employer. If they are later determined to have been eligible, they will be able to submit their receipts for reimbursement.

Pharmacist satisfaction survey winners announced Independent Health’s marketing research department recently sent out pharmacist satisfaction surveys to our pharmacy network. Pharmacists were asked to complete these surveys and return them to Independent Health by September 30, 2013. The completed surveys are being reviewed and analyzed by our marketing research department and results will be printed in the next issue of Script. The winners of the $100 gift certificates were:

Script is published quarterly for Independent Health’s network of pharmacy professionals

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• Joe Rutkowski, Tile Pharmacy • Alicia Meaney, Rite Aid Pharmacy

Director of Pharmacy: Martin Burruano

• Dawn Rae Eklum, South Dayton Pharmacy

Editors of Script: Cheryl Paul, Jennifer Gallardo

Congratulations to the winners. Thank you to everyone who took the time to complete the survey.

• Rachel Giroux, Wurlitzer Family Pharmacy

FALL 2013

Reminder: Independent Health members may be receiving new ID cards As you know, Independent Health began transitioning to a new core administrative system in July 2013. At that time, approximately 3,000 Independent Health members moved to the new system as a pilot group. Those members received new ID cards that featured new member and group ID numbers.

It is important that beginning on January 1, 2014, you ask all Independent Health members to show you their ID cards so you can verify that your pharmacy has the correct ID number on file. Please note that any claims submitted with Social Security numbers after January 1, 2014, will no longer be accepted and will reject. There will no longer be any social security based ID numbers in Independent Health’s new system.

Beginning January 1, 2014, Independent Health will begin transitioning the remainder of our members to the new core administrative platform, which means that some Independent Health members will receive new ID If you have questions, call Independent Health’s Pharmacy Help Desk cards with new member ID numbers. The new member ID numbers will (information located on the front cover). feature 11 digits and may begin with one of the following: A, AA, D, or 9.

Recent FDA MedWatch updates on safety and efficacy issues The following are recent U.S. Food and Drug Administration (FDA) alerts or changes that were made to the package labeling of drugs, based on concerns for patient safety or efficacy: • Nizoral (ketoconazole): Drug Safety Communication – Potentially Fatal Liver Injury, Risk of Drug Interactions and Adrnal Gland Problems: Nizoral tablets should be used only for the treatment of certain life-threatening mycoses when the potential benefits outweigh the risks and alternative therapeutic options are not available or tolerated. The liver status of the patient should be assessed before starting oral ketoconazole, and serum ALT levels monitored during treatment. Adrenal function should be monitored in patients with adrenal insufficiency or with borderline adrenal function and in patients under prolonged periods of stress (major surgery, intensive care, etc.). All concomitant medications should be reviewed for potential drug interactions with Nizoral tablets. • Mefloquine Hydrochloride: Drug Safety Communication – Label Changes Due To Risk of Serious Psychiatric and Nerve Side Effects: Patients, caregivers and health care professionals should watch for neurologic side effects including dizziness, loss of balance, or ringing in the ears. Psychiatric side effects include feeling anxious, mistrustful, depressed, or having hallucinations when using mefloquine to prevent malaria. If a patient develops neurologic or psychiatric symptoms, the patient should contact the prescribing health care professional, and mefloquine should be stopped and an alternate medicine should be used. Neurologic side effects can occur at any time during drug use and can last for months to years after the drug is stopped, or can be permanent. • Acetaminophen: Drug Safety Communication – Association with Risk of Serious Skin Reactions: The FDA notified healthcare professionals and patients that acetaminophen has been associated with a risk of rare but serious skin reactions known as Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP) and can be fatal. They can occur with first-time use of acetaminophen or at any time while it is being taken. Other drugs used to treat fever and pain/body aches (NSAIDS, ASA) also carry the risk of causing serious skin reactions, which is already described in the warnings section of their drug labels.

• Duragesic (fentanyl) Patches: Drug Safety Communication – Packaging Changes to Minimize Risk of Accidental Exposure: The FDA is requiring color changes to the writing on Duragesic (fentanyl) pain patches so they can be seen more easily. The FDA continues to learn of deaths from accidental exposure to fentanyl patches. • Arzerra (ofatumumab) and Rituxan (rituximab): Drug Safety Communication – New Boxed Warning, Recommendations to Decrease Risk of Hepatitis B Reactivation: Despite listing this safety concern in the Warning and Precautions sections of the package insert, cases of hepatitis B virus (HBV) reactivation continue to occur leading to death. Recommendations are for HBV screening prior to initiation of treatment with Arzerra or Rituxan. Consultation with a hepatitis expert should occur in patients who have previous HBV exposure. In addition, patients already on Arzerra or Rituxan with evidence of prior HBV infection should be monitored for clinical and laboratory signs of HBV reactivation during therapy and for several months after, since reactivations have occurred several months following completion of therapy with these drugs. • Tygacil (tigecycline): Drug Safety Communication – Increased Risk of Death: A meta-analysis of 13 Phase 3 and 4 trials showed a higher risk of death among patients receiving Tygacil compared to other antibacterial drugs. A new Boxed Warning has been added to Tygacil prescribing information describing an increased risk of death when it is used for both FDA-approved and non-approved uses. Tygacil should be reserved for use in situations when alternative treatments are not suitable. It is FDA-approved to treat complicated skin and skin structure infections (cSSSI), complicated intra-abdominal infections (cIAI), and community-acquired bacterial pneumonia (CABP). It is not indicated for treatment of diabetic foot infection or for hospital-acquired or ventilator-associated pneumonia. Script does not publish all FDA alerts. For a complete summary of all alerts, please visit www.fda.gov/Safety/MedWatch.

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HELPFUL MEDICARE PART D I NFORMATION

Independent Health’s 2014 Transition Policy Some members in our plan may be taking drugs that are not on our formulary or that are subject to certain restrictions, such as prior authorization or step therapy. The following members are eligible for the transition process and are advised to discuss with their doctors whether they should switch to a different drug that Independent Health covers or request a formulary exception in order to obtain coverage for the drug they are currently taking: • New Independent Health Medicare Part D enrollees; • Medicare Part D enrollees transitioning from one treatment setting to another; • Medicare Part D enrollees switching from one plan to another after the start of a contract year; • Medicare Part D enrollees residing in a long-term care (LTC) facility; or • Current Medicare Part D enrollees affected by formulary changes from one contract year to the next. The transition process is initiated when a transition eligible member fills a prescription for a drug that is not on our formulary or that is subject to certain restrictions, such a prior authorization or step therapy. The following steps are followed: Our adjudication system (RXClaim) automatically processes non-formulary drugs at the point-of-sale, excluding high potency narcotic drugs, excluded drugs, drugs that require review for safe utilization, or drugs otherwise not covered by Part D. The transition process will apply to any new prescription for a non-formulary drug if the distinction cannot be made between a brand new prescription for a non-formulary drug and an ongoing prescription for a non-formulary drug at the point of sale. If during the adjudication process, the claim hits an edit that requires prior authorization or step therapy, the system automatically refers to the member’s eligibility file to determine transition appropriateness. If the member meets the eligibility requirements, the claim is automatically processed, with messaging to the pharmacy stating it was a transition fill. If transition eligibility is unable to be automatically determined, the claim will reject and a manual transition process will occur. a) Upon outreach from the dispensing pharmacy, the Independent Health Pharmacy Help Desk staff uses information obtained from the RxClaim adjudication system and from the dispensing pharmacy, to determine if the member fulfills the previously mentioned criteria for transition fills. b)If the member meets one of the above transition process qualifiers, the Help Desk staff enters a transition override authorization into the RxClaim adjudication system, which triggers a point-of-sale notification to the pharmacist through the claims system, messaging “Transition” to indicate that the prescription fill is a transitional supply. c) If the Independent Health Help Desk cannot determine transition eligibility, Part B vs. Part D needs to be determined, or if additional clinical review is warranted, a Clinical Pharmacist reviews all information obtained from the member’s dispensing pharmacy, physician, or member in order to fully evaluate the member’s transition eligibility and clinical needs. If the reviewing pharmacist determines that the member is eligibile for transition, a transition override is entered into the RxClaim adjudication system. If the member is not eligible for transition, the member is offered the right to the Coverage Determination and Exceptions process. A report is generated the following day to gather all claim transactions that hit the transition supply edit. From this report, letters are generated and sent to enrollees and their prescribing provider, notifying them of the fill. Coverage and Timeframes • In the retail setting, the one-time temporary supply of non-formulary Part D drugs is for at least a 30 day supply of medication, unless the enrollee presents a prescription written for less than 30 days in which case Independent Health allows multiple fills to provide up to a total of 30 days of medication, anytime during the first 90 days of a member’s enrollment in a plan. • In the LTC setting, coverage is provided for a 91 to 98 day supply (unless the member presents with a prescription written for less), with multiple refills as necessary up to a 91 to 98 day supply during the first 90 days of the beneficiary’s enrollment in a plan beginning on the enrollee’s effective date of coverage. If the enrollee in a LTC setting is outside his or her 90-day transition period, Independent Health provides an emergency supply of non-formulary Part D drugs for 31 days, unless the prescription is written for less than 31 days. • For enrollees admitted or discharged from a LTC facility or have any change in level of care, early refills are allowed, and early refill edits cannot be applied. All such edits must be promptly overridden so we are not limiting appropriate and necessary access to the member’s Part D benefit. Independent Health provides sufficient refills for prescriptions dispensed for less than the written amount due to quantity limits for safety purposes or drug utilization edits that are based on approved product labeling. continued on next page 4

HELPFUL MEDICARE PART D I NFORMATION At the point of sale, the pharmacist is advised to reprocess the claim, the adjudication system applies appropriate cost-share based on the member’s low-income subsidy (LIS) or non-LIS status, and the pharmacy transaction is complete. Low-Income Subsidy Independent Health requires that cost-sharing for a temporary supply of drugs provided under its transition process never exceeds the statutory maximum co-payment amounts for LIS eligible members. Non-Low-Income Subsidy For non-LIS members, Independent Health requires that cost-sharing for a temporary supply of drugs provided under its transition process is based on one of its approved cost-sharing tiers and is consistent with cost-sharing Independent Health would charge for non-formulary drugs approved under a coverage exception. A letter is generated to the enrollee or enrollee’s representative advising him/her of the issue identified and potential formulary alternative(s) that are available without restriction(s) within 3 business days of temporary fill via US Mail. The notice includes: • An explanation of the temporary nature of the transition supply the enrollee has received. • Instructions for working with Independent Health and the enrollee’s prescriber to identify appropriate therapeutic alternatives that are on the formulary. • An explanation of the enrollee’s right to request a formulary exception. • A description of the procedures for requesting a formulary exception to continue coverage beyond the override period. For long-term care residents dispensed multiple supplies of a drug in increments of 14 days or less, the written notice is provided within 3 business days after adjudication of the first temporary fill. Independent Health sends a copy of the letter to the physician so that he/she is aware of the steps Independent Health took to notify the enrollee or enrollee’s representative of therapeutically appropriate formulary alternative(s). The enrollee/physician is asked to respond before the override period is exhausted. If the enrollee or physician requests the medical exception within the override time period, Independent Health processes the medical exception request in accordance with its Medicare Advantage Part D Coverage Determinations and Exceptions Policy and Procedures. Failing an affirmative medical necessity determination, the enrollee and physician are notified of the denial which includes the formulary alternatives. For LTC members, if the enrollee or physician does not request the medical exception within the override time period, Independent Health provides an additional 31 day supply, while an exception is being processed. If after the additional 30 day time period such request is not received, future claims deny and the enrollee will be responsible for payment of the full cost of the prescription. However, Independent Health extends the transition period on a case-by-case basis, if the enrollee’s exception request or appeal has not been processed by the end of the minimum transition period. In preparation for the new Plan Year, Independent Health mails a formulary change letter to all Part D members impacted by the negative formulary changes from one contract year to the next. This notification is sent out at least 60 days in advance. In addition, all negative changes are posted in a document on the Independent Health website for public reference.

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HELPFUL MEDICARE PART D I NFORMATION

2014 formulary changes for drugs considered to be high risk in the elderly The Medicare Part D formulary for 2014 contains several changes to improve patient safety, targeting drugs that are considered high risk in the elderly.1 The following table summarizes the formulary changes, with the safety reason for the change and the alternative therapy to be considered. While the changes don’t go into effect until January 1, 2014, we would appreciate your assistance in helping these members transition to safer alternatives. DRUG NAME/CATEGORY FORMULARY CHANGE Glyburide Non-formulary Muscle Relaxants: Carisoprodol, Non-formulary cyclobenzaprine, methocarbamol, orphenadrine, Lorzone

SAFETY CONCERN Increased risk of hypoglycemia Anticholinergic adverse effects, sedation, cognitive impairment, questionable efficacy

ALTERNATIVES Glipizide, glymeperide Baclofen, tizanidine

Hydroxyzine

Non-formulary

Anticholinergic adverse effects, sedation, cognitive impairment

Loratadine, fexofenadine

Meperidine

Non-formulary

Neurotoxicity, delirium, cognitive impairment, poor efficacy

Codeine, celecoxib, acetaminophen, short-term hydrocodone

Tricyclic antidepressants: Amitriptyline, Clomipramine, doxepin, imipramine (Tofranil®), trimipramine

Prior Authorization Required Anticholinergic adverse effects, (new starts only) sedation, cognitive impairment

Notriptyline, desipramine, sertraline, citalopram, venlafaxine, trazodone

Estrogen

Prior Authorization Required Breast cancer, endometrial cancer, cardiovascular risks, dementia

Digoxin 0.25mg tablets

Prior Authorization Required Risk of digoxin toxicity as kidney function declines Prior Authorization Required GI bleeding/peptic ulcer higher risk than alternate NSAIDs, edema may worsen heart failure

End treatment after menopause. Alternatively, vaginal estrogen, bisphosphonates Digoxin 0.125mg

NSAIDs: Indomethacin, ketorolac

Alpha blockers: Guanfacine, methyldopa, Reserpine

Prior Authorization Required Orthostatic hypotension, bradycardia, CNS adverse effects

Hydrocodone/apap, oxycodone/apap. If chronic NSAID use is required, use other NSAID and add GI protection. Consider celecoxib except in heart failure. Thiazide diuretic, ACEI, ARB, Beta blocker, calcium channel blocker or combination

Dipyridamole

Prior Authorization Required Orthostatic hypotension, more effective options available

Codeine, celecoxib, acetaminophen, short-term hydrocodone

Phenobarbita

Prior Authorization Required Dependence, tolerance, risk of (new starts only) overdose

Trazodone, sleep hygiene

Anti-Parkinson’s agents: Benztropine, trihexyphenidyl

Prior Authorization Required Highly anticholinergic: delirium, worsening cognitive impairment, urinary retention, more effective options available

For extrapyramidal disorders caused by antipsychotic medications, decrease antipsychotic dose or switch to atypical antipsychotic.

First generation antihistamines: Prior Authorization Required Anticholinergic adverse effects, Carbinoxamine, cleastine, sedation, cognitive impairment cyproheptadine, diphenhydramine, promethazine.

− Loratadine, fexofenadine. − For nausea: ondansetron or granisetron.

Meprobamate

Prior Authorization Required Physical dependence, very sedating

SSRIs, SNRIs, or buspirone

Butalbital

Prior Authorization Required Physical dependence, very sedating

Triptan medication like sumatriptan or naratriptan

Thioridazine

Prior Authorization Required QT prolongation, orthostatic (new starts only) hypotension, bradycardia, lowers seizure threshold, anticholinergic effects

− Atypical antipsychotics: risperidone, olanzapine, aripiprazole − Caution with all antipsychotics especially in elderly with dementia

Disopyramide

Prior Authorization Required Increased risk of heart failure and has anticholinergic side effects

Alternative antiarrhythmic treatment to be determined by cardiologist

Ticlopidine

Prior Authorization Required Life-threatening hematological adverse Clopidogrel reactions, safer alternatives exist Prior Authorization Required Low level of effectiveness and carries Nausea: ondansetron or granisetron risk of extrapyramidal side effects

Trimethobenzamide Immediate release Nifedipine

Prior Authorization Required Hypotension, MI, death

Nitrofurantoin

Quantity limits: short-term (10 day) use

Long-acting nifedipine or alternate hypertension treatment

Pulmonary toxicity, contraindicated in Smz/tmp, flouroquonlones crcl 3yo • Brisdelle – Tier 3 • Fetzima – Tier 3, ST • Gilotrif – Tier 3, PA limited to oncology and hematology, SP • Minastrin – Tier 3 • Nymalize – Tier 3, PA, QL • Sitavig – Non-formulary • Astagraf XL – Tier 3, PA • Naftin 2% – Tier 3 The following changes in restriction were approved: • Keppra – Remove PA • Singulair – Remove ST • Nizoral – Add PA • Epiduo – Add dermatology to pediatric exception • Vicoprofen – Remove PA • Cyclogyl – Remove from formulary 1/1/14 • Syprine – Add PA, remove maintenance status 1/1/14 • Levocarnitine – Add PA 1/1/14 • Nutropin – Move to Tier 3, PA 1/1/14 • Rebif – Move to Tier 3, PA 1/1/14 • Betaseron – Move to non-formulary 1/1/14

Prior authorization applies Obtained from specialty pharmacy

The following drugs are non-formulary (not covered): • Sitavig The following new generics have been added to the commercial formulary: • Rilutek – riluzole • Soriatane – acitretin (PA except dermatology) • Prandin – repaglinide • Stalevo – carbidopa monohydrate; entacapone; levodopa • Aricept 23 mg – donepezil ST • Verelan – verapamil cp24 • Campral – acamprosate PA • Temodar – temozolomide • Metrogel 1% – metronidazole gel For updated versions of our drug formularies, please visit www.independenthealth.com.

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511 Farber Lakes Drive, Buffalo, New York 14221

PRSRT STD U.S. POSTAGE PAID PERMIT NO. 757 BUFFALO, NY

update

PHARMACY POLICIE S

All of Independent Health’s policies and clinical practice guidelines are available on our website. To access these guidelines: 1. Log in to the Providers page on the home page of our website at independenthealth.com using “partners” as both the user name and password. 2. Go to the box entitled “Reference and Policies” 3. Click on the “Pharmacy Policies” link If you have any questions, please call the Provider Relations Department at (716) 631-3282 or 1-800-736-5771, Monday through Friday from 8 a.m. to 6 p.m. The following drug specific policies are new: • Breo Ellipta • Diclegis • Enteral Formula – MediSource • Growth Hormone – MediSource • Kynamro • Mekinist • Procysbi • Ravicti • Tafinlar • Tecfidera

The following drug specific policies have been reviewed and revised: • Neulasta • Aldurazyme • Oral Protease Inhibitor • Ampyra • Purified proteinase inhibitor • Aranesp • Reclast • ARB-CCB • Revlimid • Arcalyst • Aromatase Inhibitor • Somavert • Symlin • Avastin • Testosterone Top Soln • Benlysta • Tygacil • Byetta • Uloric • Epogen-Procrit • Victoza • Fabrazyme • Xeljanz • Gleevec • Xgeva • Growth Hormone • Xtandi • Hizentra • Zyprexa Relprevv • Inj Meds Infertility • Zytiga • Inspra • Zyvox • Letairis The following existing administrative policy has been reviewed and revised: • Specialty Pharmacy – Any Willing Provider Requirements

The following drug specific policies have been reviewed without any changes made: • Amrix • Prialt • Celebrex • Proton Pump Inhibitor • Chenodal • Proton Pump Inhibitor-HD • Fuzeon • Rhophylac • Lunesta • Rozerem • Neupro • Sylatron • Panretin • Xiaflex The following existing administrative policy has been reviewed without any changes made: • Pharmaceutical Manufacturer Presentation – Clinical and Product Specific Presentations The following polices are being archived: • Prescriber Gold Carding • Celebrex – Medicare • Sylatron – Medicare