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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

April 2017

P&T Committee Updates


At the March 6th, 2017 meeting, the Harvard Pilgrim Pharmacy & Therapeutics Committee reviewed three medications and decided the following:

P&T Committee Review and Decisions

Name

Description and Indication

Decision

Vraylar (cariprazine) 

Vraylar (cariprazine) is an atypical antipsychotic indicated in adults for the acute treatment of manic or mixed episodes associated with bipolar I disorder and the treatment of schizophrenia.

  • Premium formulary: Continued coverage at non-preferred brand tier, step therapy required
  • Value formulary: Remains non-covered
  • Medicare Advantage Formulary: Continued coverage at Tier 5 (Specialty Tier), step therapy required

ADHD Drug Formulations:

Quillivent XR suspension (methylphenidate HCl ER)

Quillichew ER tablets
(methylphenidate HCl ER)

Aptensio ER capsules
(methylphenidate HCl ER)

Dyanaval XR suspension
(amphetamine XR)

These medications are CNS stimulants indicated for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). 

Quillivent XR suspension

  • Premium formulary: Continued coverage at non-preferred brand tier
  • Value formulary: Continued coverage at non-preferred brand tier
  • Medicare Advantage formulary: Remains non-covered

Quillichew ER tablets, Aptensio ER capsules, Dyanaval XR suspension

  • Premium formulary: Continued coverage at non-preferred brand tier
  • Value formulary: Remains non-covered
  • Medicare Advantage formulary: Remains non-covered

Xtampza ER (oxycodone ER) 

Xtampza ER is an opioid agonist indicated for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.

  • Premium formulary: Continued coverage at non-preferred brand tier with prior authorization
  • Value formulary: Remains non-covered
  • Medicare Advantage formulary: Remains non-covered

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