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

August 2018

Pharmacy & Therapeutics Committee Meeting Update


At the March 12, 2018 meeting, the Harvard Pilgrim Pharmacy & Therapeutics Committee reviewed three medications and decided the following:

P&T Committee Review and Decisions

Name

Indication

Decision

Austedo (deutetrabenazine) 

Used to treat chorea associated with Huntington’s disease, as well as tardive dyskinesia in adults.

• Premium and Value formularies: Moved to preferred brand with prior authorization 

• Medicare Advantage Formulary: Continued coverage on specialty tier

Ingrezza (valbenazine) 

Used to treat adults with tardive dyskinesia.

• Premium formulary: Remains non-formulary 

• Medicare Advantage formulary: Continued coverage on specialty tier

Mydayis (mixed salts of a single-entity amphetamine product) 

Used to treat ADHD in patients 13 years and older.

• Premium and Value formularies: Moved from non-formulary to preferred brand tier 

• Medicare Advantage formulary: Remains non-formulary

Adzenys XR ODT (amphetamine) 

Used to treat ADHD in patients 6 years and older.

• Premium and Value formularies: Remains non-formulary

• Medicare Advantage formulary: Remains non-formulary

Ozempic (semaglutide) 

Used in addition to diet and exercise to improve glycemic control in adults with type 2 diabetes.

• Premium and Value formularies: Moved to preferred brand

• Medicare Advantage formulary:
Moved to preferred brand

Farxiga (dapagliflozin)
 

Used in addition to diet and exercise to improve glycemic control in adults with type 2 diabetes.

• Premium and Value formularies: Remains non-preferred brand

• Medicare Advantage formulary: Remains non-formulary

Xigduo XR (dapagliflozin/metformin HCl extended-release) 

Used in addition to diet and exercise to improve glycemic control in adults with type 2 diabetes when treatment with both dapagliflozin and metformin is appropriate.

• Premium and Value formularies: Remains non-preferred brand

• Medicare Advantage formulary: Remains non-formulary

Steglatro (ertugliflozin)
 

Used in addition to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

• Premium and Value formularies: Moved to non-preferred brand

• Medicare Advantage formulary: Moved to non-preferred brand

Segluromet 

Used in addition to diet and exercise to improve glycemic control in adults with type 2 diabetes who are not adequately
controlled on a regimen containing ertugliflozin or metformin, or in patients who are already treated with both ertugliflozin and metformin.

• Premium and Value formularies: Moved to non-preferred brand

• Medicare Advantage formulary: Moved to non-preferred brand

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