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

January 2015

P&T Committee Updates 


At the December 8, 2014 meeting, the Harvard Pilgrim Pharmacy & Therapeutics Committee reviewed six medications and made the decisions noted below.  The information provided in the chart applies to the formularies for our commercial products; there were no changes to the 2015 Medicare Advantage formulary.

P&T Committee Review and Decisions

Name

Description and Indication

Decision

Adempas (riociguat)
 

Adempas is a soluble guanylate cyclase (sGC) stimulator indicated for the treatment of adults with persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH, WHO Group 4) and pulmonary arterial hypertension (PAH, WHO Group I) to improve exercise capacity and WHO functional class and  delay clinical worsening.  

Moved to

  • Tier 2 for 3-Tier Premium formulary
  • Tier 3 for 4-Tier Premium formulary

Diclegis
(doxylamine + pyridoxine)   

Diclegis — fixed dose combination tablet consisting of doxylamine succinate (an antihistamine) and pyridoxine hydrochloride (a vitamin B6 analog) — is used to treat nausea and vomiting during pregnancy. 

Continued coverage at

  • Tier 3 for 3-Tier Premium formulary
  • Tier 4 for 4-Tier Premium formulary

Gilenya  (fingolimod)   

Gilenya is a sphingosine 1-phosphate receptor modulator indicated for the treatment of patients with relapsing forms of multiple sclerosis to reduce the frequency of MS flare-ups and slow physical problems caused by MS. 

Moved to

  • Tier 2 for 3-Tier Premium formulary
  • Tier 3 for 4-Tier Premium formulary 

Opsumit (macitentan) 

Opsumit is an endothelin receptor antagonist (ERA) used to delay the progression of  pulmonary arterial hypertension (PAH, WHO Group I)  and reduce hospitalizations for PAH. 

Moved to

  • Tier 2 for 3-Tier Premium formulary
  • Tier 3 for 4-Tier Premium formulary

Orenitram (treprostinil) 

Orenitram is a prostacyclin vasodilator indicated for the treatment of pulmonary arterial hypertension (PAH, WHO Group 1) to improve exercise capacity. 
 

Continued coverage at

  • Tier 3 for 3-Tier Premium formulary
  • Tier 4 for 4-Tier Premium formulary  

Xarelto (rivaroxaban)    

Xarelto is a factor Xa inhibitor indicated to reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation; for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), as well as to reduce the risk of recurrence of DVT and of PE; and for the prophylaxis of DVT, which may lead to PE in patients undergoing knee or hip replacement surgery. 

Moved to

  • Tier 2 for 3-Tier Premium formulary
  • Tier 3 for 4-Tier Premium formulary

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