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

July 2015

P&T Committee Updates 


At the June 1, 2015 meeting, the Harvard Pilgrim Pharmacy & Therapeutics Committee reviewed several medications used for the treatment of diabetes, and the chart below details the committee’s decisions. We note formulary placement as “Preferred Brand” or “Non-Preferred Brand.” Corresponding tier level varies by formulary, as shown in the “Formulary Information” table below.

Formulary Information
General Tier Description (Some exceptions may apply.) Premium 3-Tier Premium 4-Tier Value
4-Tier
Value
5-Tier
Medicare Advantage

Low Cost Generic

0

1

0

1

1

Generic

1

2

1

2

Preferred Brand

2

3

2

3

3

Non-Preferred Brand*

3

4

3

4

4

Specialty†

0 0


4

5

5

*Preferred specialty also included on this tier for the Commercial Value formularies
†Non-preferred specialty for the Commercial Value formularies. The Premium formularies do not have designated “Specialty” tiers; instead, on the Premium formularies, specialty drugs are included primarily in the “Preferred Brand” and “Non-Preferred Brand” tiers.

P&T Committee Review and Decisions

Drug Class & Drugs Reviewed

Description & Drugs Reviewed

Decision

GLP-1 Agonists

  • Tanzeum (albiglutide)
  • Trulicity (dulaglutide)

GLP-1 agonists are used in conjunction with diet and exercise to improve glycemic control in adults with type 2 diabetes. By binding to the GLP-1 receptor, they stimulate glucose-depended insulin release. All products in the class are administered by subcutaneous injection. The frequency of dosing varies from twice daily to once weekly. 

Tanzeum (albiglutide)

  • Continues as non-covered on Value formularies
  • Continued coverage as Non-Preferred Brand on Premium and Medicare Advantage formularies

Trulicity (dulaglutide)

  • Added as a Non-Preferred Brand to the Value and Medicare Advantage formularies
  • Continued coverage as Non-Preferred Brand on the Premium formularies

Note: Preferred brands currently include Byetta, Bydureon Pen, and Victoza. 

SGLT2 Inhibitors

  • Jardiance (empagliflozin) 

SGLT2 inhibitors are the newest class of oral medications used in conjunction with diet and exercise to improve glycemic control in adults with type 2 diabetes. They work by increasing the renal excretion of glucose and are dosed once daily.

Invokana (canagliflozin)

  • Added as a Preferred Brand to the Premium and Value formularies
  • Continued coverage as Preferred Brand on Medicare Advantage formulary

Jardiance (empagliflozin)

  • Continued coverage as Non-Preferred Brand on Premium & Value formularies
  • Added as Non-Preferred Brand to Medicare Advantage formulary

Farxiga (dapagliflozin)

  • Continues as non-covered on Value formularies
  • Continued coverage as Non-Preferred Brand on Premium and Medicare Advantage formularies

Combination Agents

  • Glyxambi (empagliflozin/ linagliptin)
  • Invokamet (canagliflozin/metformin)
  • Xigduo XR (dapagliflozin/metformin ER)

Combination agents bringing together two or more oral antidiabetic agents in one fixed-dose product.

Invokamet (canagliflozin/metformin)

  • Added as a Preferred Brand to the Premium and Value formularies
  • Continued coverage as a Preferred Brand on Medicare Advantage formulary

Glyxambi (empagliflozin/ linagliptin) and Xigduo XR (dapagliflozin/metformin ER)

  • Continued coverage as Non-Preferred Brands on the Premium formularies
  • Non-covered on the Value and Medicare Advantage formularies

The Harvard Pilgrim Pharmacy & Therapeutics Committee also decided to add Januvia (sitagliptin), Janumet (sitagliptin/metformin), and Janumet XR (sitagliptin/metformin ER) as preferred brands effective immediately. At that time, Harvard Pilgrim will also add Januvia as a first-line therapy to the DPP-IV Inhibitors Step Therapy Guideline. Under our step therapy requirements, Nesina (alogliptin) or Onglyza (saxagliptin) will be covered only after the member has used Januvia (sitagliptin) or Tradjenta (linagliptin) as a first-line agent. Januvia and Tradjenta will be available unrestricted on both the Premium and Commercial formularies.

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