Pharmacy and Therapeutics Committee Meeting Update

At the June 14, 2021 meeting, the Harvard Pilgrim Pharmacy & Therapeutics Committee reviewed the medication below and decided the following.

Name & Indication Decision
Kynmobi (apomorphine hydrochloride sublingual film) – Non-ergoline dopamine agonist indicated for acute and intermittent treatment of “off” episodes in patients with Parkinson’s. Premium and Value formularies:
Non-preferred brand with step therapy

Core NH formulary:
Remain Non-Formulary

Medicare Advantage formulary:
Specialty tier (Tier 5) with prior authorization and quantity limit

Ongentys (opicapone) – COMT inhibitor indicated for adjunctive treatment to levodopa/carbidopa in “off” episodes in patients with Parkinson’s. Premium and Value formularies:
Remain Non-Formulary

Core NH formulary:
Remain Non-Formulary

Medicare Advantage formulary:
Remain Non-Formulary

Gimoti (intranasal metoclopramide) – Indicated for acute and chronic symptomatic relief of diabetic gastroparesis in adults. Premium and Value formularies:
Remain Non-Formulary

Core NH formulary:
Remain Non-Formulary

Medicare Advantage formulary:
Remain Non-Formulary

Mycapssa (octreotide delayed-release capsule) – Indicated for long-term treatment of acromegaly in patients who have responded to octreotide or lanreotide. Premium and Value formularies:
Non-Preferred brand (specialty) with prior authorization

Core NH formulary:
Remain Non-Formulary

Medicare Advantage formulary:
Remain Non-Formulary

Rybelsus (semaglutide) – An oral GLP-1 agonist indicated for the treatment of type 2 diabetes adjunct to diet and exercise. Premium and Value formularies:
Preferred brand with step therapy and quantity limit

Core NH formulary:
Remain Non-Formulary

Medicare Advantage formulary:
Preferred brand (Tier 3) with quantity limit


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