21-324 Medication Trend Updates and Preferred Drug List Changes - 2nd Quarter 2021
Date: 04/30/21
Review changes that improve patient safety and encourage medication adherence
Stay up-to-date with information about:
- Patent expiration for commonly used brand-name medications
- California Health & Wellness Plan (CHWP) prefers biosimilars
- Osteoporosis member outreach reports are available
- Changes to the CHWP Preferred Drug List (formulary) for the second quarter of 2021
Patent expiration for commonly used brand-name medications
Patents are granted by the United States Patent and Trademark Office along the development lifeline of a medication. Patents expire 20 years from the date of filing. Many factors can affect the duration of a patent. When a brand-name medication loses its patent, lower-priced generics enter the market.
The Food and Drug Administration- (FDA-) approved generic drugs are made under the same rigorous standards as their brand-name counterparts and are bioequivalent, delivering the same amount of active ingredients into a patient's bloodstream in the same amount of time as their brand-name product. During the upcoming year, it is anticipated that the key medications listed below will be available as generic equivalents.
Quarter | Medication Patent Expirations for 2021 |
|---|---|
1st | Amitiza®, Northera® |
2nd | Absorica®, Banzel® tablet, Chantix®, Perforomist® |
3rd | Bystolic®, Sutent® |
4th | Brovana®, Pradaxa® |
CHWP prefers biosimilars
The FDA approves safe and effective medicines that are highly similar to existing biologic medicines. The FDA regulates biosimilar manufacturing to ensure they scientifically demonstrate safety and effectiveness while showing no clinically meaningful differences. Since biosimilars tend to cost less than their brand name counterparts, they can help lower the overall cost of care for members while still providing quality care.
Since September 1, 2020, CHWP has preferred the following biosimilars over their brand counterparts for Medi-Cal members. Patients must try and fail (or have contraindications to) the preferred biosimilar before the brand name product will be approved.
Reference product (Non-preferred) | Preferred biosimilar(s) |
|---|---|
Epogen®, Procrit® (epoetin alfa) | Retacrit® (epoetin alfa-epbx) |
Neupogen® (filgrastim) | Zarxio® (filgrastim-sndz) |
Neulasta® (peg-filgrastim)* *requires Zarxio® step requirement | ZiextenzoTM (pegfilgrastim-bmez)
|
Remicade® | Inflectra® (infliximab-dyyb) Renflexis® (infliximab-abda) |
Rituxan® | Ruxience® (rituximab-pvvr) |
Avastin® (for non-ophthalmic diagnoses) | MvasiTM (bevacizumab-awwb) ZirabevTM (bevacizumab-bvcr) |
Herceptin® | Ogivri® (trastuzumab-dkst) TrazimeraTM (trastuzumab-qyyp) |
Preferred Drug List changes
The CHWP Pharmacy and Therapeutics (P&T) Committee reviews the Preferred Drug List (PDL) quarterly to determine placement of medications on the drug list and any limitations to coverage. The P&T Committee consists of practicing physicians, pharmacists and other health care professionals.
Medication | Status | Formulary alternative(s) | Comments |
|---|---|---|---|
Dojolvi™ (triheptanoin) oral liquid | NF* |
| Treatment of pediatric and adult patients with molecularly confirmed long-chain fatty acid oxidation disorders (LC-FAOD) |
Gavreto™ (pralsetinib) capsule | NF* |
| Treatment of adult patients with metastatic RET fusion-positive non-small cell lung cancer (NSCLC) as detected by an FDA approved test |
Inqovi® (decitabine/ cedazuridine) tablet | NF* | decitabine (Dacogen®) injection *,** | Treatment of adult patients with myelodysplastic syndromes (MDS), including previously treated and untreated, de novo and secondary MDS with the following French American-British subtypes (refractory anemia, refractory anemia with ringed sideroblasts, refractory anemia with excess blasts, and chronic myelomonocytic leukemia [CMML]) and intermediate-1, intermediate-2, and high-risk International Prognostic Scoring System (IPSS) groinued |
Isturisa® (osilodrostat) tablet | NF* |
| Treatment of adult patients with Cushing’s disease for whom pituitary surgery is not an option or has not been curative |
Lampit® (nifurtimox) tablet | NF* |
| Pediatric patients (birth to less than age 18 and weighing at least 2.5 kg) for the treatment of Chagas disease (American Trypanosomiasis), caused by Trypanosoma cruzi (T. cruzi). |
Medication | Status | Formulary alternative(s) | Comments |
|---|---|---|---|
Jelmyto™ (mitomycin for pyelocalyceal solution) single-dose vial | Medical benefit* |
| Treatment of adult patients with low-grade upper tract urothelial cancer (LG-UTUC) |
Medication | Status | Formulary alternative(s) | Comments |
|---|---|---|---|
Uplizna™ (inebilizumab-cdon) single-dose vial | Medical benefit* | Soliris® *,** | Treatment of neuromyelitis optica spectrum disorder (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive |
Viltepso™ (viltolarsen) single-dose vial | Medical benefit* | prednisone | Treatment of Duchenne muscular dystrophy (DMD) in patients who have a confirmed mutation of the DMD gene that is amenable to exon 53 skipping |
*Prior authorization (PA) is required to verify member eligibility and that the member satisfies clinical protocols to ensure appropriate use of the medication.
**CCS = California Children’s Services: refer to www.dhcs.gov for the local telephone number to determine member’s coverage eligibility.
NF indicates nonformulary. These medications require member-specific medical reasons why formulary medications cannot be considered. Requests are reviewed via the plan’s prior authorization process.
Additional information
Providers are encouraged to access CHWP’s provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CHWP at 877-658-0305