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California Health & Wellness is no longer a Medi-Cal plan starting January 1, 2024. Regardless of the county you live in, your Medi-Cal service and benefits will not be impacted by the health plan changes since you will be assigned to a new health plan. The county you live in determines your new health plan. Learn more

20-142 Medication Trend Updates and Preferred Drug List Changes - 1st Quarter 2020

Date: 02/11/20

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
  • Changes to the California Health & Wellness Plan (CHWP) Preferred Drug List (formulary) for the first quarter of 2020.

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. U.S. Food & Drug Administration (FDA)-approved generic drugs are made under the same rigorous standards as their brand-name counterparts and are bioequivalent. In other words, they deliver 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, the medications below are anticipated to be available as generic equivalents.

Medication patent expirations

 

2020

1st Quarter

Noxafil®1, Zortress®

2nd Quarter

Travatan Z®

3rd Quarter

Truvada®, Atripla®

4th Quarter

Absorica®1, Chantix®, Dulera®1, Jadenu®

1 Nonformulary

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.

The following changes to the PDL are effective immediately, unless otherwise noted.

Providers are encouraged to access CHWP’s provider portal online at www.CAHealthWellness.com 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 1-877-658-0305.

Preferred Drug List changes

Medication

Status

Formulary alternative(s)

Comments

Oral medications

Aemcolo™ (rifamycin) delayed-release tablet

NF

ciprofloxacin, levofloxacin, ofloxacin, azithromycin

Treatment of travelers’ diarrhea (TD) caused by noninvasive strains of Escherichia coli in adults

Limitation(s) of use: Aemcolo is not indicated in patients with diarrhea complicated by fever or bloody stool or due to pathogens other than noninvasive strains of Escherichia coli.

Nubeqa® (darolutamide) tablet

NF

Anti-androgens: bicalutamide (Casodex®)**, flutamide**

Treatment of patients with non-metastatic castration resistant prostate cancer (nmCRPC)

Piqray® (alpelisib) tablet

NF

Endocrine therapy:

anastrozole (Arimidex®)**, exemestane (Aromasin®)**, letrozole (Femara®)**, megestrol acetate**, tamoxifen (Nolvadex®)**, toremifene (Fareston®)**

In combination with fulvestrant for the treatment of postmenopausal women, and men, with hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, PIK3CA-mutated, advanced or metastatic breast cancer as detected by an FDA-approved test following progression on or after an endocrine-based regimen

Sunosi™ (solriamfetol) tablet

NF

Narcolepsy, OSA: armodafinil (Nuvigil®)*, modafinil (Provigil®)*

Narcolepsy:

amphetamine immediate-release (IR), amphetamine/dextroamphetamine (Adderall®), dextroamphetamine (Dexedrine®), methylphenidate (Ritalin®)

To improve wakefulness in adult patients with excessive daytime sleepiness associated with narcolepsy or obstructive sleep apnea (OSA)

Turalio™ (pexidartinib) capsule

NF

 

Treatment of adult patients with symptomatic tenosynovial giant cell tumor (TGCT) associated with severe morbidity or functional limitations and not amenable to improvement with surgery

Xpovio™ (selinexor) tablet

NF

Proteasome inhibitors: Ninlaro*,**

Immunomodulatory agents:

Pomalyst®**

Anti‐CD38 monoclonal antibody:

Darzalex®*

 

 

In combination with dexamethasone for the treatment of adult patients with relapsed or refractory multiple myeloma (RRMM) who have received at least four prior therapies and whose disease is refractory to at least two proteasome inhibitors, at least two immunomodulatory agents, and an anti‐CD38 monoclonal antibody

Zelnorm® (tegaserod maleate) tablet

NF

polyethylene glycol (MiraLax®)

Bulk-forming laxative:

psyllium (Metamucil®), methylcellulose powder (Citrucel®), calcium polycarbophil (FiberCon®)

Stimulant laxative:

bisacodyl

Treatment of adult women less than age 65
with irritable bowel syndrome with constipation (IBS-C)

Vaginal preparations

Annovera™ (segesterone acetate and ethinyl estradiol) vaginal ring

NF

Nuvaring®

Oral contraceptives:

ethinyl estradiol/norethindrone (Junel®, Necon®, Ortho-Novum®)

ethinyl estradiol/levonorgesterol (Lessina®)

ethinyl estradiol/norgesterol (Cryselle™, Ogestrel®)

ethinyl estradiol/ethynodiol (Kelnor®, Zovia®)

ethinyl estradiol/desogestrel (Mircette®)

ethinyl estradiol/drospirenone (Yasmin®)

ethinyl estradiol/norgestimate (Ortho-Cyclen®) 

For use by females of reproductive potential to prevent pregnancy

Injectable preparations

Ultomiris™ (ravulizumab-cwvz) single-dose vial

NF

Soliris®*

Treatment of adult patients with paroxysmal nocturnal hemoglobinuria (PNH)

Vyleesi™ (bremelanotide) single-dose prefilled autoinjector

NF

 

Treatment of premenopausal women with acquired, generalized hypoactive sexual desire disorder (HSDD) as characterized by low sexual desire that causes marked distress or interpersonal difficulty and NOT due to:

• A co-existing medical or psychiatric condition,

• Problems with the relationship, or

• The effects of a medication or drug substance.

*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 CHWP’s prior authorization process.