19-440 Medication Trends and Formulary Changes - 2nd Quarter 2019
Date: 06/13/19
Updated medication patent expirations and Preferred Drug List changes for the second quarter of 2019
Stay up to date with:
- New generic medications in 2019.
- Changes to the California Health & Wellness Plan (CHWP) Preferred Drug List (PDL) for the second quarter of 2019.
Patent expiration for brand-name medications
During 2019, the medications listed below are expected to be available as generic equivalents as their patents expire.
Medication Patent Expirations | |
1st Quarter | Fentora,® # Nuvaring® |
2nd Quarter | Lyrica,® Tarceva,® Travatan Z,® Vesicare® |
3rd Quarter | N/A |
4th Quarter | Jadenu® |
# Nonformulary
Patents are granted by the United States Patent and Trademark Office along the development lifeline of a medication and they expire 20 years from the date of filing. When a brand-name medication loses its patent, lower-priced generics enter the market. Food and Drug Administration (FDA)-approved generic drugs are made under the same strict 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.
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.
Drug Name | PDL Status | Alternative(s) | Comments |
ORAL MEDICATIONS | |||
Copiktra™ (duvelisib) capsule | NF* | CLL/SLL: Imbruvica®* QL** | Treatment of adult patients with relapsed or refractory chronic lymphocytic leukemia (CLL) or small lymphocytic lymphoma (SLL) after at least two prior therapies Treatment of adult patients with relapsed or refractory follicular lymphoma (FL) after at least two prior systemic therapies |
Doptelet® (avatrombopag) tablet | NF |
| Treatment of thrombocytopenia in adult patients with chronic liver disease who are scheduled to undergo a procedure |
Epidiolex® (cannabidiol) oral solution | NF | clonazepam, felbamate (Felbatol®), lamotrigine, levetiracetam (Keppra®), topiramate (Topamax®), valproic acid ** (Depakene®), divalproex sodium (Depakote®), Banze®l ** | Treatment of seizures associated with Dravet Syndrome (DS) or Lennox-Gastaut Syndrome (LGS) in patients age 2 and older |
Krintafel® (tafenoquine) tablet | F | hydroxychloroquine | Radical cure (prevention of relapse) of Plasmodium vivax malaria in patients age 16 and older who are receiving appropriate antimalarial therapy for acute P. vivax infection. Limitation(s) of use: Krintafel is not indicated for the treatment of acute P. vivax malaria. For Medicare, quantity limit is 2 tablets per 30 days. |
Lokelma® (sodium zirconium cyclosilicate) packet for oral suspension | NF | sodium polystyrene sulfonate (Kayexalate®) | Treatment of hyperkalemia in adults
Limitation(s) of use: Lokelma should not be used as an emergency treatment for life-threatening hyperkalemia because of its delayed onset of action.
Step therapy requires a trial of generic Kayexalate first. |
Lorbrena® (lorlatinib) tablet | NF | Alecensa®*,** | Treatment of patients with anaplastic lymphoma kinase (ALK)-positive metastatic non-small cell lung cancer (NSCLC) whose disease has progressed on the following:
|
Drug Name | PDL Status | Alternative(s) | Comments |
Mulpleta® (lusutrombopag) tablet | NF |
| Treatment of thrombocytopenia in adult patients with chronic liver disease who are scheduled to undergo a procedure |
Nuzyra™ (omadacycline) tablet | NF | amoxicillin/clavulanate, azithromycin, cefuroxime, clarithromycin, levofloxacin | Treatment of adult patients with the following infections caused by susceptible microorganisms:
Streptococcus pneumoniae, Staphylococcus aureus (methicillin-susceptible isolates), Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae
Staphylococcus aureus (methicillin-susceptible and -resistant isolates), Staphylococcus lugdunensis, Streptococcus pyogenes, Streptococcus anginosus grp. (includes S. anginosus, S. intermedius, and S. constellatus), Enterococcus faecalis, Enterobacter cloacae, and Klebsiella pneumoniae |
Seysara™ (sarecycline) tablet | NF | doxycycline, minocycline, tetracycline | Treatment of inflammatory lesions of non-nodular moderate to severe acne vulgaris in patients age 9 and older |
Talzenna™ (talazoparib) capsule | NF | Lynparza® *,** | Treatment of adult patients with deleterious or suspected deleterious germline BRCA-mutated (gBRCAm) HER2-negative locally advanced or metastatic breast cancer. Select patients for therapy based on an FDA-approved companion diagnostic for Talzenna |
Vizimpro® (dacomitinib) tablet | NF | Iressa® ** | First-line treatment of patients with metastatic non-small cell lung cancer (NSCLC) with EGFR exon 19 deletion or exon 21 L858R substitution mutations as detected by an FDA-approved test |
Drug Name | PDL Status | Alternative(s) | Comments |
OPHTHALMIC PREPARATIONS | |||
Oxervate™ (cenegermin-bkbj) ophthalmic solution | NF |
| Treatment of neurotrophic keratitis |
TOPICAL PREPARATIONS | |||
Xepi™ (ozenoxacin) cream | NF | mupirocin (Bactroban®) | Topical treatment of impetigo due to Staphylococcus aureus or Streptococcus pyogenes in adult and pediatric patients age 2 months and older |
INJECTABLE PREPARATIONS | |||
Ajovy™ (fremanezumab-vfrm) prefilled syringe | NF | Anticonvulsants: Beta-blockers: Antidepressants/tricyclic antidepressants: | Preventive treatment of migraine in adults |
Emgality™ (galcanezumab-gnlm) prefilled syringe | NF | Anticonvulsants: Beta-blockers: Antidepressants/ amitriptyline (Elavil), venlafaxine (Effexor) | Preventive treatment of migraine in adults |
Gamifant™ (emapalumab-lzsg) single-dose vial | Medical benefit |
| Treatment of adult and pediatric (newborn and older) patients with primary hemophagocytic lymphohistiocytosis (HLH) with refractory, recurrent or progressive disease or intolerance with conventional HLH therapy |
Drug Name | PDL Status | Alternative(s) | Comments |
Onpattro™ (patisiran) single-dose vial | Medical benefit |
| Treatment of the polyneuropathy of hereditary transthyretin-mediated amyloidosis in adults |
Takhzyro™ (lanadelumab-fylo) single-dose vial | NF | Cinryze® *,** | For prophylaxis to prevent attacks of hereditary angioedema (HAE) in patients age 12 and older |
Tegsedi™ (inotersen) prefilled syringe | NF |
| Treatment of the polyneuropathy of hereditary transthyretin-mediated amyloidosis in adults |
*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.dhs.gov for the local telephone number to determine member’s coverage eligibility.
- F indicates formulary.
- NF indicates nonformulary; NP indicates nonpreferred. These medications require member-specific medical reasons why formulary medications cannot be considered. Requests are reviewed via CHWP prior authorization process.
- EST indicates electronic step therapy.
- QL indicates quantity limit.
Additional information
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.