Current information for pharmacists about the MassHealth Pharmacy Program MassHealth Pharmacy Program Number 78 May 10, 2013 Pharmacy Facts MassHealth Pharmacy Program www.mass.gov/masshealth/pharmacy • Editor: Vic Vangel • Contributors: Chris Burke, Gary Gilmore, Paul Jeffrey, Kim Lenz, James Monahan, Nancy Schiff • MHDL Update Below are certain updates to the MassHealth Drug List (MHDL). See the MHDL for a complete list of updates. 1. Changes in Prior-Authorization Status a. The following second-generation (atypical) antipsychotics will require prior authorization as described below effective May 13, 2013. * Abilify (aripiprazole solution) – PA greater than or equal to 18 years old and PA greater than 750 ml/month * Abilify (aripiprazole tablet) – PA greater than or equal to 18 years old and PA greater than 30 units/month * Seroquel XR (quetiapine extended-release 50 mg, 300 mg, 400 mg) – PA greater than or equal to 18 years old and * PA greater than 60 units/month * Seroquel XR (quetiapine extended-release 150 mg, 200 mg) – PA greater than or equal to 18 years old and PA greater than 30 units/month b. The following oral hepatitis antiviral agent will require prior authorization, effective May 28, 2013. * Rebetol (ribavirin 200 mg capsule) – PA * Ribasphere (ribavirin 200 mg capsule) – PA c. The following generic drugs will be covered without prior authorization, effective May 13, 2013. * Cleocin # (clindamycin 300 mg capsule) * Fibricor # (fenofibric acid tablet 35 mg and 105 mg) d. The following nicotine replacement products will be covered without prior authorization, effective May 13, 2013. * nicotine gum, lozenge, patch e. The following lipid lowering agents will require prior authorization above newly established quantity limits as described below, effective May 13, 2013. * Mevacor # (lovastatin 10 mg, 20 mg) – PA greater than 45 units/month * Mevacor # (lovastatin 40 mg) – PA greater than 60 units/month * Pravachol # (pravastatin 10 mg, 20 mg, 40 mg) – PA greater than 45 units/month * Zocor # (simvastatin 5 mg, 10 mg, 20 mg, 40 mg) – PA greater than 45 units/month 2. Additions The following newly marketed drugs have been added to the MassHealth Drug List as of May 13, 2013. * Abilify Maintena (aripiprazole extended- release injectable suspension) – PA greater than 1 vial/month * Auvi-Q (epinephrine auto-injection) * COMETRIQ (cabozantinib) – PA * Delzicol DR (mesalamine capsule) * Eliquis (apixaban) – PA * Gattex (teduglutide injection) – PA * Giazo (balsalazide 1.1 gram tablets) – PA * Iclusig (ponatinib) – PA * Ilevro (nepafenac 0.3% ophthalmic suspension) – PA * Jetrea (ocriplasmin) ^ * Juxtapid (lomitapide) – PA * ONMEL (itraconazole 200 mg tablet) – PA * Oxtellar XR (oxcarbazepine extended-release) – PA * Pertzye DR (lipase/protease/amylase) * Quillivant XR (methylphenidate extended- release oral suspension) – PA * Skyla (levonorgestrel-releasing intrauterine system) * Vascepa (icosapent ethyl) – PA # This designates a brand-name drug with FDA “A”-rated generic equivalents. Prior authorization is required for the brand, unless a particular form of that drug (for example, tablet, capsule, or liquid) does not have an FDA “A”-rated generic equivalent. ^ This drug is available through the health care professional who administers the drug. MassHealth does not pay for this drug to be dispensed through a retail pharmacy. Please direct any questions or comments (or to be taken off of this fax distribution) to Victor Moquin of Xerox at 617-423-9830.