Microsoft word - bchp-oh_appropriate use and safety edits_061912final

Buckeye Community Health Plan
Appropriate Use and Safety Edits
he health and safety of our members is a priority for Buckeye Community Health Plan. One of the ways we address patient safety is through point-of sale (POS) edits at the time a prescription is processed at the T pharmacy. These edits are based on Food and Drug Administration (FDA) recommendations and promote safe and effective medication utilization of our members. The following outlines the type of appropriate use and safety edit and affected drug class or classes that are in place at Buckeye Community Health Plan. Quantity Limits: Restrictions on claim quantity per day implemented to prevent doses above the FDA approved guidelines. Multiple medications within different drug classes have quantity limit requirements. Lower Age Limits: Restrictions on age implemented to prevent children below the FDA approved age of receiving medications off-label. Current drug classes with lower age limits include (but are not limited to): Long-Acting ADHD Medications (Stimulants & Non-Stimulants) Migraine Rescue Medications (Triptans & Non-Triptans) Short-Acting ADHD Medications (Stimulants only) Duplicate Therapy Edits: Restrictions on claims implemented to prevent members from receiving excessive medication regimens within the same (or similar) drug classes. Current drug classes with duplicate therapy edits include (but are not limited to): ACE Inhibitor/Angiotensin Receptor Blockers Diabetic Medications (Sulfonylurea/Meglitinides) Human Immunodeficiency Virus Medications Long-Acting ADHD Medications (Stimulants & Non-Stimulants) Selective Serotonin Receptor Inhibitors & Serotonin Norepinephrine Receptor Inhibitors Short-Acting ADHD Medications (Stimulants only) For specific drug quantity limits and age limits please see the Buckeye Community Health Plan Preferred Drug List (PDL). Appropriate Use and Safety Edits

Dose Consolidation Edits: Restrictions on claims implemented to prevent members from receiving multiple
strengths of the same medication. Current drug classes with dose consolidation edits include:
Long-Acting ADHD Medications (Stimulants & Non Stimulants) Selective Serotonin Receptor Inhibitors & Serotonin Norepinephrine Receptor Inhibitors Short-Acting ADHD Medications (Stimulants only) Step Therapy Edits: Restrictions on claims implemented to steer members toward the preferred medication in the drug class. Current drug classes with step therapy restrictions include (but are not limited to): Teratogenetic Edits: Restrictions on claims implemented to prevent female members from receiving potential harmful medications prior to confirmation of pregnancy status. (Multiple medications within different drug classes have teratogenetic requirements.) Safety Edits: Restrictions on claims implemented to prevent members from receiving combination drug regimens that have been deemed toxic and potentially life threatening. Human Immunodeficiency Virus Medications For specific drug quantity limits and age limits please see the Buckeye Community Health Plan Preferred Drug List (PDL). Appropriate Use and Safety Edits

The following tables detail the specific drugs or processes that are affected by the appropriate use and safety
edits.
Duplicate Therapy Edit Medications
PDL: Adderall XR (amphetamine-dextroamphetamine ER), Concerta (methylphenidate ER), Dexedrine SR (dextroamphetamine ER), Non-PDL: Daytrana, Focalin XR, Ritalin LA, Strattera, Vyvanse PDL: Adderall (amphetamine-dextroamphetamine), Dexedrine (dextroamphetamine), Methylin/Ritalin (methylphenidate), Focalin PDL: Catapres (clonidine), Tenex (guanfacine) (one drug regimen) Applies only to age < 18 PDL: Celexa (citalopram), Effexor (venlafaxine), Effexor XR (venlafaxine ER), Luvox (fluvoxamine), Paxil (paroxetine), Paxil CR (paroxetine ER), Prozac (fluoxetine), Zoloft (sertraline). Non-PDL: Cymbalta, Lexapro, Luvox CR, Pexeva, Pristiq, Viibryd PDL: Anafranil (clomipramine), Elavil (amitriptyline), Norpramin (desipramine), Pamelor (nortiptyline), Sinequan (doxepin), Tofranil Benzodiazepines PDL: Ativan (lorazepam), Dalmane (flurazepam), Halcion (triazolam), Klonopin (clonazepam), Librium (chlordiazepoxide), Restoril (temazepam), Serax (oxazepam), Tranxene (clorazepate), Valium (diazepam), Xanax (alprazolam), Prosom (estazolam). PDL: Ambien (zolpidem), Chloral Hydrate, Dalmane (flurazepam), Halcion (triazolam), Restoril (temazepam), Sonata (zaleplon), Prosom Non-PDL: Ambien CR (zolpidem ER), Doral, Lunesta, Rozerem, Seconal. HIV Medications See safety edit below (all HIV medications are PDL) PDL: Accupril (quinapril), Altace (ramipril), Capoten (captopril), Cozaar (losartan), Lotensin (benazepril), Mavik (trandolapril), Monopril monotherapy (fosinopril), Vasotec (enalapril), Zestril (lisinopril), plus any of the following drugs in combination with HCTZ Non-PDL: Aceon (perindopril), Atacand, Avapro, Benicar, Diovan, Edarbi, Micardis, Teveten, Univasc (moexipril), plus any of the following drugs in combination with HCTZ or other cardiovascular medications For specific drug quantity limits and age limits please see the Buckeye Community Health Plan Preferred Drug List (PDL). Appropriate Use and Safety Edits

Duplicate Therapy Edit Medications
PDL: Amaryl (glimepiride), Diabeta (glyburide),Diabinese (chlorpropamide), Glucotrol (glipizide), Glucotrol XL (glipizide SR), Glucovance (glyburide-metformin), Glynase (glyburide micronized), Metaglip (glipizide-metformin), Orinase (tolbutamide), Starlix (nateglinide), Tolinase (tolazamide). Non-PDL: Avandaryl, Duetact, Dymelor (acetohexamide), Prandimet, Prandin. Dose Consolidation Edit Medications
Non-PDL: Abilify Disc, Fanapt, Invega, Saphris, Zyprexa Zydis PDL: Adderall XR (amphetamine-dextroamphetamine ER), Concerta (methylphenidate ER), Dexedrine SR (dextroamphetamine ER), Non-PDL: Daytrana, Focalin XR, Ritalin LA, Strattera, Vyvanse PDL: Adderall (amphetamine-dextroamphetamine), Dexedrine (dextroamphetamine), Methylin/Ritalin (methylphenidate), Focalin PDL: Celexa (citalopram), Luvox (fluvoxamine), Paxil (paroxetine), Paxil CR (paroxetine ER), Prozac (fluoxetine), Zoloft (sertraline). Non-PDL: Lexapro, Luvox CR, Pexeva, Pristiq, Viibryd Step Therapy Edit Medications
For specific drug quantity limits and age limits please see the Buckeye Community Health Plan Preferred Drug List (PDL). Appropriate Use and Safety Edits

Step Therapy Edit Medications
(amoxicillin-clavulanate), Biaxin (clarithromycin), Ceclor (cefaclor), Cefzil (cefprozil), Levaquin (levofloxacin), Zithromax (azithromycin) Teratogenetic Edit Programming Details
Is member between 11 – 50 years of age? Does the member have an active claim for contraception or hormone replacement Is the member pregnant? (Pharmacist to ask member at POS) Is the drug labeled as pregnancy category X? Is the drug labeled as pregnancy category D (risk outweighs benefit)? Is the drug labeled as pregnancy category D (benefits may outweigh risk)? Call prescriber. Does benefit outweigh risks? Teratogenetic Edit Medications
5-Alpha Reductase Inhibitors, Anabolic Steroids, Androgens, Anorexiants, Antineoplastics, Coumadin Anticoagulants, Endothelin Receptor Antagonists, Hepatitis Agents, HMG CoA Reductase Inhibitors, Non-Barbiturate Hypnotics, Migraine Agents, Non-Steroidal Antiinflammatory, Progesterone Receptor Antagonists, Progestins, Prostaglandins, Retinoids, Stimulant Laxatives, Etc For specific drug quantity limits and age limits please see the Buckeye Community Health Plan Preferred Drug List (PDL). Appropriate Use and Safety Edits

Teratogenetic Edit Medications
Pregnancy Category D ACE Inhibitors, Alkylating Agents, Aminoglycosides, Antiandrogents, Antiestrogens, (risk outweighs benefit) Antineoplastics, Beta Blockers, Gout Agents, Mitiotic Inhibitors, Potassium Sparing Diuretics, Sickle Cell Anemia Agents, Selective Serotonin Reuptake Inhibitors, Smoking Deterrents, Tetracyclines, Thiazide & Thiazide Like Diuretics, Trycyclic Antidepressants, Etc Anticonvulsants, Antithyroid Agents, Antiretrovirals, Antispasmodics, Barbiturate (benefits may outweigh Hypnotics, Benzodiazepines, Glucocorticoids, Hydantoins, Imidazole Antifungals, risk) Immunosuppressives, Lithiums, Non-Barbiturate Hypnotics, Etc NOTE: These lists are not all inclusive of drugs in pregnancy category X and/or D drugs. Furthermore, not all drugs within the therapeutic categories listed above are categorized as pregnancy X and/or D. Safety Edit
HIV Medications
Atripla (efavirenz, emtricitabine, tenofovir), Emtriva (emtricitabine), Truvada (emtricitabine, tenofovir) Epzicom (abacavir, lamivudine), Ziagen (abacavir), Trizivir (abacavir, lamivudine, zidovudine) Combivir (lamivudine, zidovudine), Epivir (lamivudine), Trizivir (abacavir, lamivudine, zidovudine) Truvada (emtricitabine, tenofovir), Viread (tenofovir) Complera (emtricitabine, rilpivirine, tenofovir) Reyataz (Atazanavir), Crixivan (Indinavir). Emtriva (emtricitabine), Epivir (lamivudine) Zerit (stavudine), Retrovir (zidovudine) Zerit (stavudine), Trizivir (abacavir, lamivudine, zidovudine) Zerit (stavudine), Combivir (lamivudine, zidovudine) Atripla (efavirenz, emtricitabine, tenofovir), Videx (didanosine) Videx (didanosine), Truvada (emtricitabine, tenofovir) Truvada (emtricitabine, tenofovir), Epivir (lamivudine) Truvada (emtricitabine, tenofovir), Epzicom (abacavir, lamivudine) Truvada (emtricitabine, tenofovir), Trizivir (abacavir, lamivudine, zidovudine) Truvada (emtricitabine, tenofovir), Combivir (lamivudine, zidovudine) Atripla (efavirenz, emtricitabine, tenofovir), Epivir (lamivudine) Atripla (efavirenz, emtricitabine, tenofovir), Epzicom (abacavir, lamivudine) Atripla (efavirenz, emtricitabine, tenofovir), Trizivir (abacavir, lamivudine, zidovudine) Atripla (efavirenz, emtricitabine, tenofovir), Combivir (lamivudine, zidovudine) Trizivir (abacavir, lamivudine, zidovudine) Combivir (lamivudine, zidovudine), Emtriva (emtricitabine) Rescriptor (Delavirdine), Sustiva (Efavirenz), INTELENCE (Etravirine), Viramune (Nevirapine), Atripla (Efavirenz, Emtricitabine, Tenofovir), Edurant (Rilpivirine) All Buckeye Community Health Plan covered products are listed in the PDL. For the most current PDL please contact Buckeye Community Health Plan at 1-866-246-4358 (TTY/TTD 1-800-750-0750) or visit the website at www.bchpohio.com. For specific drug quantity limits and age limits please see the Buckeye Community Health Plan Preferred Drug List (PDL).

Source: http://www.bchpohio.com/files/2011/09/BCHP-OH_Appropriate-Use-and-Safety-Edits_061912final.pdf?61572d