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PDL Drug Class Review Announcement
July 10, 2018
Drug Classes to be reviewed:
Anticoagulants (Oral & Injectable), Anticonvulsants, Bone Resorption Suppression & Related Agents, Colony Stimulating Factors, Contraceptives, Diabetes Management Agents (Amylin, Biguanides, DPP-4 Inhibitors, GLP-1 Analogues, Hypoglycemic Combinations, Meglitinides, SGLT-2 Inhibitors, Thiazolidinediones), Erythropoiesis Stimulating Agents, GI Motility (Chronic), Newer HAE – Hereditary Angioedema Agents, Ophthalmic Immunomodulators, Overactive Bladder Agents, Prenatal Vitamins and Stimulants and other ADHD Agents.
These drug classes will be reviewed at the July 10th, 2018 P&T Committee meeting from 1‐5pm. The location is
303 East 17th Avenue, Denver, CO 80203 7th Floor Conference Rooms. Dossiers and Supplemental Rebate offers
are due to Magellan by June 29, 2018.
Please provide your public comments to Jessica Czechowski, Clinical Account Manager
(jlczechowski@magellanhealth.com) no later than July 6, 2018 to ensure they are included in the information
supplied to the P&T Committee members. Please carbon copy Brittany Schock, PDL Pharmacist
(Brittany.schock@state.co.us) on all clinical information and public comment submissions.
ANTICOAGULANTS- ORAL
Brand Name Generic Name
Coumadin Warfarin
Jantoven Warfarin
Warfarin
Eliquis Apixaban
Pradaxa Dabigatran
Savaysa Edoxaban
Xarelto rivaroxaban
ANTICOAGULANTS- INJECTABLE
Brand Name Generic Name
Arixtra Fondaparinux
Fondaparinux
Fragmin Dalteparin
Lovenox Enoxaparin
Enoxaparin
ANTICONVULSANTS
Brand Name Generic Name
Aptiom Eslicarbaepine
Banzel Rufinamide
Briviact Brivaracetam
Carbatrol ER Carbamazepine ER
Carbamazepine ER
Celontin Methsuximide
Depakene Valproic Acid
Valproic Acid
Depakote DR, Depakote ER Divalproex Sodium
Divalproex Sodium
Dilantin Phenytoin
Epitol Carbamazepine
Equetro Carbamazepine
Felbatol Felbamate
Felbamate
Fycompa Perampanel
Gabitril Tiagabine
Tiagabine
Keppra, Keppra XR Levetiracetam
Levetiracetam
Klonopin Clonazepam
Clonazepam
Lamictal, Lamictal XR Lamotrigine
Lamotrigine
Mysoline Primidone
Primidone
Onfi Clobazam
Oxtellar XR Oxcarbazepine
Peganone Ethotoin
Phenobarbital
Phenytek Phenytoin ER
Phenytoin ER
Potiga Ezogabine
Qudexy XR Topiramate ER
Topiramate ER
Roweepra XR Levetiracetam ER
Sabril Vigabatrin
Vigabatrin
Spritam Levetiracetam
Tegretol Carbamazepine
Carbamazepine
Topamax Topiramate
Trileptal Oxcarbazepine
Oxcarbazepine
Trokendi XR Topiramate
Vimpat Lacosamide
Zarontin Ethosuximide
Ethosuximide
Zonegran Zonisamide
Zonisamide
BONE RESORPTION SUPPRESSION & RELATED AGENTS
Brand Name Generic Name
Actonel Risedronate
Risedronate
Actonel with calcium Risedronate with calcium
Atelvia Risedronate
Risedronate
Binosto Alendronate
Boniva Ibandronate
Ibandronate
Calcitonin
Etidronate
Evista Raloxifene
Raloxifene
Forteo Teriparatide
Fosamax Alendronate
Alendronate
Fosamax Plus D Alendronate with D
Fosamax solution Alendronate oral solution
Alendronate oral solution
Tymlos Abaloparatide
COLONY STIMULATING FACTORS
Brand Name Generic Name
Granix tbo-Flilgrastim
Leukine Sargramostim
Neulasta Pegfilgrastim
Neupogen Filgrastim
Zarxio* Filgrastim-sndz
*biosimilar to Neupogen
CONTRACEPTIVES:
Brand Name Generic Name
Altavera Levonorgestrel/Ethinyl Estradiol
Alyacen Norethindrone/Ethinyl Estradiol
Amethyst Levonorgestrel/Ethinyl Estradiol
Apri Desogestrel/Ethinyl Estradiol
Aranelle Norethindrone/Ethinyl Estradiol
Aubra Levonorgestrel/Ethinyl Estradiol
Aviane Levonorgestrel/Ethinyl Estradiol
Azurette Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol
Balcoltra Levonorgestrel/Ethinyl Estradiol/Iron
Balziva Norethindrone/Ethinyl Estradiol
Bekyree Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol
Beyaz Dropirenone/Ethinyl Estradiol/Levonorgestrel
Blisovi Fe Norethindrone/Ethinyl Estradiol/Iron
Briellyn Norethindrone/Ethinyl Estradiol
Camila Norethindrone
Caziant Desogestrel/Ethinyl Estradiol
Chateal Levonorgestrel/Ethinyl Estradiol
Cryselle Norgestrel/Ethinyl Estradiol
Cyclafem Norethindrone/Ethinyl Estradiol
Cyclessa Desogestrel/Ethinyl Estradiol
Cyred Desogestrel/Ethinyl Estradiol
Dasetta Norethindrone/Ethinyl Estradiol
Deblitane Norethindrone
Desogestrel/Ethinyl Estradiol
Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol
Drospirenone/Ethinyl Estradiol
Drospirenone/Ethinyl Estradiol/Levomethofolate
Elinest Norgestrel/Ethinyl Estradiol
Emoquette Desogestrel/Ethinyl Estradiol
Enpresse Levonorgestrel/Ethinyl Estradiol
Enskyce Desogestrel/Ethinyl Estradiol
Errin Norethindrone
Estarylla/Tri-Estarylla/Tri-Lo-Estarylla Norgestimate/Ethinyl Estradiol
Estrostep Fe Norethindrone/Ethinyl Estradiol/Iron
Ethynodiol/Ethinyl Estradiol
Falmina Levonorgestrel/Ethinyl Estradiol
Femynor/Tri Femynor Norgestimate/Ethinyl Estradiol
Generess Fe (chewable) Norethindrone/Ethinyl Estradiol/Iron
Gianvi Drospirenone/Ethinyl Estradiol
Gildagia Norethindrone/Ethinyl Estradiol
Heather Norethindrone
Isibloom Desogestrel/Ethinyl Estradiol
Jencycla Norethindrone
Jolivette Norethindrone
Juleber Desogestrel/Ethinyl Estradiol
Junel/Junel Fe Norethindrone/Ethinyl Estradiol
Kaitlib Fe (chewable) Norethidrone/Ethinyl Estradiol
Kariva Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol
Kelnor Ethynodiol/Ethinyl Estradiol
Kurvelo Levonorgestrel/Ethinyl Estradiol
Kimidess Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol
Larin /Larin Fe Norethindrone/Ethinyl Estradiol
Larissa Levonorgestrel/Ethinyl Estradiol
Layolis Fe (chewable) Norethindrone/Ethinyl Estradiol/Iron
Leena Norethindrone/Ethinyl Estradiol
Lessina Levonorgestrel/Ethinyl Estradiol
Levonest Levonorgestrel/Ethinyl Estradiol
Levonorgestrel/Ethinyl Estradiol
Levora Levonorgestrel/Ethinyl Estradiol
Lillow Levonorgestrel/Ethinyl Estradiol
Lo Loestrin/Lo Loestrin Fe Norethindrone/Ethinyl Estradiol
Lomedia Fe Norethindrone/Ethinyl Estradiol/Iron
Loryna Drospirenone/Ethinyl Estradiol
Low-Ogestrel Norgestrel/Ethinyl Estradiol
Lutera Levonorgestrel/Ethinyl Estradiol
Lyza Norethindrone
Marlissa Levonorgestrel/Ethinyl Estradiol
Melodetta Fe (chewable) Norethindrone/Ethinyl Estradiol/Iron
Mibelas Fe (chewable) Norethindrone/Ethinyl Estradiol/Iron
Microgestin/Microgestin Fe Norethindrone/Ethinyl Estradiol
Minastrin Fe (chewable) Norethindrone/Ethinyl Estradiol/Iron
Mircette Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol
Mono-Linyah Norgestimate/Ethinyl Estradiol
Mononessa Norgestimate/Ethinyl Estradiol
Myzilra Levonorgestrel/Ethinyl Estradiol
Natazia Dienogestrel/Estradiol Valerate
Necon Norethindrone/Ethinyl Estradiol
Nikki Drospirenone/Ethinyl Estradiol
Nora-Be Norethindrone
Norethindrone
Norethindrone/Ethinyl Estradiol
Norethindrone/Ethinyl Estradiol/Iron
Norgestimate/Ethinyl Estradiol
Norinyl Norethindrone/Ethinyl Estradiol
Norlyda Norethindrone
Nortrel Norethindrone/Ethinyl Estradiol
Ocella Drospirenone/Ethinyl Estradiol
Ogestrel Norgestrel/Ethinyl Estradiol
Orsythia Levonorgestrel/Ethinyl Estradiol
Ortho-Cyclen Norgestimate/Ethinyl Estradiol
Ortho-Micronor Norethindrone
Ortho-Novum Norethindrone/Ethinyl Estradiol
Ortho Tri-Cyclen/Ortho Tri-Cyclen Lo Norgestimate/Ethinyl Estradiol
Philith Norethindrone/Ethinyl Estradiol
Pimtrea Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol
Pirmella Norethindrone/Ethinyl Estradiol
Portia Levonorgestrel/Ethinyl Estradiol
Previfem/Tri-Previfem Norgestimate/Ethinyl Estradiol
Rajani Drospirenone/Ethinyl Estradiol/Levomethofolate
Reclipsen Desogestrel/Ethinyl Estradiol
Safyral Drospirenone/Ethinyl Estradiol/Levomethofolate
Sharobel Norethindrone
Sprintec/Tri-Sprintec/Tri-Lo-Sprintec Norgestimate/Ethinyl Estradiol
Sronyx Levonorgestrel/Ethinyl Estradiol
Syeda Drospirenone/Ethinyl Estradiol
Tarina Fe Norethindrone/Ethinyl Estradiol/Iron
Taytulla Norethindrone/Ethinyl Estradiol/Iron
Tilia Fe Norethindrone/Ethinyl Estradiol/Iron
Tri-Legest Fe Norethindrone/Ethinyl Estradiol/Iron
Tri-Linyah Norgestimate/Ethinyl Estradiol
Tri-Lo-Marzia Norgestimate/Ethinyl Estradiol
Trinessa/Trinessa Lo
Tri-Norinyl Norethindrone/Ethinyl Estradiol
Trivora Levonorgestrel/Ethinyl Estradiol
Tydemy Drospirenone/Ethinyl Estradiol/Levomethofolate
Velivet Desogestrel/Ethinyl Estradiol
Vestura Drospirenone/Ethinyl Estradiol
Vienva Levonorgestrel/Ethinyl Estradiol
Viorele Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol
Vyfemla Norethindrone/Ethinyl Estradiol
Vylibra/Tri-Vylibra Norgestimate/Ethinyl Estradiol
Wera Norethindrone/Ethinyl Estradiol
Wymzya Fe (chewable) Norethindrone/Ethinyl Estradiol/Iron
Yasmin/Yaz Drospirenone/Ethinyl Estradiol
Zarah Drospirenone/Ethinyl Estradiol
Zenchent Norethindrone/Ethinyl Estradiol
Zovia Ethynodiol/Ethinyl Estradiol
CONTRACEPTIVES: Extended Therapy
Brand Name Generic Name
Amethia/Amethia Lo Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Ashlyna Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Camrese/Camrese Lo Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Daysee Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Fayosim Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Jolessa Levonorgestrel/Ethinyl Estradiol
Introvale Levonorgestrel/Ethinyl Estradiol
LoSeasonique Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Quartette Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Quasense Levonorgestrel/Ethinyl Estradiol
Rivelsa Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Seasonale Levonorgestrel/Ethinyl Estradiol
Levonorgestrel/Ethinyl Estradiol
Seasonique Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Setlakin Levonorgestrel/Ethinyl Estradiol
DIABETES MANAGEMENT CLASSES: Amylin
Brand Name Generic Name
Symlin Pramlintide
DIABETES MANAGEMENT CLASSES: Biguanides
Brand Name Generic Name
Fortamet ER Metformin ER
Metformin ER
Glucophage Metformin
Metformin
Glucophage XR Metformin ER
Metformin ER
Glumetza ER Metformin ER
Metformin ER
Riomet Metformin solution
DIABETES MANAGEMENT CLASSES: DPP-4 Inhibitors
Brand Name Generic Name
Januvia Sitagliptin
Nesina Alogliptin
Alogliptin
Onglyza Saxagliptin
Tradjenta Linagliptin
DIABETES MANAGEMENT CLASSES: GLP-1 Analogues Brand Name Generic Name
Adlyxin Lixisenatide
Bydureon Exenatide
Bydureon BCISE Exenatide
Byetta Exenatide
Ozempic Semaglutide
Tanzeum Albiglutide
Trulicity Dulaglutide
Victoza Liraglutide
DIABETES MANAGEMENT CLASSES: Hypoglycemic Combinations
Brand Name Generic Name
Actoplus Met Pioglitazone/ metformin
Pioglitazone/ metformin
Actoplus Met XR Pioglitazone/ metformin ER
Duetact Pioglitazone/ glimepiride
Pioglitazone/ glimepiride
Glipizide/ metformin
Glucovance Glyburide/ metformin
Glyburide/ metformin
Glyxambi Empagliflozin/ linagliptin
Invokamet Canagliflozin/ metformin
Invokamet XR Canagliflozin/ metformin ER
Janumet Sitagliptin/ metformin
Janumet XR Sitagliptin/ metformin ER
Jentadueto Linagliptin/ metformin
Jentadueto XR Linagliptin/ metformin ER
Kazano Alogliptin/ metformin
Alogliptin/ metformin
Kombiglyze XR Saxagliptin/ metformin ER
Oseni Alogliptin/ pioglitazone
Alogliptin/ pioglitazone
Qtern Dapagliflozin/Saxagliptin
Repaglinide/ metformin
Segluromet Empagliflozin/metformin
Soliqua Lixisenatide/ insulin glargine
Steglujan Ertugliflozin/sitagliptin
Synjardy Empagliflozin/metformin
Synjardy XR Empagliflozin/metformin ER
Xigduo XR Dapagliflozin/metformin ER
Xultophy Liraglutide/insulin degludec
DIABETES MANAGEMENT CLASSES: Meglitinides
Brand Name Generic Name
Prandin Repaglinide
Repaglinide
Starlix Nateglinide
Nateglinide
DIABETES MANAGEMENT CLASSES: SGLT-2 Inhibitors
Brand Name Generic Name
Farxiga Dapagliflozin
Invokana Canagliflozin
Jardiance Empagliflozin
Steglatro Ertugliflozin
DIABETES MANAGEMENT CLASSES: Thiazolidinediones
Brand Name Generic Name
Actos Pioglitazone
Pioglitazone
Avandia Rosiglitazone
ERYTHROPOIESIS STIMULATING AGENTS
Brand Name Generic Name
Aranesp Darbepoetin alfa
Epogen Epoetin alfa
Mircera Methoxy peg- epoetin beta
Procrit Epoetin alfa
GI MOTILITY, CHRONIC
Brand Name Generic Name
Amitiza Lubiprostone
Linzess Linaclotide
Lotronex Alosetron
Alosetron
Movantik Naloxegol
Relistor Methylnaltrexone
Symproic Naldemedine
Trulance Plecanatide
Viberzi Eluxadoline
NEWER HAE – HEREDITARY ANGIOEDEMA AGENTS
Brand Name Generic Name
Berinert C1 Esterase Inhibitor
Cinryze C1 Esterase Inhibitor
Firazyr Icatibant
Haegarda C1 Esterase Inhibitor
Ruconest C1 Esterase Inhibitor, recombinant
OPHTHALMIC, IMMUNOMODULATORS
Brand Name Generic Name
Restasis Cyclosporine
Restasis Multidose Cyclosporine
Xiidra Lifitegrast
OVERACTIVE BLADDER AGENTS
Brand Name Generic Name
Flavoxate
Trospium
Trospium ER
Detrol Tolterodine
Tolterodine
Detrol LA Tolterodine ER
Tolterodine ER
Ditropan Oxybutynin
Oxybutynin
Ditropan XL Oxybutynin ER
Oxybutynin ER
Enablex Darifenacin
Darifenacin
Gelnique Oxybutynin gel
Myrbetriq Mirabegron
Oxytrol Oxybutynin patch
Toviaz Fesoterodine ER
Vesicare Solifenacin
PRENATAL VITAMINS
Brand Name Generic Name
Calcium-PNV PNV/Ca/Fe/FA/DHA
Citranatal Various formulations
C-Nate DHA PNV/FeF/FA/Omega 3
Complete Natal DHA PNV/Fe/FA
Completenate PNV/FeF/FA
Concept Various Formulations
Dothelle DHA PNV/FeF/FA/Omega 3
Elite OB PNV/Fe/FA
Enbrace HR PNV/Fe/Folate/DHA
Extra-Virt Plus DHA PNV/Fe/FA/DSS/DHA
Focalgin Various Formulations
Folivane-OB PNV/FeF/FA
Macnatal CN DHA PNV/Fe/FA/DSS/DHA
Marnatal-F PNV/Ca/Fe/FA
Nestabs Various Formulations
Nexa-Plus PNV/FeF/FA/DSS/DHA
Niva-Plus PNV/Ca/Fe/FA
OB Complete Various Formulations
O-Cal Tablet Various Formulations
PNV Various Formulations
Prefera OB Various Formulations
Prenaissance Various Formulations
Prenata PNV/Fe/FA
Prenatal Plus Various Formulations
Prenate Various Formulations
Preplus PNV/Ca/Fe/FA
Pretab PNV/Ca/Fe/FA
Primacare PNV/Fe/Folate/DHA
Provida Various Formulations
PureFe Various Formulations
Relnate DHA PNV/FeF/FA/Omega 3
Rulavite DHA PNV/Fe/Folate/DHA
Select-OB Various Formulations
SE-Natal Various Formulations
Taron Various Formulations
Thrivite Various Formulations
Tricare Prenatal Various Formulations
Trinatal Rx 1 PNV/Ca/Fe/FA
Tristart DHA PNV/Fe/Folate/DHA
Tri-tabs DHA PNV/Fe/FA/DHA
Triveen-Duo DHA PNV/Fe/FA/Omega 3
Trust Natal DHA PNV/Fe/FA/Omega 3
UltimateCare One Various Formulations
Vemavite-PRX 2 PNV/Fe/FA/DSS/DHA
Vinate DHA PNV/Fe/LMF
Virt-Advance/Virt-C DHA/Virt-Nate/Virt-PN
/Virt-Select/Virt-Vite
Various Formulations
Virtprex PNV/Fe/FA/DSS/DHA
Vitafol Various Formulations
Vol-Nate/Vol-Plus/Vol-Tab Various Formulations
VP-CH/VP-GGR/VP-Heme/VP-PNV Various Formulations
Zatean-PN Various Formulations
Note: Ca – Calcium, DSS – Docusate Sodium, FA – Folic Acid Fe – Iron, FeF – Iron fumarate, FeG – Iron Gluconate, LMF – L-
methylfolate, PNV – prenatal vitamin
STIMULANTS and other ADHD Agents
Brand Name Generic Name
Adderall (tablet) Dextroamphetamine/ amphetamine
Dextroamphetamine/ amphetamine
Adderall XR (capsule) Dextroamphetamine/ amphetamine ER
Dextroamphetamine/ amphetamine ER
Adzenys ER (suspension) Amphetamine
Adzenys XR-ODT (OD tablet) Amphetamine ER
Aptensio XR (capsule) Methylphenidate ER
Concerta (tablet) Methylphenidate ER
Methylphenidate ER
Cotempla XR-ODT Methylphenidate
Daytrana (patch) Methylphenidate patch
Desoxyn (tablet) Methamphetamine
Methamphetamine
Dexedrine (capsule, tablet) Dextroamphetamine
Dextroamphetamine
Dyanavel XR (suspension) Amphetamine suspension ER
Evekeo (tablet) Amphetamine
Focalin (tablet) Dexmethylphenidate
Dexmethylphenidate
Focalin XR (capsule) Dexmethylphenidate ER
Dexmethylphenidate ER
Intuniv (tablet) Guanfacine ER
Guanfacine ER
Kapvay (tablet) Clonidine ER
Clonidine ER
Metadate CD (capsule) Methylphenidate ER
Methylphenidate ER
Metadate ER (tablet) Methylphenidate ER
Methylphenidate ER
Methylin (solution, tablet) Methylphenidate
Methylphenidate
Methylphenidate ER 72mg
Mydayis ER Dextroamphetamine/Amphetamine
Nuvigil (tablet) Armodafinil
Armodafinil
Procentra (solution) Dextroamphetamine solution
Dextroamphetamine solution
Provigil (tablet) Modafinil
Modafinil
Quillichew ER (chewable tablet) Methylphenidate ER
Quillivant XR (suspension) Methylphenidate ER
Ritalin (tablet) Methylphenidate
Methylphenidate
Ritalin LA (capsule) Methylphenidate ER
Methylphenidate ER
Ritalin SR (tablet) Methylphenidate ER
Methylphenidate ER
Strattera (capsule) Atomoxetine
Atomoxetine
Vyvanse (capsule, chewable tablet) Lisdexamfetamine
Zenzedi (tablet) Dextroamphetamine
Dextroamphetamine
Recommended