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PDL Drug Class Review Announcement July 14, 2020
Drug Classes to be reviewed: Anti-coagulants (Oral & Parenteral), Anti-convulsants (Oral), Bone Resorption Suppression and Related Agents, Colony Stimulating Factors, Contraceptives (Oral), Diabetes Management Classes – Non-Insulins (Amylin, Biguanides, DPP-4 Inhibitors, GLP-1 Analogues, Hypoglycemic Combinations, Meglitinides, SGLT-2 Inhibitors, Thiazolidinediones), Erythropoiesis Stimulating Agents, GI Motility (Chronic), Newer Hereditary Angioedema Products, Ophthalmic Immunomodulators, Overactive Bladder Agents, Prenatal Vitamins and Stimulants and Related Agents. These drug classes will be reviewed at the July 14th, 2020 P&T Committee meeting from 1-5pm. The meeting will be held virtually. Dossiers and Supplemental Rebate offers are due to Magellan by June 16, 2020. Please provide your public comments to Jessica Czechowski, Pharmacist Account Executive ([email protected]) no later than July 2, 2020 to ensure they are included in the information supplied to the P&T Committee members. Please carbon copy Brittany Schock, PDL Pharmacist ([email protected]) on all clinical information and public comment submissions.
ANTI-COAGULANTS (ORAL & PARENTERAL) Brand Name Generic Name
Bevyxxa Betrixaban
Coumadin Warfarin
Jantoven Warfarin
Warfarin
Eliquis Apixaban
Pradaxa Dabigatran
Savaysa Edoxaban
Xarelto Rivaroxaban
Brand Name Generic Name
Arixtra Fondaparinux
Fondaparinux
Fragmin Dalteparin
Lovenox Enoxaparin
Enoxaparin
ANTI-CONVULSANTS (ORAL) Brand Name Generic Name
Phenobarbital
Valproic Acid
Aptiom Eslicarbazepine
Banzel Rufinamide
Briviact Brivaracetam
Carbatrol ER Carbamazepine ER
Carbamazepine ER
Celontin Methsuximide
Depakote DR, Depakote ER Divalproex Sodium
Divalproex Sodium
Diacomit Stiripentol
Dilantin Phenytoin
Phenytoin
Epidiolex Cannabidiol (CBD)
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
Clobazam
Oxtellar XR Oxcarbazepine
Peganone Ethotoin
Phenytek Phenytoin ER
Qudexy XR Topiramate ER
Topiramate ER
Roweepra XR Levetiracetam ER
Sabril Vigabatrin
Vigabatrin
Spritam Levetiracetam
Subvenite Lamotrigine
Sympazan Clobazam
Tegretol, Tegretol XR Carbamazepine
Carbamazepine
Topamax Topiramate
Topiramate
Trileptal Oxcarbazepine
Oxcarbazepine
Trokendi XR Topiramate
Vimpat Lacosamide
Xcopri Cenobamate
Zarontin Ethosuximide
Ethosuximide
Zonegran Zonisamide
Zonisamide
BONE RESORPTION SUPPRESSION AND RELATED AGENTS Brand Name Generic Name
Calcitonin-Salmon, Synthetic
Actonel Risedronate
Risedronate
Atelvia Risedronate
Binosto Alendronate
Boniva Ibandronate
Ibandronate
Evista Raloxifene
Raloxifene
Forteo Teriparatide
Teriparatide
Fosamax Alendronate
Alendronate
Fosamax Plus D Alendronate with D
Tymlos Abaloparatide
COLONY STIMULATING FACTORS Brand Name Generic Name
Granix tbo-Flilgrastim
Fulphila** Pegfilgrastim-jmdb
Leukine Sargramostim
Neulasta Pegfilgrastim
Neupogen Filgrastim
Nivestym* Filgrastim-aafi
Udenyca** Pegfilgrastim-cbqv
Zarxio* Filgrastim-sndz
Ziextenzo** Pegfilgrastim-bmez
*biosimilar to Neupogen **biosimilar to Neulasta
CONTRACEPTIVES (ORAL) Brand Name Generic Name
Desogestrel/Ethinyl Estradiol
Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol
Drospirenone/Ethinyl Estradiol
Drospirenone/Ethinyl Estradiol/Levomethofolate
Ethynodiol/Ethinyl Estradiol
Norethindrone/Ethinyl Estradiol
Norethindrone/Ethinyl Estradiol/Iron
Norgestimate/Ethinyl Estradiol
Afirmelle Levonorgestrel/Ethinyl Estradiol
Altavera Levonorgestrel/Ethinyl Estradiol
Alyacen Norethindrone/Ethinyl Estradiol
Amethia/Amethia Lo Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Amethyst Levonorgestrel/Ethinyl Estradiol
Apri Desogestrel/Ethinyl Estradiol
Aranelle Norethindrone/Ethinyl Estradiol
Ashlyna Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Aubra/Aubra EQ Levonorgestrel/Ethinyl Estradiol
Aurovela/Aurovela Fe/Aurovela 24 Fe Norethindrone/Ethinyl Estradiol
Aviane Levonorgestrel/Ethinyl Estradiol
Ayuna 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/Blisovi 24 Fe Norethindrone/Ethinyl Estradiol/Iron
Briellyn Norethindrone/Ethinyl Estradiol
Camila Norethindrone
Camrese/Camrese Lo Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Caziant Desogestrel/Ethinyl Estradiol
Chateal/Chatel EQ Levonorgestrel/Ethinyl Estradiol
Cryselle Norgestrel/Ethinyl Estradiol
Cyclafem Norethindrone/Ethinyl Estradiol
Cyred/Cyred EQ Desogestrel/Ethinyl Estradiol
Dasetta Norethindrone/Ethinyl Estradiol
Daysee Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Deblitane Norethindrone
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
Falmina Levonorgestrel/Ethinyl Estradiol
Fayosim Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Femynor/Tri Femynor Norgestimate/Ethinyl Estradiol
Generess Fe (chewable) Norethindrone/Ethinyl Estradiol/Iron
Gianvi Drospirenone/Ethinyl Estradiol
Hailey/Hailey 24 Fe Norethindrone/Ethinyl Estradiol/Iron
Heather Norethindrone
Incassia Norethindrone
Introvale Levonorgestrel/Ethinyl Estradiol
Isibloom Desogestrel/Ethinyl Estradiol
Jaimiess/LoJaimiess Levonorgest/Ethinyl Estradiol/Ethinyl Estradiol
Jasmiel Drospirenone/Ethinyl Estradiol
Jencycla Norethindrone
Jolessa Levonorgestrel/Ethinyl Estradiol
Jolivette Norethindrone
Juleber Desogestrel/Ethinyl Estradiol
Junel/Junel Fe/Junel Fe 24 Norethindrone/Ethinyl Estradiol
Kaitlib Fe (chewable) Norethidrone/Ethinyl Estradiol
Kalliga Desogestrel/Ethinyl Estradiol
Kariva Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol
Kelnor Ethynodiol/Ethinyl Estradiol
Kurvelo Levonorgestrel/Ethinyl Estradiol
Larin /Larin Fe/Larin24 Fe Norethindrone/Ethinyl Estradiol
Larissia 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
Loestrin/Lo Loestrin/Lo Loestrin Fe Norethindrone/Ethinyl Estradiol
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
Mili/Tri-Mili Norgestimate/Ethinyl Estradiol
Minastrin Fe (chewable) Norethindrone/Ethinyl Estradiol/Iron
Mircette Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol
Mono-Linyah Norgestimate/Ethinyl Estradiol
Myzilra Levonorgestrel/Ethinyl Estradiol
Natazia Dienogestrel/Estradiol Valerate
Necon Norethindrone/Ethinyl Estradiol
Nikki Drospirenone/Ethinyl Estradiol
Nora-Be Norethindrone
Norethindrone
Norlyda Norethindrone
Nortrel Norethindrone/Ethinyl Estradiol
Ocella Drospirenone/Ethinyl Estradiol
Ogestrel Norgestrel/Ethinyl Estradiol
Orsythia Levonorgestrel/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
Quartette Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Rajani Drospirenone/Ethinyl Estradiol/Levomethofolate
Reclipsen Desogestrel/Ethinyl Estradiol
Rivelsa Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Safyral Drospirenone/Ethinyl Estradiol/Levomethofolate
Seasonique/LoSeasonique Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Levonorgestrel/Ethinyl Estradiol/Ethinyl Estradiol
Setlakin Levonorgestrel/Ethinyl Estradiol
Sharobel Norethindrone
Simliya Desogestrel/Ethinyl Estradiol/Ethinyl Estradiol
Slynd Drospirenone
Sprintec/Tri-Sprintec/Tri-Lo-Sprintec Norgestimate/Ethinyl Estradiol
Sronyx Levonorgestrel/Ethinyl Estradiol
Syeda Drospirenone/Ethinyl Estradiol
Tarina Fe/Tarina 24 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 Norgestimate/Ethinyl Estradiol
Trivora Levonorgestrel/Ethinyl Estradiol
Tulana Norethindrone
Tydemy Drospirenone/Ethinyl Estradiol/Levomethofolate
Velivet Desogestrel/Ethinyl Estradiol
Vienva Levonorgestrel/Ethinyl Estradiol
Viorele Desogestrel-Ethinyl Estradiol/Ethinyl Estradiol
Volnea 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
Zovia Ethynodiol/Ethinyl Estradiol
Zumandimine/Lo-Zumandimine Drospirenone/Ethinyl Estradiol
DIABETES MANAGEMENT CLASSES: Amylin Brand Name Generic Name
Symlin Pramlintide
DIABETES MANAGEMENT CLASSES: Biguanides Brand Name Generic Name
Fortamet ER Metformin ER Osm-Tab
Metformin ER Osm-Tab
Glucophage/Glucophage XR Metformin
Metformin
Glumetza ER Metformin ER
Metformin ER
Riomet/Riomet ER Metformin solution
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/Bydureon BCISE Exenatide
Byetta Exenatide
Ozempic Semaglutide
Rybelsus Semaglutide
Trulicity Dulaglutide
Victoza Liraglutide
DIABETES MANAGEMENT CLASSES: Hypoglycemic Combinations Brand Name Generic Name
Repaglinide/ metformin
Actoplus Met Pioglitazone/ metformin
Pioglitazone/ metformin
Duetact Pioglitazone/ glimepiride
Pioglitazone/ glimepiride
Glipizide/ metformin
Glyburide/ metformin
Glyxambi Empagliflozin/ linagliptin
Invokamet/Invokamet XR Canagliflozin/Metformin
Janumet/Janumet XR Sitagliptin/Metformin
Jentadueto/Jentadueto XR Linagliptin/Metformin
Kazano Alogliptin/Metformin
Alogliptin/Metformin
Kombiglyze XR Saxagliptin/Metformin
Oseni Alogliptin/ pioglitazone
Alogliptin/ pioglitazone
Qtern Dapagliflozin/Saxagliptin
Segluromet Ertugliflozin/Metformin
Soliqua Lixisenatide/ insulin glargine
Steglujan Ertugliflozin/sitagliptin
Synjardy/Synjardy XR Empagliflozin/Metformin
Trijardy XR Empagliflozin/Linagliptin/Metformin
Xigduo XR Dapagliflozin/Metformin
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
Retacrit* Epoetin alfa-epbx
*biosimilar to Procrit
GI MOTILITY (CHRONIC) Brand Name Generic Name
Amitiza Lubiprostone
Linzess Linaclotide
Lotronex Alosetron
Alosetron
Motegrity Prucalopride
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
Icatibant
Haegarda C1 Esterase Inhibitor
Ruconest C1 Esterase Inhibitor, recombinant
Takhzyro Lanadelumab-flyo
OPHTHALMIC, IMMUNOMODULATORS Brand Name Generic Name
Cequa Cyclosporine
Restasis Cyclosporine
Restasis Multidose Cyclosporine
Xiidra Lifitegrast
OVERACTIVE BLADDER AGENTS Brand Name Generic Name
Flavoxate
Oxybutynin
Trospium
Detrol/Detrol LA Tolterodine
Tolterodine
Ditropan XL Oxybutynin ER
Oxybutynin ER
Enablex Darifenacin ER
Darifenacin ER
Gelnique Oxybutynin gel
Myrbetriq ER Mirabegron
Oxytrol Oxybutynin patch
Toviaz ER Fesoterodine ER
Vesicare Solifenacin
Solifenacin
PRENATAL VITAMINS Brand Name Generic Name
Citranatal/Citranatal Assure/Citranatal 90/ Citranatal DHA/Citranatal Harmony/ Citranatal Rx
Various formulations
C-Nate DHA PNV/FeF/FA/Omega 3
Complete Natal DHA PNV/Fe/FA
Completenate Chew PNV/FeF/FA
Concept DHA/Concept OB Various Formulations
Elite OB PNV/Fe/FA
Enbrace HR PNV/Fe/Folate/DHA
Folivane-OB PNV/FeF/FA
M-Natal Plus PNV/Ca/Fe/FA
Marnatal-F PNV/Ca/Fe/FA
Nestabs/Nestabs ABC/Nestabs DHA/Nestabs One
Various Formulations
Niva-Plus MVI/MIN60/FeF/FA
OB Complete Various Formulations
O-Cal FA Tablet Various Formulations
PNV/PNV OB+DHA/PNV-Select/PNV-VP-U/ PNV-DHA/PNV-Omega
Various Formulations
Prenaissance Various Formulations
Prenatal Vitamin Plus Low Iron PNV/Ca/Fe/FA
Prenate/Prenate AM/Prenate DHA/Prenate Elite/Prenate Enhance/Prenate Essential/ Prenate Mini/Prenate Pixie/ Prenate Plus/ Prenate Restore/ Prenate Star
Various Formulations
Preplus PNV/Ca/Fe/FA
Pretab PNV/Ca/Fe/FA
Primacare PNV/Fe/Folate/DHA
Provida OB Various Formulations
PureFe Various Formulations
Select-OB Various Formulations
SE-Natal 19 Various Formulations
Taron-C/Taron-Prex Various Formulations
Thrivite Various Formulations
Tricare Prenatal Various Formulations
Trinatal Rx 1 PNV/Ca/Fe/FA
Tristart DHA PNV/Fe/Folate/DHA
Triveen-Duo DHA PNV/Fe/FA/Omega 3
Trust Natal DHA PNV/Fe/FA/Omega 3
Vinate DHA PNV/Fe/LMF
Virt-Advance/Virt-C DHA/Virt-Nate/Virt-PN /Virt-Select/Virt-Vite
Various Formulations
Vitafol/Vitafol-Fe/Vitafol Nano/Vitafol-OB/ Vitafol-One/ Vitafol-Ultra
Various Formulations
Vol-Plus MVI/MIN60/FeF/FA
VP-CH/VP-GGR/VP-Heme/VP-PNV Various Formulations
Zatean-PN/Zatean-PN Plus 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 RELATED AGENTS Brand Name Generic Name
Clonidine ER
Methylphenidate CD/ER
Methylphenidate ER 72mg
Adderall/Adderall XR Dextroamphetamine/amphetamine
Dextroamphetamine/amphetamine
Adhansia XR Methylphenidate
Adzenys ER Amphetamine ER
Amphetamine ER
Adzenys XR-ODT Amphetamine ER
Aptensio XR Methylphenidate ER
Methylphenidate ER
Concerta Methylphenidate ER
Methylphenidate ER
Cotempla XR-ODT Methylphenidate
Daytrana Methylphenidate patch
Desoxyn Methamphetamine
Methamphetamine
Dexedrine Dextroamphetamine
Dextroamphetamine
Dyanavel XR Amphetamine suspension ER
Evekeo Amphetamine
Amphetamine
Focalin/Focalin XR Dexmethylphenidate
Dexmethylphenidate
Intuniv Guanfacine ER
Guanfacine ER
Jornay PM Methylphenidate
Methylin Methylphenidate
Methylphenidate
Mydayis ER Dextroamphetamine/Amphetamine
Nuvigil Armodafinil
Armodafinil
Procentra Dextroamphetamine solution
Dextroamphetamine solution
Provigil Modafinil
Modafinil
Quillichew ER Methylphenidate ER
Quillivant XR Methylphenidate ER
Relexxi ER Methylphenidate ER
Methylphenidate ER
Ritalin/Ritalin LA/Ritalin SR Methylphenidate
Methylphenidate
Strattera Atomoxetine
Atomoxetine
Sunosi Solriamfetol
Vyvanse Lisdexamfetamine
Wakix Pitolisant
Zenzedi Dextroamphetamine
Dextroamphetamine