An Information Service of the Division of Medical Assistance. North Carolina Medicaid Pharmacy Newsletter. Number 229 April In This Issue...

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1 An Information Service of the Division of Medical Assistance North Carolina Medicaid Pharmacy Newsletter Number 229 April 2014 In This Issue... N.C. Medicaid and N.C. Health Choice Preferred Drug List Changes Makena will be available June 1, 2014 via Point of Sale New/Reinstated Labelers in the Medicaid Drug Rebate Program Terminated Labelers in the Medicaid Drug Rebate Program 72-Hour Emergency Supply Available for Pharmacy Prior Authorization Drugs Updated Federal Upper Limit Reimbursement List Published by CSC, fiscal agent for the North Carolina Medicaid Program

2 N.C. Medicaid and N.C. Health Choice Preferred Drug List Changes Effective with an estimated date of service of May 17th, 2014, the N.C. Division of Medical Assistance (DMA) will make changes to the N.C. Medicaid and N.C. Health Choice Preferred Drug List (PDL). Below are highlights of some of the changes that will occur: The prior authorization criteria will be removed from the second generation anticonvulsant class The use of only Spiriva in the COPD class will be required before moving to a non-preferred agent Adderall XR and Adderall generics will be removed from the PDL entirely. Prior authorization will be required for these generic products. New classes are being added: Under CARDIOVASULAR, Sympatholytics and Combinations, under ENDROCRINOLOGY, Sodium Glucose Co-Transporter 2 (SGLT2), under OPTHALMIC, Antibiotics-Steroid Combinations, under OTIC, Anti-Infectives and Anesthetics, under TOPICALS, Antibiotics-Vaginal, and under MISCELLANEOUS, Estrogen Agent Combinations and Estrogen Agent Oral/Transdermal In addition to the changes above, the preferred brands with non-preferred generic equivalents will be updated and are listed in the chart below: Brand Name Accolate Adderall Adderall XR Alphagan P Aricept ODT Astelin/Astepro Benzaclin Cardizem LA Catapress-TTS Derma-Smoothe-FS Differin Diovan HCT Dovonex Cream Diastat / Diastat Accudial Exelon Gabitril Kadian ER Gris-Peg Lovenox Marinol Metrogel Vaginal Opana ER Generic Name Zafirlukast Amphetamine Salt Combo Amphetamine Salt Combo ER Brimonidine Donepezil ODT Azelastine Hydrochloride Clindamycin/Benzoyl Peroxide Diltiazem LA Clonidine Patches Fluocinolone 0.01% Oil Adapalene Valsartan Hydrochlorothiazide Calcipotriene 0.005% Cream Diazepam Rectal & Rectal Device Rivastigmine Tiagabine Morphine Sulfate ER Griseofulvin Ultramicrosize Enoxaparin Dronabinol Metronidazole Gel Vaginal Oxymorphone ER 2

3 Pulmicort 0.25mg/2ml, 0.5mg/2ml Retin-A Micro Singulair Granules Tobradex Suspension Toprol XL Travatan Trilipix Uroxatral Vancocin Zovirax Ointment Budesonide 0.25mg/2ml, 0.5mg/2ml Tretinoin Microsphere Montelukast Granules Tobramycin/Dexamethasone Susp Metoprolol Succinate Travoprost Fenofibric Acid Alfuzosin Vancomycin Acyclovir Ointment Makena will be available June 1, 2014 via Point of Sale Makena is still available through the Physicians Drug Program (PDP) at a rate of $2.87 per milligram. In addition, the Division of Medical Assistance (DMA) also covers the compounded product, 17P, through the PDP program. The compounding product may be unavailable soon and, in order to prevent any barrier in obtaining the product, DMA has chosen to allow Makena to be dispensed at point-of-sale (POS) starting June 1, DMA may impose a prior authorization requirement in the near future. Makena may have limited distribution. Visit the manufacturer s web site (Ther-Rx Corp - ) or call the manufacturer ( ) to learn more about obtaining Makena through the PDP program or through POS. New/Reinstated Labelers in the Medicaid Drug Rebate Program: Labeler Code Labeler Name Optional Effective Date (for State Coverage) Mandatory Effective Date (for State Coverage) ZYLERA PHARMACEUTICALS, 04/24/ /01/2014 LLC MIST PHARMACEUTICALS, 04/10/ /01/2014 LLC CONCORDIA 03/07/ /01/2014 PHARMACEUTICALS, INC AMERIGEN 02/11/ /01/2014 PHARMACEUTICALS, INC NEXTSOURCE 01/05/ /01/2014 BIOTECHNOLOGY, LLC VANSEN PHARMA INC. 01/01/ /01/ VANSEN PHARMA INC. 01/01/ /01/ GALEN US INCORPORATED 11/22/ /01/ PHARMACYCLICS, INC. 11/22/ /01/ DISCOVERY LABORATORIES, INC. 11/22/ /01/2014 3

4 Terminated Labelers in the Medicaid Drug Rebate Program: Labeler Code Labeler Name Effective Date (Voluntary Termination) CutisPharma 7/1/ Coloplast Corporation 7/1/ Hercon Laboratories Corporation 7/1/ Plymouth Pharmaceuticals, Inc. 7/1/ A. AARONS, INC 4/1/ SHIONOGI USA, INC. 4/1/ MEDIMMUNE ONCOLOGY, INC. 4/1/ NOVO NORDISK, INC. 4/1/ (Voluntary Termination) ETHEX CORPORATION 4/1/ (Voluntary Termination) GLADES PHARMACEUTICALS 4/1/2014 LLC (Voluntary Termination) RARE DISEASE THERAPEUTICS, 4/1/2014 INC (Voluntary Termination) OSCIENT PHARMACEUTICALS 4/1/2014 CORPORATION (Voluntary Termination) NORTHSTAR RX LLC 4/1/ Hour Emergency Supply Available for Pharmacy Prior Authorization Drugs Pharmacy providers are encouraged to use the 72-hour emergency supply allowed for drugs requiring prior authorization. Federal law requires that this emergency supply be available to Medicaid recipients for drugs requiring prior authorization. [Social Security Act, Section 1927, 42 U.S.C. 1396r-8(d)(5)(B)]. Use of this emergency supply will ensure access to medically necessary medications. The system will bypass the prior authorization requirement if an emergency supply is indicated. A "3" in the Level of Service field (418-DI) should be used to indicate that the transaction is an emergency fill. Please Note: Co-payments will apply and only the drug cost will be reimbursed. There is no limit to the number of times the emergency supply can be used. Updated Federal Upper Limit Reimbursement List Certain drugs have been identified for which the Federal Upper Limit (FUL) reimbursement rate does not cover the cost of the drug. Medicaid pharmacy programs are required to reference this reimbursement information when pricing drug claims. In order to receive adequate reimbursement, pharmacy providers may use the DAW1 override to override the FUL reimbursement rate for the drugs listed on the FUL list until the FUL rate has been adjusted to adequately cover the cost of the drug. As indicated in previous communications, use of the DAW1 override code is being monitored. A claim submitted for more than the State Maximum Allowable Cost (SMAC) rate on file may lead 4

5 to an identifiable overpayment. Any difference between the SMAC rate on file for the date of service and the actual rate applied to the claim (if higher) may be considered an overpayment and subject to recoupment. NDC NAME ACETYLCYSTEI 200 MG VIAL ROXANE ALBUTEROL SULF 4MG TAB MUTUAL ALCLOMETASONE 0.05% CREAM TARO BACLOFEN 20MG TABLET UPSHIRE SMITH BENAZAPRIL/HCTZ 20/25MG TAB MYLAN BETAMETH DIP 0.05 % LOT PERRIGO BETAMETHASONE DIP 0.05 % CRM SANDOZ BETAMETHASONE DIP 0.05 % CRM SANDOZ BETAMETHASONE VAL 0.1 % CREAM ACTAVIS BETAMETHASONE VAL 0.1 % CRM SANDOZ BETAMETHASONE VAL 0.1% CREAM SANDOZ CAPTOPRIL 12.5MG TAB WOCKHARDT CARBAMAZEPINE 100 MG SUS TARO CARBAMAZEPINE 100 MG/5 ML SUSP MORTON GROVE CARISOPRODOL ASA MG TAB SANDOZ CARISOPRODOL ASA MG TAB SANDOZ CHOLESTYRAMINE SUCR 4 G PWD PAR CHOLESTYRAMINE SUCR 4 G PWD SANDOZ CHOLESTYRAMN 4 G PWD UPSHER SMITH CLARITHROMYCIN 250 MG TAB SANDOZ CLARITHROMYCIN 500 MG TAB ROXANE CLARITHROMYCIN 500 MG TAB SANDOZ CLARITHROMYCIN 500 MG TAB WOCKHARDT CLARITHROMYCIN 500 MG TAB ZYDUS CLINDAMY PHOS 1 % GEL GRN STONE CLINDAMY PHOS 1 % GEL GRN STONE CLINDAMY PHOS 1 % SOL GRN STONE CLINDAMYCIN 1 % SOLN GREENSTONE CLINDAMYCIN 1% LOTION GRN STONE CLINDAMYCIN PHOS 1 % GEL SANDOZ CLINDAMYCIN PHOS 1 % GEL SANDOZ CLINDAMYCIN PHOSP 1% LOTION SANDOZ CLOBETASOL 0.05 % OINT TARO CLOBETASOL 0.05 %CRM HI-TECH CLOBETASOL 0.05 %CRM HI-TECH CLOBETASOL 0.05 %CRM HI-TECH CLOBETASOL 0.05 %CRM HI-TECH 5

6 CLOBETASOL 0.05% OINT SANDOZ CLOBETASOL 0.05% OINT SANDOZ CLOBETASOL 0.05% OINT SANDOZ CLOBETASOL 0.05% OINT SANDOZ CLOMIPRAMINE 25 MG CAPSULE SANDOZ CLOMIPRAMINE 25 MG CAPSULE TARO CLOMIPRAMINE 50 MG CAPSULE MYLAN CLOMIPRAMINE 50 MG CAPSULE SANDOZ CLOMIPRAMINE 75 MG CAP TARO CLOMIPRAMINE HCL 25MG CAP MYLAN CLOMIPRAMINE HCL 25MG CAP TARO CLOMIPRAMINE HCL 50 MG CAP TARO CLOMIPRAMINE HCL 50 MG CAP TARO CLORAZEPATE 3.75 MG TABLET MYLAN CLOTRIMAZOLE 1 %-0.05% CRM TARO CLOTRIMAZOLE 1 %-0.05% CRM TARO CLOTRIMAZOLE-BETAMETH LOT TARO CLOTRM BMETH 1 %-0.05% CRM ACTAVIS CLOTRM BMETH 1 %-0.05% CRM ACTAVIS CLOTRM BMETH 1 %-0.05% CRM SANDOZ CLOTRM BMETH 1 %-0.05% CRM SANDOZ CLOTRM BMETH 1 %-0.05% LOT SANDOZ D-AMPHET SULF 10 MG TAB BARR D-AMPHET SULF 10 MG TAB MALLINCKRODT DESONIDE 0.05 % CREAM - ACTAVIS DESONIDE 0.05 % CRM PERRIGO DESONIDE 0.05 % CRM PERRIGO DESONIDE 0.05 % LOT ACTAVIS DESONIDE 0.05 % LOT ACTAVIS DESONIDE 0.05 % LOT SANDOZ DESONIDE 0.05 % LOT SANDOZ DESONIDE 0.05 % OINT PERRIGO DESONIDE 0.05 %CRM TARO DESONIDE 0.05 %OINT PERRIGO DESONIDE 0.05% CRM 15GM TARO DESONIDE 0.05% OINT TARO DICYCLOMINE 20 MG TABLET ACTAVIS DIGIOXIN 0.125MG TAB GLOBAL PHARM DIGOX 0.125MG TAB LANNETT DIGOX 250MCG TABLET LANNETT DIGOXIN 125 MCG TAB LANNETT CO 6

7 DIGOXIN 250 MCG TAB LANNETT CO DOXAZOSIN MESYLATE 2 MG TAB APOTEX DOXAZOSIN MESYLATE 4 MG TAB APOTEX DOXEPIN 10MG CAPSULE MYLAN DOXEPIN 10MG CAPSULE MYLAN DOXEPIN 50 MG CAPSULE MYLAN DOXEPIN HCL 100 MG CAP MYLAN DOXEPIN HCL 100 MG CAP MYLAN DOXEPIN HCL 50 MG CAP MYLAN DOXEPIN HCL 75 MG CAP MYLAN DOXY HYCLATE 100 MG CAP ACTAVIS DOXY HYCLATE 100 MG CAP MAJOR DOXY HYCLATE 100 MG CAP WEST WARD DOXY HYCLATE 100 MG CAP WEST WARD DOXY HYCLATE 100 MG CAP WEST WARD DOXY HYCLATE 100 MG TAB ACTAVIS DOXY HYCLATE 100 MG TAB MUTUAL DOXY HYCLATE 100 MG TAB MUTUAL DOXY HYCLATE 100 MG TAB WEST WARD DOXY HYCLATE 100MG CAP MUTUAL DOXY HYCLATE 100MG CAP MUTUAL DOXY HYCLATE 50 MG CAP MUTUAL DOXY HYCLATE 50 MG CAP WEST WARD DOXYCYCLINE HYC 100MG TAB WEST WARD FLUCONAZOLE 200 MG TABLET GLENMARK FLUCONAZOLE 200 MG TABLET IVAX FLUOCINONIDE 0.05 % CRM TARO FLUOCINONIDE 0.05 % CRM TARO FLUOCINONIDE 0.05 % CRM TARO FLUOCINONIDE 0.05 % CRM TARO FLUOCINONIDE 0.05 % SOL SANDOZ FLUOCINONIDE 0.05 % SOL TARO FLUOCINONIDE 0.05% CREAM TEVA FLUOCINONIDE E 0.05 % CRM TEVA FLUOCINONIDE E 0.05 % CRM TEVA GENTAMICIN 0.3% EYE DROP SANDOZ GENTAMICIN SULF 0.1% CREAM PERRIGO HALOBETASOL PROP 0.05 % OINT G&M LABS HC BUTYRATE 0.1 % CRM TARO HC VALERATE 0.2 % CRM PERRIGO HC VALERATE 0.2 % CRM PERRIGO 7

8 HC VALERATE 0.2 % CRM PERRIGO HC VALERATE 0.2 % CRM TARO HC VALERATE 0.2 % CRM TARO HC VALERATE 0.2 % CRM TARO HC VALERATE 0.2 % OINT TARO HC VALERATE 0.2 % OINT TARO HC VALERATE 0.2 % OINT TARO HCTZ PROPRANOLOL 25MG /80 MG TAB MYLAN HCTZ TRIAM 75 MG-50MG TAB SANDOZ HCTZ TRIAM 75 MG-50MG TAB SANDOZ HCTZ TRIAM75 MG-50TABMYLA HCTZ TRIAM75 MG-50TABMYLA IBUPROFEN 400 MG TABLET AMNEAL ISOSORB DINI20 MG TAB SANDOZ ISOSORB DINI20 MG TAB SANDOZ LABETALOL 300 MG TAB ACTAVIS LABETALOL HCL 100 MG TABLET ACTAVIS METHAZOLAMDE 50 MG TAB FERA METHAZOLAMDE 50 MG TAB SANDOZ METHOTREXATE 2.5 MG TAB BARR METHOTREXATE 2.5 MG TAB BARR METHOTREXATE 2.5 MG TAB ROXANE METHOTREXATE 2.5 MG TAB ROXANE METHYLPHENIDATE 5MG TAB UCB METHYLPHN HCL 10 MG TAB ACTAVIS METHYLPHN HCL 10 MG TAB CARACO METHYLPHN HCL 10 MG TAB MALLINCKRODT METHYLPHN HCL 10 MG TAB MALLINCKRODT METHYLPHN HCL 10 MG TAB SANDOZ METHYLPHN HCL 20 MG TAB ACTAVIS METHYLPHN HCL 20 MG TAB CARACO METHYLPHN HCL 20 MG TAB MALLINCKRODT METHYLPHN HCL 20 MG TAB SANDOZ METHYLPHN HCL 5 MG TAB CARACO METHYLPHN HCL 5 MG TAB MALLINCKRODT METHYLPHN HCL 5 MG TAB MALLINCKRODT METHYLPHN HCL 5 MG TAB SANDOZ METHYLPREDNISOL 4 MG TAB QUALITEST METHYLPREDNISOL 4 MG TAB QUALITEST METHYLPREDNISOLONE 4 MG TAB CADISTA METHYLTREXATE SODIUM 2.5 MG TAB DAVA 8

9 METRONIDAZOL 500 MG TAB ACTAVIS METRONIDAZOLE 0.75 % CRM HARRIS METRONIDAZOLE 0.75 % GEL TARO METRONIDAZOLE 0.75 % LOT SANDOZ METRONIDAZOLE 0.75% CREAM ACTAVIS METRONIDAZOLE 250 MG TAB PLIVA METRONIDAZOLE 250 MG TABLET ACTAVIS METRONIDAZOLE 500 MG TAB PLIVA METRONIDAZOLE 500 MG TAB PLIVA MOMETASONE 0.1 % CRM G&M LABS NADOLOL 20 MG TAB TEVA NADOLOL 20MG CAP SANDOZ NADOLOL 20MG TABLET MYLAN NADOLOL 40 MG TAB MYLAN NADOLOL 40 MG TAB SANDOZ NADOLOL 40 MG TAB TEVA NEO POL DEXA OINT SANDOZ NEO POLYMX HCL % SOL SANDOZ NEOMYC-POLYM-DEXAMET EYE OINT VALEANT No Drug No Drug NORTRPTYLINE HCL 25 MG CAP ACTAVIS NORTRPTYLINE HCL 25 MG CAP ACTAVIS NORTRPTYLINE HCL 25 MG CAP ACTAVIS NYST TRIAMC CRM SANDOZ NYST TRIAMCI CRM SANDOZ NYST TRIAMCIN CRM TARO NYST TRIAMCIN CRM TARO NYST TRIAMCIN CRM TARO NYST TRIAMCIN OINT TARO NYST TRIAMCIN OINT TARO NYST TRIAMCIN OINT TARO NYSTATIN 100,000 UNIT/GM CRM SANDOZ NYSTATIN UNIT CREAM PERRIGO NYSTATIN /G CRM ACTAVIS NYSTATIN /G CRM ACTAVIS NYSTATIN /G CRM QUALITEST NYSTATIN /G CRM QUALITEST NYSTATIN /G CRM TARO NYSTATIN /G CRM TARO NYSTATIN /G OINT ACTAVIS 9

10 NYSTATIN /G OINT ACTAVIS NYSTATIN /G OINT PERRIGO NYSTATIN /G OINT PERRIGO OXAPROZIN 600MG TAB TEVA OXAZEPAM 10 MG CAP ACTAVIS OXAZEPAM 15 MG CAP ACTAVIS OXAZEPAM 15 MG CAPSULE SANDOZ OXYBUTYNIN 5 MG TABLET PLIVA OXYBUTYNIN 5MG TAB PLIVA OXYBUTYNIN 5MG TABLET UPSHIRE SMITH OXYBUTYNIN CHLORIDE 5MG TABLET QUALITEST OXYBUTYNIN CHLORIDE 5MG TABLET QUALITEST OXYBUTYNIN CHLORIDE 5MG TABLET QUALITEST OXYCODON HCL 20 MG/ML CONC GLENMARK OXYCODON HCL 20 MG/ML CONC LANNETT OXYCODON HCL 20 MG/ML CONC LANNETT OXYCODON HCL 20MG/ML CONC. VISTA OXYCODONE 5 MG CAPSULE MIDLOTHIAN LAB OXYCODONE 5 MG CAPSULE- GLENMARK OXYCODONE HCL 5 MG TAB AHP OXYCODONE HCL 5 MG TAB AHP OXYCODONE HCL 5 MG TAB ALVOGEN OXYCODONE HCL 5 MG TAB AUROBINDO OXYCODONE HCL 5 MG TAB KVK-TECH OXYCODONE HCL 5 MG TAB MALLINCKRODT OXYCODONE HCL 5 MG TAB MALLINCKRODT OXYCODONE HCL 5 MG TAB MALLINCKRODT OXYCODONE HCL 5 MG TAB MIDLOTHIAN LAB OXYCODONE HCL 5 MG TAB QUALITEST OXYCODONE HCL 5 MG TAB QUALITEST OXYCODONE HCL 5 MG TAB ZYDUS PHENADOZ 12.5 MG SUP ACTAVIS PHENADOZ 12.5MG SUP WATSON PHENADOZ 25 MG SUP WATSON PHENADOZ 25MG SUP ACTAVIS PIROXICAM 20 MG CAP NOSTRUM LAB PIROXICAM 20 MG CAP NOSTRUM LAB PIROXICAM 20 MG CAP TEVA PIROXICAM 20 MG CAP TEVA POTASSIUM CL ER 10 MEQ TAB ACTAVIS PRAVASTATIN 40MG TAB - TEVA 10

11 PRAVASTATIN 40MG TABLET TEVA PREDNISOLONE 1% DROP SANDOZ PREDNISOLONE ACET 1 % DRP SANDOZ PREDNISOLONE ACET 1 % DRP SANDOZ PREDNISONE 10 MG TABLET PREDNISONE 10 MG TABLET ROXANE PREDNISONE 20 MG TABLET ROXANE PROMETHAZINE 12.5 MG SUPPOS PERRIGO PROMETHEGAN 12.5 MG SUP G&M LABS PROMETHEGAN 25 MG SUPP.RECT - G & W LABS SILVER SULFA DIAZ 1 % CRM ACTAVIS SILVER SULFA DIAZ 1 % CRM ACTAVIS SILVER SULFA DIAZ 1 % CRM ACTAVIS SILVER SULFADIAZINE CREAM ASCEND SILVER SULFADIAZINE CREAM ASCEND SSD 1 % CRM DR. REDDY SSD 1 % CRM DR. REDDY SSD 1% CREAM DR.REDDY'S LAB SSD CREAM - DR. REDDY'S SULFACETA NA10 % DRP VALEANT SULFACETAMIDE NA 10 % DRP SANDOZ TOBRAMYCIN SULF 0.3 % DRP SANDOZ TRIAMCIN ACET 0.1 % CRM PERRIGO TRIAMCIN ACET 0.1 % CRM PERRIGO TRIAMCIN ACET 0.1 % CRM PERRIGO TRIAMCIN ACET 0.1 % CRM TARO TRIAMCIN ACET 0.5 % CRM PERRIGO TRIAMCINOLOLNE ACET 0.1% CREAM ASCEND TRIAMCINOLONE 0.1% OINTMENT PERRIGO TRIAMCINOLONE ACET 0.025% CRM SANDOZ TRIAMCINOLONE ACET 0.025% CRM SANDOZ TRIAMCINOLONE ACET 0.1 % CRM SANDOZ TRIAMCINOLONE ACET 0.1 % CRM SANDOZ TRIAMCINOLONE ACET 0.1 % CRM SANDOZ TRIAMCINOLONE ACET 0.1 % OINT SANDOZ TRIAMCINOLONE ACET 0.1 % OINT SANDOZ TRIAMCINOLONE ACET 0.1 % OINT SANDOZ TRIAMCINOLONE ACET 0.5 % CRM SANDOZ TRIAZOLAM MG TABLET GREENSTONE TRIAZOLAM 0.25 MG TABLET ROXANE TRIHEXYPHENIDYL 5 MG TABLET PACK 11

12 Electronic Cut-Off Schedule Checkwrite Schedule May 2, 2014 May 6, 2014 May 9, 2014 May 13, 2014 May 16, 2014 May 23, 2014 May 20, 2014 May 28, 2014 May 30, 2014 June 3, 2014 POS Claims must be transmitted and completed by 11:59 p.m. on the day of the electronic cut-off date to be included in the next checkwrite. Jason Swartz, R.Ph, MBA Outpatient Pharmacy Program Manager Division of Medical Assistance NC Department of Health and Human Services Sandra Terrell, RN Acting Director Division of Medical Assistance NC Department of Health and Human Services Nancy Henley, MD Chief Medical Officer Division of Medical Assistance NC Department of Health and Human Services Rick Paderick, R.Ph. Pharmacy Director NCTracks CSC Lori Landman Deputy Executive Account Director NCTracks CSC Paul Guthery Executive Account Director NCTracks CSC 12

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