Committed to delivering health and human services innovations at the national, state and local level through planning, direct services, evaluation and organizational capacity building. Broward Regional Health Planning Council, Inc. 00 Oakwood Lane, Suite 00 Hollywood, Florida 00 T: () - F: () - MEDICAL QI NETWORK Wednesday, May 0, 0 at :00 P.M. Ryan White Part A Program Office AGENDA I. Call to Order II. Welcome/Introductions ( Minutes) III. Review and Approve May 0, 0 Agenda and April, 0 Meeting Minutes ( Minutes) IV. NQC In+Care Retention Rates Summary a. Barriers and Challenges to Retention b. QIP Development V. LPAC Directives a. Part A Drug Formulary (Handout A) b. Part A Drug Utilization (Handout B) c. Recommendations for Additions/Deletions to the Formulary VI. Old/New Business ( Minutes) VII. Agenda Items for Next Meeting ( Minutes) VIII. Adjournment Next Meeting Date: June, 0 at :00 P.M.
COMMUNITY PARTNERSHIPS DIVISION Health Care Services Section S Andrews Avenue, Room A00 Fort Lauderdale, Florida 0 --0 FAX -- MEDICAL QI NETWORK April, 0 at :00 P.M. Ryan White Part A Program Office MEMBERS PRESENT Dr. Esther Schumann, AHF Dr. Kenneth Poon, BCFHC Dr. Michael Sension, NBHD Dr. Paula Eckardt, SBHD Dr. Robert Heglar, Care Resource GUESTS Brenda Colon, BCFHC Claudette Grant, NBHD Angela Savage, SBHD Brendan Kavanaugh, NSU Laurie Yadoff, Legal Services MINUTES MEMBERS ABSENT None PART A GRANTEE Kim Strong Leonard Jones CLINICAL QUALITY MANAGEMENT (CQM) SUPPORT STAFF Ariela Eshel Nekisha Smith I. Call to Order The Medical QI Network meeting was called to order at : P.M. II. III. IV. Welcome/Introductions Members and guests were welcomed and introductions were made. Review and Approve April, 0 Meeting Agenda and February 0 Meeting Minutes The following item was added to the agenda: Legal Services. The Network approved the minutes and amended agenda via consensus. Legal Services A representative from Legal Services asked for input from the medical providers regarding an increase in neurological complaints from Part A clients. Providers were unaware of any arising medical issues that would lead to an increase in neurological symptoms. V. Cervical Screening QIP Development There was consensus at the February meeting to look at a comparison between agency EMR clinic data and Provide Enterprise (PE) data to identify discrepancies in cervical screening rates. Grantee and CQM staff conducted a number of site visits to compare EMR and PE data; partial findings were provided. A complete summary of findings, along with recommendations for exclusions to be programmed in PE, is pending additional site visits. It was noted that one cervical screening exclusion would need to be programmed for Transgender clients. There was discussion regarding the tracking methods in PE for transgender clients. Providers were concerned that there may be discrepancies in documentation when comparing a client s gender between PE and EMR. The Grantee confirmed that PE allowed providers to indicate whether the individual identifies as Male, Female, Transgender Male to Female, or Transgender Female to Male. VI. Operation H.O.P.E.F.U.L. Discussion AETC has requested that providers submit the self-assessment evaluation to determine the impact of the program. Although members provided positive feedback, several concerns were identified. The process of reviewing the cards with clients is time consuming. It also prompts additional conversation and questions from the client which is a positive consequence of using the cards, however it is difficult to conduct an in-depth conversation in the context of a minute visit. Members noted that clients faced some difficulty with the level of the language used on the cards. There was agreement that the program would best be utilized by medical case managers as they have the ability to spend more time with the client. A recommendation was made to utilize the program in a support group setting and in the waiting room prior to the client visiting with the doctor. Providers preferred Operation HOPEFUL not become mandatory and be used at the provider s discretion. There was discussion regarding Broward County Board of County Commissioners Sue Gunzburger Dale V.C. Holness Kristin Jacobs Chip LaMarca Ilene Lieberman Stacy Ritter John E. Rodstrom, Jr. Barbara Sharief Lois Wexler www.broward.org
the benefits of using incentives such as bus passes to reward clients positive behavior and the use of pill boxes as a means for improving adherence. VII. NQC In + Care Retention Rates Summary (Handout A) Barriers and Challenges to Retention and QIP Development The third set of data was submitted to NQC on April nd (copy on file). It was noted that the rates for the Viral Load Suppression measure were lower than previous measurement periods. The Network surmised the reduction in Viral Load Suppression could be a result of ADAP-related barriers to access to medications. It was noted that clients on the ADAP waitlist who receive medications through the Patient Assistance Programs (PAPs) do not receive regular ADAP recertification reminders thereby increasing the chance of dropping out of ADAP. It was also noted that navigating the Ryan White service system was difficult and created a barrier for clients. Discussion was raised regarding the need for additional medical case managers to assist clients with addressing the social needs that pose a barrier to care. It was noted that better communication about clients was needed between the providers and medical case managers, especially when the medical case managers and physicians were located at different sites. Suggestions were made to introduce a patient navigation system and a medication card to help clients keep track of their medical appointments and medications. To promote access to care, the Network discussed whether the Ryan White and ADAP certification process could be combined. The Grantee advised that there have been discussions regarding combining the processes however at this time there are several barriers to doing so, including HRSA requirements. Providers noted that access to transportation and utilization of outreach services were helpful ways to promote access to care. The Network will continue discussing barriers to retention in care at the next meeting to facilitate the development of a QIP. VIII. LPAC Directives a. Part A Formulary Changes 0-0 (Handout C) This item was tabled to the next meeting. b. Part A Drug Utilization (Handout D) This item was tabled to the next meeting. c. Recommended Additions to the Part A Formulary (Handout E) At the last Medical Case Management QI Network meeting a request was made to add Megace, currently on Tier, to the formulary due to the unsuccessful use of Periactin. Statins and Oral Diabetic medications, also on Tier, were requested to be added. The Department of Health ADAP representative will provide historical cost and utilization data for Statins and Diabetes medication at the next Medical Case Management QI Network meeting. It was noted that Crestor was the only drug recommended that did not have a generic alternative and was high in cost. There was a request to add Ensure to the formulary with additional discussion due to the high cost. CQM support staff was requested to provide documentation at the next meeting of the work previously done by the Nutritional Network regarding nutritional supplements. Ensure was previously available through PAP; however, new applications are currently not being accepted. Access to Ensure is expected to become available again through PAP in the upcoming months. Providers advised that there was an alternative to Crestor on PAP. Megace was not seen as an adequate alternative to Periactin and was not typically prescribed to clients due to health concerns. Providers insisted that Actos be removed from the formulary and to add Glibizide or Glyburide in place of it. A suggestion was made to add Myambutol (Ethambutol) and Azithro (Clarithro) from the ADAP Tier to the Tier Part A of the formulary to work against Tuberculosis. IX. Old/New Business X. Agenda Items for Next Meeting a. Part A Formulary Changes 0-0 b. Part A Drug Utilization XI. Adjournment Consent Item # Action: To adjourn at : P.M. Passed Unanimously
RYAN WHITE PART A PHARMACY FORMULARY - Updated 0// TIER THREE In order to access Tier Three clients must meet the Ryan Part A eligibility requirements and have a Patient Assistance Program (PAP) application completed for each medication. Client may be eligible to receive a 0-day supply, with an option for extention, while waiting for approval. ANTIRETROVIALS Nucleosides/Nucleotide (NRTIs) Hivid (Zalcitabine) Protease Inhibitor Agenerase (Amprenavir) OTHER CONDITIONS Anticonvulsant Levetiracetam (Keppra) Antiemetics Hydrea (Hydroxyurea) Other Side Effects/Conditions Depakote (Divalproex) Geodon (Ziprasidone) Risperdal (Risperidone) Supplement Folinic Acid (Leucovorin) Wasting Marinol (Bronabinol) Megace (Megestrol) Flu Medication Relenza (Zanamivir) Hyperglycemia Diabeta (Glyburide) Glucophage (Metformin) Glucotrol (Glipizide) Hyperlipidemia Crestor (Rosuvastatin) Lipitor (Atorvastatin) Lopid (Gemfibrozil) Pravachol (Pravastatin) Tricor (Fenofibrate) Neuropathy Cymbalta (Duloxetine) Elavil (Amitriptyline) Lamictal (Lamotrigine) Lyrica (Pregabalin) Neurontin (Gabapentin) Pamelor (Nortriptyline) Opportunistic Infections (OIs) Imiquimod (Aldara) Mupirocin (Bactroban)
Date Range: //0 to /0/0 $.0 $.0 Acetaminophen $.0 Acetaminophen-Codeine Phosphate 0 $. $.0 Acetaminophen-Hydrocodone Bitartrate $,. $,.0 0 Acetaminophen-Oxycodone Hydrochloride $. $.0 Acetaminophen/Butalbital/Caffeine $. $.00 Actos $.0 $0.00 Albuterol $0. $.00 Albuterol Sulfate $. $.0 Albuterol-Ipratropium Bromide $,0.0 $.0 Allopurinol 0 $.0 $.00 Alomide $0. $.0 Alphagan P $. $.0 Amlactin $.0 $.0 Amlodipine Besylate 0 $,0. $,.0 0 Ammonium Lactate $.0 $.00 Amoxicillin $. $.00 0 Amoxicillin-Clavulanate 0 $,. $.0 0 Analpram-HC $.0 $.0 Antioxidant Formula, $,. $,0.00 0 Antioxidant Ultra Formula $. $.0 Anucort-HC $. $.00 ApexiCon E 0 $,. $.00 Artificial Tears $. $.0 Aspir-Low $. $.0 Aspirin $,0. $,0.00 Aspirin EC Lo-Dose $. $.0 Aspirin Enteric Coated $. $0.00 Atenolol $,0. $,. 0 Atrovent HFA $. $.0 Avandia $. $.0 Avapro $,. $,.0 Azithromycin $0.0 $.00 Azithromycin Day Dose Pack $. $.0 Azopt $.0 $.0 Bacitracin-Neo-Poly $.0 $.00 Baclofen $. $.0 Beconase AQ $,. $,0.0 Benzamycin 0 $.0 $.00 Benzoyl Peroxide $. $.0 Benzoyl Peroxide Wash $. $.0 /0/0 Page of
Date Range: //0 to /0/0 Benzoyl Peroxide-Erythromycin $. $.0 Benztropine Mesylate 0 $. $.00 Betamethasone Dipropionate $0. $.0 Betamethasone Dipropionate, Augmented $. $.0 Betamethasone Valerate $0. $.00 Betamethasone-Clotrimazole $.0 $.0 Betoptic S $. $.00 Bicillin L-A $. $0.00 BLOOD GLUCOSE TRUTRACK $,. $,0.00 Bumetanide $.0 $.0 BusPIRone Hydrochloride $. $.0 Calan SR $. $.0 Calcium Acetate $0. $.0 Carbamazepine $.0 $.0 Carbidopa-Levodopa $. Carisoprodol $. $0.00 Cartia XT $.0 $.0 Carvedilol $,. $,.00 Cefdinir $. $.0 Ceftriaxone Sodium $. $.0 Cefuroxime Axetil $. $.0 Celebrex $,.0 $,0.00 Celexa $. $.0 Cephalexin Monohydrate $. $.0 Ceron-DM $0.0 $0.00 Cheratussin AC $. $.0 Chlorhexidine Gluconate $0. $.0 ChlorproMAZINE $.0 $.00 Cipro HC $0. $.00 Ciprofloxacin Hydrochloride $. $.00 Ciprofloxacin Ophthalmic $. $0.00 Citalopram Hydrobromide $,. $,0.0 Clear-Atadine 0 $,0.0 $.0 Cleocin HCl $. $.0 Cleocin T $. $.0 Clindamycin Hydrochloride $.0 $.00 0 Clindamycin, Topical $. $.0 Clindamycin, Vaginal $. $0.00 Clobetasol Propionate $. $0.00 Clobetasol Propionate Emollient $. $.00 Clobex $. $.0 Clonazepam 0 $. $.00 0 /0/0 Page of
Date Range: //0 to /0/0 Clonidine 0 $,. $,0.00 Clonidine Hydrochloride $. $.00 Clotrimazole, Topical $. $.00 Colchicine $.0 $.0 Colcrys $.0 $.0 Colyte with Flavor Packs $.0 $.0 Combivent $,. $,0.0 0 Condylox $. $.0 Cortisporin Otic $. $0.00 Cosopt $. $0.0 Coumadin 0 $00. $.00 CP Dec DM $. $.0 Cyclobenzaprine Hydrochloride $,. $,.0 Cyclogyl $.0 $.0 Cyproheptadine Hydrochloride 0 $,.0 $,.0 Daily Multiple Vitamins $.00 $.0 De-Chlor DM $. $.0 Decavac $0. $.0 Deep Sea Nasal Spray $.0 $.0 Depo-Provera Contraceptive 0 $0.0 $0.00 Derma-Smoothe/FS $,00. $.0 Dexamethasone $. $0.00 Dextromethorphan-Guaifenesin $00. $0.00 Diabetic Tuss DM $. $.0 Diamox Sequels $. $.0 Diazepam $0. $0.00 Dicloxacillin Sodium $. $.0 Dicyclomine Hydrochloride 0 $0. $.00 Diflorasone Diacetate $0. $.00 Diflucan $. $.0 Digoxin $. $.00 Diltiazem Hydrochloride $0. $.00 Diltiazem Hydrochloride CD 0 $,0.0 $,0.00 Diltiazem Hydrochloride XR $0.0 $.0 Diphenhist $. $.0 DiphenhydrAMINE Hydrochloride 0 $. $.00 Doc-Q-Lace $. $.00 DOC-Q-LACE 00 MG CAPSULE $. $0.00 Docusate Sodium $. $.00 Dorzolamide Hydrochloride-Timolol Maleate $. $.0 Doxepin Hydrochloride $,.0 $0.00 Doxycycline Hyclate 0 $,. $,0.0 /0/0 Page of
Date Range: //0 to /0/0 Doxycycline Monohydrate $0.0 $.0 DuoNeb $. $.0 Enalapril Maleate $,. $,.0 Endocet $0.0 $0.00 Erythromycin Base $.0 $.0 Erythromycin, Ophthalmic $. $.00 Erythromycin, Topical $. $.00 Famotidine $. $0.00 Farbee with C 0 $.0 $.0 FeroSul $. $.0 Ferrous Sulfate 0 $,. $,.00 Flagyl $. $0.00 Fluarix $. $0.00 Fluconazole $. FluLaval $. $.0 Fluocinolone Acetonide $. $.0 Fluorometholone $. $.0 Fluphenazine Hydrochloride $. $.0 FML Liquifilm $.0 $.00 Folic Acid $. $.0 Furosemide $0. $.0 Gentamicin Sulfate, Ophthalmic $.0 $.0 Gentamicin Sulfate, Topical $. $.0 GoLYTELY $.0 $.0 Guaifenesin $0. $.0 Haloperidol $. $0.00 Humalog $0. $0.00 Humalog Mix / $.0 $.0 Humulin 0/0 $. $0.00 Humulin R $0. $.0 Hydrochlorothiazide, $,. $,00.00 Hydrochlorothiazide-Triamterene $,.0 $,0.00 Hydrocortisone Acetate-Pramoxine HCl $0. $.0 Hydrocortisone, Rectal 0 $. $0.00 Hydrocortisone, Topical 0 $,. $.0 Hydrocortisone/Neomycin/Polymyxin B $0. $0.00 Hydrocortisone/Neomycin/Polymyxin B, Otic $00. HydrOXYzine Hydrochloride $,0. $,0.00 HydrOXYzine Pamoate $,. $,0.00 Ibu $. $.0 Ibuprofen $,. $,0.0 Imitrex $. $.00 /0/0 Page of
Date Range: //0 to /0/0 INSULIN SYRINGE U00 0. ML $,0. $,.00 Ipratropium Bromide $0.0 $.0 Isoniazid $. $.0 0 Isosorbide Dinitrate $. $.0 Isosorbide Mononitrate Extended Release $.0 $0.00 Keppra $0.0 $.0 Klor-Con 0 $. $0.00 Klor-Con M0 $0.0 Klor-Con M0 $. $.0 Labetalol Hydrochloride $. $0.0 0 Lac-Hydrin $. $0.00 Laclotion $. $.0 Lactulose $. $.00 Lamisil AT Jock Itch $. $.00 Lanoxin $0. $0.00 Lansoprazole 0 $,.0 $,.0 Lantus $,. $,.0 Lantus OptiClik Cartridge $00. $.0 Levothyroxine Sodium 0 $. $.00 Levoxyl $,. $,.0 Lidocaine Viscous $. $.0 Lidocaine, Topical $.0 $.0 Lidoderm $,. $.0 Liquitears $. $.0 Lisinopril,0 $0,. $,.0 Lithium Carbonate $0. $0.00 Loperamide Hydrochloride $,.0 $.0 Lopressor $. $.00 Loratadine $,. $,0.00 00 Lorazepam $,.0 $,.0 Lortab./00 $. $.0 Low-Ogestrel- $. $.0 Lumigan $. $0.00 Macrobid $. $0.00 Macrodantin $. $.0 Magic Mouthwash $. $.0 Mapap $.0 $0.00 Maxzide $. $.00 Meclizine Hydrochloride $. $0.00 0 Medrol Dosepak $0. $.0 MedroxyPROGESTERone Acetate 0 $. $0.00 Methadone Hydrochloride $. $0.00 /0/0 Page of
Date Range: //0 to /0/0 MethylPREDNISolone $00.0 $.00 MethylPREDNISolone Dose Pack $. $.00 Metoclopramide Hydrochloride 0 $. $0.00 Metoprolol Succinate ER $. $.0 Metoprolol Tartrate $,0. $,.0 MetroCream $0.0 $.0 MetroGel $. $.0 MetroGel-Vaginal $. $.00 Metronidazole $0. $.00 Metronidazole Topical $. Metronidazole Vaginal $,. $.00 Mi-Acid II $. $.00 Mucinex $. $0.00 Mucinex DM $.0 $.00 MucusRelief $.0 $.0 Multivitamin $. $.0 0 Mytab Gas $. $0.00 Naprosyn $. Naproxen $,0. $,.0 Naproxen Enteric Coated $. $.0 Neo DM $. $.0 Nephrocaps 0 $.00 $0.00 Nifedical XL $,0. $.0 Nifedipine ER $,0. $.0 Nitrofurantoin Macrocrystals $0.0 $.0 Nitrofurantoin Monohydrate/Macrocrystals $. $.0 Nitroglycerin $. $.00 Nitroquick $. $.00 Nitrostat $. $0.00 Norvasc, $0,. $0,.00 0 Novolin 0/0 $,. $,0.00 Novolin N $. $0.00 Novolin R $. $.0 NuLYTELY with Flavor Packs $.0 $.00 Nystatin $0. $0.00 Nystatin Topical $. $0.00 Nystatin-Triamcinolone $,. $,.0 0 Oralone $. $.0 Ortho Tri-Cyclen $. $.0 Oxy 0 Balance $. $.0 Oxybutynin Chloride $. $.0 Oxycodone Hydrochloride $. $.0 /0/0 Page of
Date Range: //0 to /0/0 Pain Relieve $.00 $.00 Pancreaze $.0 $.00 Paroxetine Hydrochloride $,.0 $,.0 Penicillin V Potassium 0 $. $.0 Permethrin $. $.00 Perphenazine $,. $.0 0 Phenazopyridine Hydrochloride $. $.0 Phenytoin Sodium, Extended Release $.0 $.0 Phenytoin, Extended Release $,0. $.0 PhosLo Gelcap $. $.0 Plavix $,. $,.0 Pneumovax $. $.0 Pneumovax (obsolete) $. $.0 Potassium Chloride SR $. $.0 Pred Forte $. $0.00 PredniSONE $. $.0 0 Premarin 0 $,. $.0 Prenatal Multivitamins $.0 $0.00 PRESTIGE Test Strips $,.0 $,.0 0 Prevacid $,. $,.00 Prevacid SoluTab $. $.00 ProAir HFA $,. $0.00 Procardia XL $. $0.00 Proctosol-HC $. $.0 Proctozone HC $. $.00 Promethazine Hydrochloride $0.0 $.0 Propranolol Hydrochloride $0. $.00 Proventil HFA $,0.0 $,.0 Provera $. $.0 Prozac $0.00 Pyridoxine $. $.0 Q-Tussin DM $. $.0 Qvar $. $0.00 Ranitidine Hydrochloride $,. $,0.00 Restoril $,.0 $,0.00 Reversal: Acetaminophen - ($.) $0.00 Reversal: Acetaminophen-Codeine Phosphate - ($.) $.0 Reversal: Acetaminophen-Hydrocodone Bitartrate - ($.) $0.00 0 Reversal: Acetaminophen/Butalbital/Caffeine - ($.) $.0 Reversal: Actos - ($0.) $.0 Reversal: Albuterol - ($.) $.00 Reversal: Allopurinol - ($.) /0/0 Page of
Date Range: //0 to /0/0 Reversal: Alomide - ($0.0) $.0 Reversal: Alphagan P - ($.) $.0 Reversal: Amlodipine Besylate -0 ($.) $.00 0 Reversal: Ammonium Lactate - ($.) $0.00 Reversal: Amoxicillin - ($.) $.0 Reversal: Amoxicillin-Clavulanate - ($.) $0.00 Reversal: Antioxidant Formula - ($.) $.00 Reversal: Aspir-Low - ($.) $0.00 Reversal: Aspirin - ($.) $.0 Reversal: Aspirin Enteric Coated - ($.) $.0 Reversal: Atenolol - ($.) $.0 Reversal: Atrovent HFA - ($.) $.0 Reversal: Avandia - ($.) $.0 Reversal: Avapro - ($,.) $0.0 Reversal: Baclofen - ($.) $.0 Reversal: Beconase AQ - ($.) $.0 Reversal: Benzamycin - ($.) $.0 Reversal: Benzoyl Peroxide - ($.) $.0 Reversal: Benzoyl Peroxide Wash - ($.) $.0 Reversal: Benzoyl Peroxide-Erythromycin - ($.) $.0 Reversal: Betamethasone Dipropionate, Augmented - ($.0) $.0 Reversal: Betamethasone Valerate - ($0.0) $.0 Reversal: Betoptic S - ($.) $.0 Reversal: BLOOD GLUCOSE TRUTRACK - ($,.) $0.00 Reversal: BusPIRone Hydrochloride - ($.) $.0 Reversal: Carbamazepine - ($.) $.00 Reversal: Carvedilol - ($.) $0.00 Reversal: Celebrex - ($.) $.0 Reversal: Cephalexin Monohydrate - ($.) $.00 Reversal: Ceron-DM - ($.) $0.00 Reversal: Cheratussin AC - ($.) $0.00 Reversal: Chlorhexidine Gluconate - ($.) $.0 0 Reversal: ChlorproMAZINE - ($.) $.00 Reversal: Ciprofloxacin Hydrochloride - ($.) Reversal: Ciprofloxacin Ophthalmic - ($.0) $0.00 Reversal: Citalopram Hydrobromide - ($.) $0.00 Reversal: Clear-Atadine - ($.0) $.0 Reversal: Clindamycin Hydrochloride - ($.) $.0 Reversal: Clobetasol Propionate - ($0.) $0.00 Reversal: Clobetasol Propionate Emollient - ($.) $.0 Reversal: Clonazepam - ($.0) $.00 Reversal: Clonidine - ($.) $.0 /0/0 Page of
Date Range: //0 to /0/0 Reversal: Colchicine - ($.) $.0 Reversal: Combivent -0 ($.) $.00 0 Reversal: Cortisporin Otic - ($.) $.00 Reversal: Cosopt - ($.0) $.00 Reversal: Coumadin - ($.) $.00 Reversal: Cyclobenzaprine Hydrochloride - ($.0) $0.00 Reversal: Cyproheptadine Hydrochloride - ($.) $.0 Reversal: Deep Sea Nasal Spray - ($.0) $.0 Reversal: Derma-Smoothe/FS - ($.) $0.00 Reversal: Diazepam - ($.) $0.00 Reversal: Digoxin - ($.) $.00 Reversal: Diltiazem Hydrochloride - ($.) $.0 Reversal: Diltiazem Hydrochloride CD - ($0.) $.0 Reversal: DOC-Q-LACE 00 MG CAPSULE - ($.) $.0 Reversal: Docusate Sodium - ($.) $.00 Reversal: Doxepin Hydrochloride - ($.) $0.00 Reversal: Doxycycline Hyclate - ($.) $0.00 Reversal: DuoNeb - ($.) $.0 Reversal: Enalapril Maleate - ($0.0) $0.00 Reversal: Erythromycin, Topical - ($.) $.0 Reversal: Farbee with C - ($.) $.00 Reversal: Ferrous Sulfate - ($.) $.00 Reversal: Folic Acid - ($.) $.00 Reversal: Furosemide - ($.) $.0 Reversal: Guaifenesin - ($.) $0.00 Reversal: Humalog - ($.00) $.0 Reversal: Humalog Mix / - ($0.0) $0.00 Reversal: Humulin 0/0 - ($.) $.00 Reversal: Hydrochlorothiazide - ($.) $.00 0 Reversal: Hydrochlorothiazide-Triamterene - ($.) $.0 Reversal: Hydrocortisone, Rectal - ($.) $.0 Reversal: Hydrocortisone, Topical - ($.) $.0 Reversal: Hydrocortisone/Neomycin/Polymyxin B - ($0.) $.0 Reversal: HydrOXYzine Hydrochloride - ($.) $.0 Reversal: HydrOXYzine Pamoate - ($.0) Reversal: Ibu - ($.) $.00 Reversal: Ibuprofen -0 ($.) $.00 Reversal: INSULIN SYRINGE U00 0. ML - ($.) $.0 Reversal: Ipratropium Bromide - ($.) $.0 Reversal: Isoniazid - ($.) $.00 Reversal: Isosorbide Mononitrate Extended Release - ($.00) $.00 Reversal: Klor-Con 0 - ($0.) $.00 /0/0 Page of
Date Range: //0 to /0/0 Reversal: Klor-Con M0 - ($.) $.00 Reversal: Labetalol Hydrochloride - ($.) $.0 Reversal: Lac-Hydrin - ($.) $.00 Reversal: Lactulose - ($.) $.0 Reversal: Lamisil AT Jock Itch - ($.) $.0 Reversal: Lansoprazole - ($.) $.0 Reversal: Lantus - ($.0) $.0 Reversal: Levoxyl - ($0.) $0.00 Reversal: Lidocaine, Topical - ($.) $.00 Reversal: Lidoderm - ($.0) $.00 Reversal: Lisinopril - ($,.) $,.0 Reversal: Lithium Carbonate - ($.) $.0 Reversal: Loperamide Hydrochloride -0 ($0.) $.00 0 Reversal: Loratadine - ($.) $0.00 Reversal: Lorazepam - ($.0) $.0 Reversal: Lumigan - ($.) $0.00 Reversal: Magic Mouthwash - ($.00) $.00 Reversal: Mapap - ($.0) $.00 Reversal: Meclizine Hydrochloride - ($.) $.0 Reversal: MedroxyPROGESTERone Acetate - ($.) $.0 Reversal: MethylPREDNISolone - ($.) $.0 Reversal: MethylPREDNISolone Dose Pack - ($.) $.0 Reversal: Metoprolol Succinate ER - ($.) $.0 Reversal: Metoprolol Tartrate - ($0.) $.00 Reversal: MetroGel-Vaginal - ($.) $.0 Reversal: Metronidazole - ($.) $.0 Reversal: Metronidazole Topical - ($.) $.0 Reversal: Mucinex - ($.) $.00 Reversal: Multivitamin - ($.) $.00 Reversal: Mytab Gas - ($.) $.00 Reversal: Naproxen - ($.) $.0 Reversal: Nephrocaps - ($.0) $.0 Reversal: Nifedical XL - ($.) $0.00 Reversal: Nifedipine ER - ($0.) $0.00 Reversal: Norvasc - ($.) $0.00 Reversal: Novolin 0/0 - ($0.0) $.0 Reversal: Novolin N - ($.0) $.00 Reversal: Novolin R - ($.0) $.00 Reversal: Nystatin Topical - ($.00) $.0 Reversal: Nystatin-Triamcinolone - ($.) $0.00 Reversal: Ortho Tri-Cyclen - ($.) $.0 Reversal: Oxybutynin Chloride - ($.) $.0 /0/0 Page 0 of
Date Range: //0 to /0/0 Reversal: Paroxetine Hydrochloride - ($0.) $0.00 0 Reversal: Penicillin V Potassium - ($.) $.00 Reversal: Permethrin - ($.) $.0 Reversal: Phenytoin, Extended Release - ($.) $.0 Reversal: PhosLo Gelcap - ($.) $.00 Reversal: Plavix - ($,0.) $.0 Reversal: Pred Forte - ($.) $.00 Reversal: PredniSONE - ($.00) $.0 Reversal: Premarin - ($.) $.0 Reversal: PRESTIGE Test Strips - ($.) $.00 Reversal: Prevacid - ($,.) $0.00 0 Reversal: Prevacid SoluTab - ($.) $.0 Reversal: ProAir HFA - ($.) $.0 Reversal: Procardia XL - ($.0) $.0 Reversal: Proctosol-HC - ($.) $.00 Reversal: Proctozone HC - ($0.) $.00 Reversal: Promethazine Hydrochloride - ($.) $.0 Reversal: Propranolol Hydrochloride - ($.) $.0 Reversal: Proventil HFA - ($0.0) $.00 Reversal: Q-Tussin DM - ($.) $.00 Reversal: Qvar - ($.) $.0 Reversal: Ranitidine Hydrochloride -0 ($.) $.00 Reversal: Restoril -0 ($.00) $.00 Reversal: Rhinocort Aqua - ($,00.0) $0.0 Reversal: Serevent Diskus - ($.) $.0 Reversal: Sildec-PE DM - ($.) $.0 Reversal: Singulair - ($.) $0.00 Reversal: Spironolactone -0 ($.) $.00 Reversal: Sronyx - ($.) $.00 Reversal: Sumatriptan Succinate -0 ($.) $.00 0 Reversal: Synthroid - ($.) $.00 Reversal: SYRINGES - ($.) $.00 Reversal: Temazepam - ($.0) $.0 Reversal: Terazosin Hydrochloride - ($0.) $.0 Reversal: Terbinafine Hydrochloride - ($.) $.0 Reversal: Tetracycline Hydrochloride - ($.) $.0 Reversal: Thera - ($.0) $.00 Reversal: Therems - ($.0) $.00 Reversal: Timolol Maleate, Ophthalmic - ($.) $.0 Reversal: Tobradex - ($.) $.0 Reversal: Toprol-XL - ($0.) $.0 Reversal: Tramadol Hydrochloride -0 ($.) $.00 /0/0 Page of
Date Range: //0 to /0/0 Reversal: Trazodone Hydrochloride - ($.0) $.0 Reversal: Triamcinolone Acetonide Topical - ($0.) $.0 Reversal: Truetrack Test Strips - ($.) $.0 Reversal: Tussin - ($.) $.0 Reversal: Ventolin HFA - ($.) $.0 Reversal: Verapamil Hydrochloride - ($.) $.00 Reversal: Verapamil Hydrochloride SR - ($0.0) $.0 Reversal: Vitamin B Complex - ($0.) $.00 Reversal: X-Viate - ($.) $.0 Reversal: Xalatan - ($.) $.0 Rhinocort Aqua 00 $,0. $,00.00 Rifampin $. $.00 Robafen $.0 $.00 Saline Mist $.0 $.0 Selenium Sulfide $. $.0 Serevent Diskus 0 $,. $.00 Seroquel $. $0.00 Sildec-PE $. $.0 Sildec-PE DM $. $.00 Singulair $,.0 $,.0 0 Spironolactone $. $0.0 Sronyx $0. $.0 Sucralfate $0. $.0 SudoGest $. Sumatriptan Succinate $0.0 $0.0 Synthroid $. $.0 SYRINGES 0 $. $.00 Tears Naturale II $. $.00 Temazepam $,.0 $.0 Temovate $. $.0 Terazosin Hydrochloride $,. $,.0 Terbinafine Hydrochloride $,.0 $.0 Terbinafine Hydrochloride, Topical $.0 $.0 Tetracycline Hydrochloride $0.0 $0.00 Thera $,0.0 $,.00 THERA-TABS TABLET RW, $,. $,0.00 Theragenerix $.0 $.0 Therapeutic Vitamins $. $0.00 Therems $,00. $,.0 0 Tiazac $0.0 $.00 Timolol Maleate, Ophthalmic $0. $.00 Tobradex $. $.0 /0/0 Page of
Date Range: //0 to /0/0 Tobramycin Ophthalmic $. Tobrex $0.0 $.0 Topamax $. $.00 Topiramate $. $0.00 TOPIRMATE 0MG TABS $. $.0 Toprol-XL 0 $,0. $.00 TraMADOL Hydrochloride 0 $,. $,0.0 Trazodone Hydrochloride $,. $,.0 Triamcinolone Acetonide Topical $,00. $,.00 Triple Antibiotic $. $0.00 Trivora $0.00 Truetrack Test Strips $,.0 $.00 Tussin $0. $.0 Valtrex $. $.0 Ventolin HFA $,0. $,.0 Verapamil Hydrochloride 0 $00. $.00 Verapamil Hydrochloride SR $,. $.0 Verelan $.0 $0.00 Vistaril $0. $.0 Vitamin B Complex $. $.0 0 Vitamin B $. $0.00 Vitamin C $. $.00 Vosol HC $. $.0 Warfarin Sodium $.0 $.0 X-Viate $. $.00 Xalatan $.0 $0.00 Total, $,0. $,.0,0 /0/0 Page of
Recommended Additions to the Ryan White Part A Formulary Diabetes Medications Recommendations Glipizide Glyburide Statins and Diabetes Medications Currently on Tier or Tier Diabetes medications on current Ryan White Formulary: Insulin Analog (Humalog) Insulin NPH (Novolin) Insulin Regular (Novolin) Insulin Glaritine(Lantus) Actos (Pioglitazone) Insulin 0/0 (Novolin) Removed October 0 o Justification: Duplicate Insulin Analog (Humalog) Simplify Formulary, Cost Saving Measure Rosiglitazone (Avandia) Removed October 0 o Justification: Adverse effects, Contraindication Statins currently on Tier of the Ryan White Formulary: Crestor (Rosuvastatin); Astrazeneca Pharmaceuticals and Xubex Pharmaceutical Lipitor (Atorvastatin); Pfizer Lopid (Gemfibrozil); RX Outreach and Xubex Pharmaceutical Pravachol (Pravastatin); RX Outreach and Xubex Pharmaceutical Tricor (Fenofibrate); Abbott Additional Recommendations Myambutol (Ethambutol) (Currently on Tier ) Zithromax (Currently on Tier ) Glipizide PFIZER, INC. Connection to Care PFIZER, INC. Pfizer Pfriends RX Outreach XUBEX PHARMACEUTICAL Patients must not have any prescription drug coverage; Patients must meet program income guidelines; Hardship Exceptions: Individuals who have prescription coverage for prescription medicines may still be eligible for assistance through Connection to Care if they are experiencing significant financial or medical hardship. Income limit: 00% FPL; Shipped to provider; 0 day supply Enrolling in the program is free. You may be eligible if you have no prescription coverage; Estimated savings range up to % and depend on such factors as the particular drug purchased, amount purchased, and the pharmacy where purchased; Not based on income; Pharmacy card An individual of any age can participate in the program, as long as the program's financial guidelines are met; Income limit: 00% FPL; Shipped to patient or provider; 0 day supply This program is not based on need. Anyone can receive a free 0 day supply of medication with prescription; Shipped to patient Low Cost Pharmacy Options Target, CVS, Kmart, Walmart/Sam s, Walgreens; 0 0 day supply; $. $. Glyburide RX Outreach An individual of any age can participate in the program, as long as the program's financial guidelines are met; Income limit: 00%FPL; Shipped to provider or patient; 0 day supply XUBEX PHARMACEUTICAL This program is for generic medications only; Shipped to provider or patient Medical Network,.0. Page
Micronase (glyburide tablet ) Glynase (glyburide micro ) RX Outreach XUBEX PHARMACEUTICAL An individual of any age can participate in the program, as long as the program's financial guidelines are met; income limit: 00% FPL; Shipped to provider or patient; 0 day supply This program is for generic medications only; shipped to provider or patient Low Cost Pharmacy Options Target, CVS, Kmart, Walmart/Sam s, Walgreens; 0 0 day supply; $. $. Myambutol None None Zithro PFIZER, INC. Connection to Care Patients must not have any prescription drug coverage; Patients must meet program income guidelines; Hardship Exceptions: Individuals who have prescription coverage for prescription medicines may still be eligible for assistance through Connection to Care if they are experiencing significant financial or medical hardship. Income limit: 00% FPL; Shipped to provider; 0 Crestor PFIZER, INC. Pfizer Pfriends Astrazeneca Pharmaceuticals AZ & Me Prescription Savings Program For People Without Insurance Astrazeneca Pharmaceuticals AZ & Me Prescription Savings Program For People With Medicare Part D day supply Pfizer Pfriends is a program that helps eligible patients without prescription coverage get savings on Pfizer medicines, regardless of their age, or income, through participating pharmacies. Enrolling in the program is free. You may be eligible if you have no prescription coverage, and reside in the US, Puerto Rico or the US Virgin Islands; The Pfizer Pfriends savings program is not health insurance. For a complete list of participating pharmacies please go to www.pfizerhelpfulanswers.com or call the toll free number 0 00. There are no membership fees to participate in the Pfizer Pfriends program. Estimated savings range up to % and depend on such factors as the particular drug purchased, amount purchased, and the pharmacy where purchased; Pharmacy Card Patients must meet qualifying income eligibility criteria; Patients must not receive prescription drug coverage through private insurance or government program or such as Medicare (Part A or B), Medicare Prescription Drug Program (Part D), Medicaid, VA or military benefits, State Assistance Program for medicines. Patient must be a US resident, green card holder or work visa holder; Patients who appear to be eligible for the PAP and also appear to be eligible for federal or state programs, the AstraZeneca PAP will provide one onone education and counseling to assist that patient through the application process for those programs; Income limit; Single $,000, Couple $,000; Shipped to provider or patient; 0 day supply Patient must meet qualifying income criteria; Patient must be enrolled in Medicare Part D; Patient must have spent % of the annual household income on out of pocket prescription medicines within calendar year; Income limit; Single $,000, Couple $,000; Shipped to provider or patient; 0 day supply Lipitor Xubex Pharmaceutical Free Medication Program PFIZER, INC. Connection to Care PFIZER, INC. Lipitor $ Co Pay Card This program is not based on need. Anyone can receive a free 0 day supply of medication with prescription; Shipped to patient; 0 day supply Patients must not have any prescription drug coverage; Patients must meet program income guidelines; Hardship Exceptions: Individuals who have prescription coverage for prescription medicines may still be eligible for assistance through Connection to Care if they are experiencing significant financial or medical hardship; 00% FPL; Shipped to provider; 0 day supply This Card is not valid for prescriptions that are eligible to be reimbursed, in whole or in part, by Medicaid, Medicare or other federal or state healthcare programs, private insurance plans or other health or pharmacy benefit programs which reimburse you for the entire cost of your prescription drugs; Patient's out of pocket expense must be greater than $ per prescription. If your out of pocket expenses for a month supply (0 tablets) are $ or less, Medical Network,.0. Page
PFIZER, INC. Pfizer Pfriends you will pay $ for a month supply. If your out of pocket expenses for a month supply (0 tablets) exceed $, you qualify for up to $0 in savings for a month supply. In either case, you can only qualify for up to $00 of savings per calendar year. After maximum of $00, you will pay usual monthly out ofpocket costs; Patient takes the Co Pay card to a participating pharmacy to receive discount Pfizer Pfriends is a program that helps eligible patients without prescription coverage get savings on Pfizer medicines, regardless of their age, or income, through participating pharmacies. Enrolling in the program is free. You may be eligible if you have no prescription coverage, and reside in the US, Puerto Rico or the US Virgin Islands; The Pfizer Pfriends savings program is not health insurance. For a complete list of participating pharmacies please go to www.pfizerhelpfulanswers.com or call the toll free number 0 00. There are no membership fees to participate in the Pfizer Pfriends program. Estimated savings range up to % and depend on such factors as the particular drug purchased, amount purchased, and the pharmacy where purchased; Pharmacy Card Lopid RX Outreach An individual of any age can participate in the program, as long as the program's financial guidelines are met; 00% FPL; Shipped to provider or patient; 0 day supply XUBEX PHARMACEUTICAL Xubex Pharmaceutical Services This program is for generic medications only; Shipped to provider or patient; Amount shipped is based on amount requested on application Pravachol Rx Outreach An individual of any age can participate in the program, as long as the program's financial guidelines are met; 00% FPL; Shipped to either Provider or Patient medications sent to wherever the patient requests it; 0 day supply Tricor XUBEX PHARMACEUTICAL Xubex Pharmaceutical Services ABBOTT Abbott Patient Assistance Foundation This program is for generic medications only; Shipped to provider or patient; Amount shipped is based on amount requested on application The Abbott Patient Assistance Program is designed to help financially disadvantaged individuals receive a limited supply of Abbott pharmaceutical products at no cost; To be eligible for this program, patients must not have prescription drug coverage for the requested medication through an employer, other third party payer, Medicaid or any other state or federally funded program, and must be financially disadvantaged based upon current Federal Poverty Guidelines adjusted for household size; Patients with prescription drug coverage, including enrollment in a Medicare Part D Prescription Drug Plan, who have difficulty accessing their Abbott medications may be eligible for assistance by obtaining a Pharmaceutical Assistance Program exception based on health related expenditures and household income; Shipped to provider; 0 day supply Medical Network,.0. Page