Newfoundland and Labrador Prescription Drug Program
Dear Provider:
MCP number Required
Please be advised that the MCP number is mandatory when requesting Special Authorization or when making an enquiry on behalf of a patient.
Medigent Updates
Effective August 1st 2008 the Angiotensin II Receptor Blockers and the Proton Pump Inhibitors (rabeprazole and omeprazole 20mg) will be moved from Special Authorization to Open Benefit. These drugs will now be managed on the basis of a maximum daily quantity that can be claimed (see following table for the list of specific DIN and the Maximum Daily Quantity defined for each). For the affected DIN the NLPDP Real-Time System will compare the quantity claimed against the product of days supply and the daily maximum (the Approved Maximum Quantity). If the quantity claimed exceeds the Approved Maximum Quantity then the quantity to be paid will be reduced to the Approved Maximum Quantity and the claim paid on that basis (with the Response Code QT – Reduced to Quantity Limit).
Example:
A claim is submitted for 50 tablets of Cozaar 25mg (DIN 02182815) with a Days Supply of 30 days. The Defined Daily Maximum for this DIN is 1.5, so the Approved Maximum Quantity = 30 days * 1.5/day = 45. As the claimed quantity (50) exceeds the Approved Maximum the Paid Quantity will be reduced to 45 and the claim payment calculations based on that quantity.
Formulary Ring Special Authorization
A recent change to the NLPDP Real-Time System now allows a Special Authorization for a DIN that is a member of a formulary ring to be extended to all members of that formulary ring. This means that any DIN within the ring may be claimed for an NLPDP client as long as they have Special Authorization in place for another DIN within the ring. Regardless of which DIN is claimed the Available Quantity in the original special authorization will be reduced.
Example:
A Special Authorization is in place for Fosamax 70mg DIN 2245329, with a yearly limit of 60 tablets. The Pharmacy wishes to provide Apo-Alendronate 70mg DIN 2248730. This generic DIN can now be claimed without having to call the division for a DIN change. The appropriate quantity will be deducted from the original Special Authorization and any timeframe limitations will also remain in place.
Benefit List Additions
The following products are will be added to the Newfoundland and Labrador Prescription Drug Program (NLPDP) Benefit List effective August 1, 2008. The benefit status of each product is indicated.
Open benefit
Proton Pump Inhibitors
Omeprezole 20mg (Allowed Quantity Per Day = 1 Per Day)
DIN 02190915
DIN 02245058
DIN 02260867
DIN 02296446
Rabeprazole 10mg (Allowed Quantity Per Day = 2 Per Day)
DIN 02243796
DIN 02296632
DIN 02298074
Rabeprazole 20mg (Allowed Quantity Per Day = 1 Per Day)
DIN 02243797
DIN 02296640
DIN 02298082
Angiotensin II Receptor Blockers
Cozaar 25mg
DIN 02182815
Daily max 1.5
Cozaar 50mg
DIN 02182874
Daily max 1.5
Cozaar 100mg
DIN 02182882
Daily max 1
Teveten 400mg
DIN 02240432
Daily max 1.5
Teveten 600mg
DIN 02243942
Daily max 2
Diovan 80mg
DIN 02244781
Daily max 1.5
Diovan 160mg
DIN 02244782
Daily max 2
Avapro 75mg
DIN 02237923
Daily max 1.5
Avapro 150mg
DIN 02237924
Daily max 1.5
Avapro 300mg
DIN 02237925
Daily max 1
Atacand 8mg
DIN 02239091
Daily max 1.5
Atacand 16mg
DIN 02239092
Daily max 2
Micardis 40mg
DIN 02240769
Daily max 1.5
Micardis 80mg
DIN 02240770
Daily max 1
Hyzaar 50/12.5
DIN 02230047
Daily max 1
Hyzaar 100/12.5
DIN 02297841
Daily max 1
Hyzaar DS 100/25
DIN 02241007
Daily max 1
Teveten Plus 600/12.5
DIN 02253631
Daily max 1
Diovan-HCT 80/12.5
DIN 02241900
Daily max 1
Diovan-HCT 160/12.5
DIN 02241901
Daily max 1
Diovan-HCT 160/25
DIN 02246955
Daily max 1
Avalide 150/12.5
DIN 02241818
Daily max 1
Avalide 300/12.5
DIN 02241819
Daily max 1
Avalide 300/25
DIN 02280213
Daily max 1
Atacand Plus 16/12.5
DIN 02244021
Daily max 1
Micardis Plus 80/12.5
DIN 02244344
Daily max 1
Lamotrigene
Lamictal 2mg
DIN 02243803
Lamictal 5mg chewable
DIN 02240115
DIN 02246897
DIN 02243352
Lamotrigene 25mg
DIN 02245208
DIN 02265494
DIN 02142082
DIN 02248232
DIN 02246898
DIN 02243353
Lamotrigene 100mg
DIN 02245209
DIN 02265508
DIN 02142104
DIN 02248233
DIN 02246898
DIN 02243353
Lamotrigene 150mg
DIN 02245210
DIN 02265516
DIN 02142112
DIN 02248234
DIN 02246899
DIN 02246963
Pms-hydrochlorthiazide 12.5mg
DIN 02274086
Pms-amiodarone 100mg
DIN 02292173
Citalopram 30mg (CTP 30)
DIN 02296152
Mezavent 1.2gm
DIN 02297558
Resultz
DIN 02279592
SPECIAL AUTHORIZATION Additions effective August 1, 2008
Remicade 100mg for plaque psoriasis DIN 02244016
Enbrel 25mg DIN 02242903
Enbrel 50mg DIN 02274728
Raptiva 125mg‡ DIN 02272504
For patients with severe debilitating psoriasis who meet all of the following criteria:
· Body surface area (BSA) involvement of greater than 10% and/or significant involvement of the face, hands, feet or genital region
· Failure to respond to, contraindications to, or intolerant of methotrexate and cyclosporine
· Failure to respond to, intolerant to or unable to access phototherapy
Coverage will be approved initially for 3 months.
Can be reassessed for yearly coverage dependent on the patient achieving a response of greater than or equal to 75% reduction in PASI (Psoriasis Area Severity Index) score or greater than 50% reduction in PASI with a greater than or equal to 5 point improvement in DLOI (Dermatology Life Quality Index) or a quantitative reduction in BSA (Body Surface Area) affecting the face, hands, feet or genital region.
Two biologicals cannot be given concurrently
Dosage restricted to a maximum of:
· Remicade 5mg/kg 0, 2 & 6 weeks then Q8W
· Enbrel 50mg twice weekly for 3 months followed by a reduction to a maintenance dose of 50mg weekly.
· Raptiva 1mg/kg weekly
‡ NOTE: Patient enrolment in the manufacturer's drug registry program to collect effectiveness and harm outcome information is encouraged.
Emend 80mg DIN 02298791
Emend 125mg DIN 02298805
Emend Tri-Pak DIN 02298813
In combination with a 5-HT3 antagonist class of anti-emetics and dexamethasone for the prevention of acute and delayed nausea and vomiting due to highly emetogenic cancer chemotherapy (eg cisplatin ≥70mg/m2) in patients who have experienced emesis despite treatment with a combination of a 5-HT3 antagonist and dexamethasone in a previous cycle of highly emetogenic chemotherapy.
Sprycel 20mg DIN 02293129
Sprycel 50mg DIN 02293137
Sprycel 70mg DIN 02293145
Philadelphia chromosome positive acute lymphoblastic leukemia:
· For adult patients whose disease is resistant to imatinib-containing chemotherapy (patient must have tried 600mg/day)
· OR have experienced grade 3 non-hematologic toxicity,
· OR grade 4 hematologic toxicity to imatinib persisting for more than 7 days.
Request for renewal must specify that the patient has benefited from therapy and is expected to continue to do so.
Hepsera 10mg tablets DIN 02247823
When used in combination with lamivudine, in patients who developed failure to lamivudine, as defined by an increase in HBV DNA of ≥ 1 log10 IU/ml above the nadir, measured on two separate occasions within an interval of at least one month, after the first three months of lamivudine therapy, and when failure to lamivudine is not due to poor adherence to therapy.
Baraclude 0.5mg tablets DIN 02282224
For the treatment of chronic hepatitis B infection in patients with:
· documented cirrhosis on radiographic or histologic grounds AND
· a HBV DNA concentration above 2000 IU/ml.
Eprex 20,000 units/0.5ml DIN 02206072
Anemia in chronic renal failure, anemia in hematologic malignancy
Drugs Reviewed and NOT recommended:
The following is a list of medications that have been reviewed by the Atlantic Common Drug Review (ACDR), the National Common Drug Review (CDR) or the Joint Oncology Drug Review (JODR) and received a negative recommendation and therefore will not be considered under NLPDP.
Remicade 100mg Psoriatic arthritis
Humatrope Idiopathic Short-Stature (ISS)
Revlimid 5mg, 10mg Anemia due to myelodysplastic anemia
Spriafil 40mg/ml Prophylaxis/treatment of aspergillosis and candida
Thelin 100mg Primary Pulmonary Hypertension
Fosrenal 250mg, 500mg, 750mg, 1000mg Phosphate binder for use in renal disease
Aclasta 5mg/100ml Treatment of osteoporosis
Adderall XR 5mg, 10mg,20mg,25mg,30mg Attention Deficit Hyperactivity Disorder in adolescents and adults
Rasilez 150mg, 300mg Mild to moderate hypertension
Ralivia 100mg, 200mg, 300mg Moderate to severe pain
Januvia 100mg Glycemic control in type II diabetes
Tridural 100mg, 200mg, 300mg Moderate to severe pain
Humatrope Idiopathic short stature
Sativex 5.5ml vial Advanced cancer pain
Fosrenal 250mg, 500mg, 750mg, 1000mg Phosphate binder in renal disease