Pharmacie française en ligne: Acheter des antibiotiques sans ordonnance en ligne prix bas et Livraison rapide.
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Pharmacy and Therapeutics Committee Decisions
March 19, 2010
Drug/Therapeutic Class
P&T Decision
Bepreve® (bepotastine besilate ophthalmic solution) •
Non-formulary
Medications
– Treatment of Allergic Conjunctivitis
Effient® (prasugrel) – Platelet Aggregation Inhibitor •
Formulary Multaq® (dronedarone) – Treatment of Arrhythmias •
Non-formulary Sabril® (vigabatrin) – Treatment of Seizures and
•
Formulary with Prior
Authorization
Samsca® (tolvaptan) – Treatment of Hyponatremia
•
Formulary with Prior
Authorization
Votrient® (pazopanib) – Treatment of Renal Cell
•
Formulary with Prior
Authorization
Therapeutic
Acne Vulgaris
•
Formulary: benzoyl peroxide,
Acanya® (benzoyl peroxide/clindamycin), Aczone®
(dapsone), Avita® (tretinoin), Azelex® (azelaic
peroxide/erythromycin), benzoyl peroxide, benzoyl
peroxide/erythromycin, clindamycin topical,
•
Non-formulary: Acanya, Aczone,
peroxide/clindamycin), Epiduo® (adapalene/benzoyl
peroxide), erythromycin topical, Retin-A® Micro
(tretinoin), sulfacetamide, Tazorac® (tazarotene),
tretinoin, Ziana® (clindamycin/tretinoin)
Gel, Duac, Epiduo, Retin-A Micro, Tazorac, Ziana
Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
•
Non-formulary: Janumet, Januvia,
Janumet® (sitagliptin phosphate/metformin),
Januvia® (sitagliptin phosphate), Onglyza®
(saxagliptin)
Central Nervous System Stimulants
•
Formulary: amphetamine/
amphetamine/dextroamphetamine, amphetamine/
(methylphenidate ER), Daytrana® (methylphenidate
dextroamphetamine, dextroamphetamine SR,
Focalin® XR (dexmethylphenidate ER), Intuniv®
(guanfacine ER), Metadate® CD (methylphenidate
ER), Metadate® ER (methylphenidate ER),
•
Non-formulary: Daytrana,
methamphetamine, Methylin® (methylphenidate),
methylphenidate, methylphenidate ER, Ritalin® LA
(methylphenidate SR), Strattera® (atomoxetine),
720 Olive Way, Suite 300 Seattle WA 98101 | www.chpw.org | 1.800.440.1561 | 206.521.8833
Drug/Therapeutic Class
P&T Decision
Vyvanse® (lisdexamfetamine)
Fibromyalgia Agents
•
Formulary: Cymbalta (prior auth)
Cymbalta® (duloxetine), Lyrica® (pregabalin),
•
Non-formulary: Lyrica, Savella
Savella® (milnacipran)
Pulmonary Arterial Hypertension
•
Formulary: Adcirca (prior auth),
Adcirca® (tadalafil), Letairis® (ambrisentan),
Revatio® (sildenafil citrate), Tracleer® (bosentan),
Tyvaso® (treprostinil inhalation), Ventavis®
•
Non-formulary: Tyvaso, Ventavis
(iloprost inhalation)
Atypical Antipsychotics
•
Formulary: Abilify (step therapy 2nd
Abilify®/Abilify® Discmelt/Abilify® Solution
(aripiprazole)
, Fanapt® (iloperidone), Geodon®
(ziprasidone), Invega® (paliperidone), risperidone,
risperidone orally disintegrating, risperidone
solution , Saphris® (asenapine), Seroquel®
(quetiapine), Seroquel® XR (quetiapine extended-
release), Symbyax® (olanzapine/fluoxetine),
•
Non-formulary: Abilify Discmelt,
Abilify Solution, Fanapt, Geodon, Invega, Saphris, Symbyax, Zyprexa Zydis
Bowel Evacuants
•
Formulary: NuLytely, Nulytely
Colyte® with Flavor Packets, GoLytely®, Half-
Lytely-Bisacodyl® with Flavor Packs, MoviPrep®,
•
Non-formulary: Colyte with Flavor
NuLytely®, Nulytely® with Flavor Packs, PEG-
Bisacodyl with Flavor Packs, MoviPrep, TriLyte with Flavor Packs
Leukotriene Pathway Inhibitors
•
Formulary: Singulair (step therapy)
Accolate® (zafirlukast), Singulair® (montelukast),
•
Non-formulary: Accolate, Zyflo CR
Zyflo® CR (zileuton extended-release)
Oral Hepatitis B Agents
•
Formulary: Baraclude, Epivir HBV,
Baraclude® (entecavir), Epivir® HBV (lamivudine),
Hepsera® (adefovir dipivoxil), Tyzeka®
•
Non-formulary: Hepsera, Tyzeka
(telbivudine), Viread® (tenofovir)
Macrolide/Ketolide Antibiotics
•
Formulary: azithromycin,
azithromycin, clarithromycin, clarithromycin ER,
erythromycin, Ketek®, PCE® Dispertab, Zmax®
•
Non-formulary: clarithromycin ER,
Multiple Sclerosis Drugs
•
Formulary: Avonex, Betaseron,
Avonex® (interferon beta-1a [IM]), Betaseron®
(interferon beta-1b), Copaxone® (glatiramer
acetate), Extavia® (interferon beta-1b), Rebif®
(interferon beta-1a [SC])
Nasal Steroids
•
Formulary: fluticasone propionate
Beconase® AQ (beclomethasone), flunisolide,
•
Non-formulary: Beconase AQ,
(mometasone), Omnaris® (ciclesonide), Rhinocort® Aqua (budesonide), Veramyst® (fluticasone furoate)
Copayment/Coinsurance for all pharmaceuticals & pharmaceutical classes above:
• Healthy Options, Basic Health Plus, Children’s Health Insurance Program, & General Assistance Unemployable = $0 • Basic Health Plan = $10 copay for formulary generic products; 50% coinsurance for formulary brand products
720 Olive Way, Suite 300 Seattle WA 98101 | www.chpw.org | 1.800.440.1561 | 206.521.8833
Prior Authorization Criteria for:
•
Abilify = trial of Seroquel or Seroquel XR first (step therapy; 2nd step); treatment of major depressive
disorder after trial of three antidepressants; treatment of irritability with autistic disorder after trial of risperidone or clinical concerns regarding use of risperidone first
•
Adcirca = FDA-approved indications and not currently taking nitrates
•
Cymbalta = Trial of a tricyclic antidepressant, gabapentin and an SSRI first for treatment of
fibromyalgia; trial of 2 formulary SSRIs and Effexor XR or 1 formulary SSRI and venlafaxine IR for treatment of depression; trial of gabapentin for the treatment of diabetic peripheral neuropathy
•
Letairis = FDA-approved indications after trial of Adcirca or Revatio first (step therapy) unless
contraindication to Adcirca or Revatio; diagnosis of World Health Organization (WHO) class IV symptoms
•
Revatio = FDA-approved indications and not currently taking nitrates
•
Sabril = Treatment of refractory complex seizures after trial of ≥ 4 other antiepileptic drugs and infantile
•
Samsca = FDA-approved indications
•
Seroquel/Seroquel XR = trial of risperidone first (step therapy; 1st step) in patients < 65 years of age;
treatment of major depressive disorder after trial of three antidepressants; bipolar depression or depressive episodes associated with bipolar disorder
•
Singulair = Covered for patients < 12 years of age; for non-asthmatic patients ≥ 12 years of age trial of
non-sedating antihistamine and nasal steroid first (step therapy); for asthmatic patients ≥ 12 years of age trial with an inhaled corticosteroid first (step therapy); interstitial cystitis if the patient has tried two alternative therapies for this condition
•
Tracleer = FDA-approved indications after trial of Adcirca or Revatio first (step therapy) unless
contraindication to Adcirca or Revatio; diagnosis of World Health Organization (WHO) class IV symptoms
•
Votrient = FDA-approved indications
•
Zyprexa = trial of Seroquel or Seroquel XR first (step therapy; 2nd step)
720 Olive Way, Suite 300 Seattle WA 98101 | www.chpw.org | 1.800.440.1561 | 206.521.8833
Source: http://www.chpw.org/assets/file/PTDecisions.pdf
Liste de médicaments à emporter Favorisez les produits de la gamme LYOC (sécables). Ils conviennent aux adultes et aux enfants, à posologie différente. L’avantage de ces cachets est que vous pouvez les prendre sans eau. Beaucoup d’antibiotiques se trouvent maintenant en Ethiopie. Nous recommandons uniquement d’en apporter en cas d’al ergie connue. De même, pour les personnes à t
Mohamed S. Ahmed, MD,PhD,PC 3117 Military Road Suite #2 MOHAMED S AHMED, MD, PHD, PC Niagara Falls, NY 14304 Phone: 716-298-4869 HEMATOLOGY-ONCOLOGY Fax: 888-847-3060 CHEMOTHERAPY ORDERS Patient Name: __________________________________________ Diagnosis: _________________________________ Protocol: _______________________________________________ Course # _________
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