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pharmacy & THERAPEUTICS® Member-Specific Prescription Information • FDA Warnings • Formulary Decisions
Newly Available Generics • Future Generic Approvals
VISCoSUPPlEmEnTATIon foR oSTEoARTHRITIS: IS IT EffECTIVE? By Anthony May, PharmD, MBA, SelectHealth PGY-1 Pharmacy Resident For patients suffering from osteoarthritis, results from six unpublished studies, and reporting quality present in many managing the pain and disability of something that past analyses of the smaller trials. This difference joint degeneration can be a difficult failed to take into account.3 was especially evident in a select and frustrating process. Nonsteroidal number of trials in which effect sizes The initial analysis of pain outcomes, anti-inflammatory drugs (NSAIDS) for viscosupplementation were two to which included all trial types, found a have become the mainstay of therapy, three times those expected for a total clinically significant effect size in favor but these medications have adverse joint replacement. In terms of safety, a of viscosupplementation. However, effects including serious gastrointestinal majority of the reports did not provide a subsequent stratified analysis that and cardiovascular events. Hoping adequate data on adverse events, and only included the 18 larger trials with to provide patients with alternative only eight trials offered a description blinded outcome assessments found no treatments, the FDA approved intra- of the SAEs that occurred. Among the clinically significant difference between articular injections of hyaluronic acid, eight trials, 27 serious SAEs occurred viscosupplementation and placebo also known as viscosupplementation, in the pooled viscosupplementation in terms of both pain reduction and for the management of pain associated group, compared to 21 SAEs in the restoration of physical function. For the with osteoarthritis of the knee.1 Since placebo group. Of note is that SAEs in safety analysis, viscosupplementation its approval in 1997, studies evaluating the treatment group included cancer (six was associated with an increased risk the efficacy of viscosupplemention have events versus zero events), cardiovascular for Serious Adverse Events (SAEs), produced varying results, leaving both events (five events versus two events), dropouts due to adverse events, and patients and providers to question the and musculoskeletal events (four events local adverse events. There was no effectiveness of these costly treatments.2 versus two events). While reporting of significant difference in rates of flare- all SAEs is encouraged, it is difficult to A meta-analysis published in the June up or effusion at the injected knee. attribute events such as cancer to the 2012 issue of the Annals of Internal Based on these findings, the authors injections, especially considering that no Medicine took a closer look at the risks concluded that due to the increased trials lasted longer than six months.4 and benefits of viscosupplementation. risk for serious and local adverse events, Using the most recent data, the administration of hyaluronic acid Based on the results of this meta-analysis, authors concluded that the benefit preparations should be discouraged. it is difficult to completely disregard of viscosupplementation on pain and the efficacy of viscosupplementation. While analysis of the 18 large blinded function in patients with symptomatic Nonetheless, evidence supporting its use studies supports the authors' conclusions, osteoarthritis of the knee is minimal is not compelling and does not warrant it is interesting to note that the initial or nonexistent. The analysis accounted use in a large population, especially for trial analyses assessing knee pain found for 89 randomized trials comparing an extended period of time. Additionally, a clinically significant benefit in favor viscosupplementation to placebo the lack of more specific safety data of viscosupplementation. According and assessed three outcomes: knee warrants further investigation into to the authors, this difference can be pain, physical function, and safety. the adverse effects of these agents.
attributed to the poor methodological Additionally, the analysis included Continued on next page viscosupplements used in the treatment 2 Lo, Grace H., PhD. "Intra-articular Hyaluronic Acid in the Treatment of Knee Osteoarthritis." Intra- It appears that viscosupplementation of osteoarthritis of the knee—including articular Hyaluronic Acid in the Treatment of Knee is best suited for individuals Hyalgan, Supartz, Orthovisc and Gel- Osteoarthritis 290.23 (2003): 3115-121. JAMA. 17 Dec. in whom lifestyle changes and One—are subject to preauthorization 2003. Web. 18 Sept. 2012. <http://jama.jamanetwork.
NSAIDS have not been effective and require patients to fail prior therapy and surgery is not an immediate with a preferred viscosupplement.
3 Rutjes, Anne W.S, PhD, and Peter Juni, MD. option. In these patients, short-term "Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review and Meta-analysis." treatment with a viscosupplement References: 1 DeGroot, Henry, MD, Sofi Uzunishvili, MD, and Annals of Internal Medicine 157.3 (2012): 1-13. Print may provide temporary benefit.4 Robert Weir, MD. "Intra-Articular Injection of 4 Richmond, John, MD. Joseph Bosco, MD "Study: We currently cover Synvisc, Synvisc- Hyaluronic Acid Is Not Superior to Saline Solution Injections Ineffective for Knee Arthritis." Fox News. N.p., 12 June 2012. Web. 18 Sept. 2012. <http://www.
One, and Euflexxa under the medical Injection for Ankle Arthritis." The Journal of Bone and Joint Surgery 94.1 (2012): 2+. Print.
benefit without preauthorization. Other mEmbER-SPECIfIC PRESCRIPTIon InfoRmATIon By Ghazal Palmer, PharmD, SelectHealth Clinical Coordinator An interactive "Drug Lookup" search tool, which gives access to prescription drug tier
information and alternative drugs within a class, is available at selecthealth.org.
The tool also shows applicable • RX button (blue and white) – Allows
for a medication or it was covered by a restriction criteria such as step therapy, the prescriber to view additional different insurer, it will not be displayed.
quantity limits, and preauthorization. claim details (such as the dispensing pharmacy). Clicking on the drug SelectHealth members can access name connects the prescriber Providers also have the opportunity to their prescription history and benefit to drug interaction information, explore formulary status and other health information including copay/ drug indications, and more.
plan coverage details for our members coinsurance requirements—by logging • $ button (green) – Displays
using the EPrescribe tool. Once the in to My Health—at selecthealth.org.
therapeutic alternatives provider has logged in to HELP2 and and tier statuses.
Providers can access member-specific navigated to EPrescribe, a bar in the benefit information and prescription • My Pharmacy Benefits search bar –
right-hand corner signifies the member's (located at the bottom of the RX history in HELP2. After a member is Claims screen) Displays information health plan (if that data is available successfully identified and selected, about the patient's benefits (e.g., in HELP2). For our members, each the provider can click the "RX" tab on copays and accumulators).
prescribed drug will have highlighted the HELP2 home page. From there, • Pharmacy Lookup tab – Allows the
information showing the most updated a tab in the upper right-hand corner prescriber to view participating tier status and other prescribing titled "View SelectHealth RX Claim pharmacies for the patient restrictions (e.g., quantity limits). If a History" will take the provider to our based on geographic area.
brand-name medication is prescribed, prescription information website.
• Drug Cost Lookup tool – (in
it may be listed as "non-formulary" or the RX Home section) Displays Here are some shortcuts to "not covered" when there are existing formulary status, therapeutics navigating the site: generics that could be used instead. alternatives, and approximate drug costs and member responsibility • RX Claims tab – Providers can view
(e.g., copay and coinsurance).
the selected patient's prescription history for the current calendar Prescription history is based on pharmacy year. The date parameters can benefit claims. Injectable medications be changed to accommodate filled under the medical benefit will not the prescriber's needs.
be displayed. If a member paid cash pharmacy & therapeutics FDA WARNINGS
Azithromycin use can lead to potentially fatal arrhythmias, especially in high-risk individuals. Individuals at higher risk for arrhythmias while taking azithromycin include: • Patients with known abnormalities in the electrical activity of the heart • Patients taking medications known to prolong the QT interval • Patients with ongoing proarrhythmic conditions, such as electrolyte abnormalities or clinically significant bradycardia• Elderly patients • Patients with cardiac disease Patients taking either 6.25 mg or 12.5 mg extended-release zolpidem should not drive or participate in other activities that require complete mental alertness the day after taking the medication. Zolpidem levels can remain high enough the next day to impair these activities.
DRUG STATUS
DRUG STATUS
DRUG STATUS
DRUG STATUS
EFFECTIVE
BRAND NAME (Generic Name)
Humira (adalimumab) Keep Tier 4*(PA). Keep Tier 4*(PA). Keep Tier 4 (PA).
Keep Tier 4. Preferred.
Enbrel (etanercept) Keep Tier 4*(PA). Keep Tier 4*(PA). Keep Tier 4 (PA).
Keep Tier 4. Preferred.
Remicaid (infliximab) Medical Benefit (PA) Medical Benefit (PA) Medical Benefit (PA).
Medical Benefit (PA).
Tecfidera (dimethyl fumarate) Keep Tier 4*.
Keep Tier 4*.
Keep Tier 4 (PA).
Avonex (interferon beta-1a) Keep Tier 4*.
Keep Tier 4*.
Keep Tier 4.
Keep Tier 4.
Rebif (interferon beta-1a) Keep Tier 4*.
Keep Tier 4*.
Keep Tier 4.
Copaxone (glatiramer) Keep Tier 4*.
Keep Tier 4*.
Keep Tier 4*(PA).
Keep Tier 4.
Januvia (sitagliptin) and combos Move Tier 3 (ST). Move Tier 3 (ST). Move Tier 3 (ST). Move Tier 3 (1/1/14).
Onglyza (saxagliptin) and combos Move Tier 3 (ST).
Move Tier 3 (ST).
Move Tier 3 (ST).
Move Tier 3 (1/1/14).
Nesina (alogliptin) and combos Move Tier 2.
Move Tier 2.
Move Tier 2.
Move Tier 2.
Tradjenta (linagliptin) and combos Move Tier 2.
Move Tier 2.
Move Tier 2.
Move Tier 2.
Cystaran (cysteamine soln) Keep Tier 4* (PA). Keep Tier 4*(PA). Keep Tier 4 (PA). Keep Tier 4 (PA). Ravicti (glycerol phenylbutyrate) Keep Tier 4* (PA). Keep Tier 4* (PA). Keep Tier 4 (PA). Sirturo (bedaquiline) Keep Tier 4* (PA). Keep Tier 4* (PA). Keep Tier 4 (PA). Keep Tier 4 (PA). Keep Tier 3 (ST). Keep Tier 3 (ST). Keep Tier 3 (ST). Minastrin 24 FE (norethin/estradiol/FE) Keep Tier 3.
Keep Tier 3 (ST). Namenda XR (memantine) Keep Tier 3.
Keep Tier 3.
Keep Tier 3 (PA). Keep Tier 2.
Osphena (ospemifene) Keep Tier 3.
Keep Tier 3.
Keep Tier 3.
Keep Tier 3.
Diclegis (doxylamine/ vit B6) Keep Tier 3 (PA). Signifor (pasireotide) Keep Tier 4*(PA). Keep Tier 4 (PA). Keep Tier 4 (PA). Add Tier 4 (PA). Desvenlafaxine ER (desvenlafaxine) Keep Tier 3 (ST). NC (carved out).
Prolensa (bromfenac) Keep Tier 3 (ST). Keep Tier 3 (ST). Keep Tier 3.
Keep Tier 3.
Keep Tier 3 (ST). Keep Tier 3.
Invokana (canaglifozin) Keep Tier 3 (ST).
Keep Tier 3 (ST). Keep Tier 3 (ST). Keep Tier 3 (ST). Vascepa (icosapent) Keep Tier 3.
Keep Tier 3.
Keep Tier 3.
Eliquis (apixaban) Keep Tier 2.
Keep Tier 2.
Tier 2 with no PA.
Keep Tier 2.
Abilify Maintena (aripiprazole inj) Medical Benefit.
Medical Benefit.
NC (carved out).
Keep Tier 3.
Minivelle (estradiol ) Keep Tier 3 (QL). Keep Tier 3 (QL). Keep Tier 3 (QL). Keep Tier 3 (QL).
Pulmicort (budesonide) Move to Tier 2.
Move to Tier 2.
Keep Tier 2.
Keep Tier 2.
Qvar (beclomethasone) Move to Tier 2.
Move to Tier 2.
Keep Tier 2.
Keep Tier 2.
Eliquis (apixaban) Move to Tier 2.
Move to Tier 2.
Keep Tier 3.
Move to Tier 2.
Pertyze (pancrelipase) Move to Tier 2.
Move to Tier 2.
Move to Tier 2.
Keep on Tier 3.
Brilinta (ticagrelor) Move to Tier 2.
Move to Tier 2.
Keep Tier 3 (ST).
Move to Tier 2.
Neupro (rotigotine) Keep Tier 3.
Keep Tier 3.
Keep Tier 3 (ST).
Keep Tier 3.
*Tier 4 or tier 3 if plans have only 3 tiers. PA: Preauthorization ST: Step Therapy NC: Not Covered QL: Quantity Limits NEWLY AVAILABLE GENERICS
Brand Name

Generic Name
For more information about pharmacy benefits, call Pharmacy seizure/mood stabilizer Services at 800-442-3129 or visit Maxalt and Maxalt-MLT one of the following websites: zoledronic acid injection hypercalcemia of malignancy, zoledronic acid injection reduction of bone complications from cancer Zomig and Zomig-ZMT FUTURE GENERIC DRUG/oTC APPRoVALS
Brand Name
Generic Name
niacin extended-release ademark of SelectHealth.
e any questions or concerns.
13 SelectHealth. All rights r oblem or disease. P not be used to diagnose or tr ofessional medical advice, and it should t is not a substitute for pr e is for informational purposes vice or plan and ar endorse or sponsor any S ers and suppliers do not . And these manufactur ealth does not endorse or sponsor any dr er or supplier of each dr wn those trademar efers to many of the dr

Source: https://intermountainphysician.org/selecthealth/Pharmacy%20%20Therapeutics%20Newsletter/2112_Summer_PnT%202013.pdf

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"For the moment let us note that getting the better of words in writing is commonly a very hard struggle."–H.G. Widdowson Spring 2012 ENG 101- Section 428 Office Hours: W 2-5 Percival Hall 314A Writing for Others This class intends to help you strengthen your composition skills for academic, professional, and personal purposes. The course will have three main focuses: 1) language's role in constructing the world, 2) audience awareness, and 3) classical rhetoric. These are some of the most important things for writers to be aware of, and while most good writers internalize these components of composition we will consciously analyze, discuss, and use them to achieve our four official Course Goals: 1) Know the Context, 2) Think Critically, 3) Learn Processes for Writing, Revision, and Reflection, and 4) Know the Rules. These goals are explained in WiP pages xvi-xvii, and we will discuss them extensively in class.

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