Marys Medicine

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Pharmacy Update
Quarterly News Letter
Volume 2 , Issue 2
Winter 2012
Inside This Issue
Special PDL Update Edition
Annual PDL Review
MS Medicaid Moves to Annual
Beginning in Fall 2012, the Division of There were a number of changes to PDL Review
Medicaid's (DOM) Preferred Drug List, the PDL following this annual review. or PDL, will undergo an annual review This newsletter will highlight several each fall. The revisions brought about of those changes, including: by this annual review will become  The addition of prenatal vitamins PDL Summary of Events
effective the following January 1st to the PDL (page 2) with the first such update occurring
 A new miscellaneous category on January 1, 2013.
New Miscellaneous Category
Beginning in 2012, MS
Preferred Brand Name Products
year, there will be Medicaid's Preferred Drug found on other
quarterly additions, parts of the PDL List, or PDL, will undergo
Provider Summary of PDL
an annual review each fall.
Changes Effective January 1,
Changes outside of January 1st imple- mentation annual review updates will cluding some common preferred PPI Use in PEG Tubes Clinical
generally be small. Providers are en- brand name drugs which have Resource
couraged to monitor the non-preferred generics (page 3) frequently for advanced notice of (Continued on page 2) these PDL updates. Mississippi Legislature Ruling
PREFERRED BRANDS will not count towards the 2 brand monthly prescription limit as of July 1, 2012. They will however still count toward the 5 prescrip-tion limit. Mississippi Evidence-Based DUR Initiative (MS- MEDICAID UPDATES MS Medicaid PDL update (continued…)
Medicaid often receives questions regarding why some brand name drugs are preferred when a ge-neric is available. The simple answer is: rebates. Sim-ilar to commercial insurance plans, Medicaid may receive rebates from pharmaceutical companies which lowers Medicaid's overall cost of the branded drug, sometimes lower than the generic. Oftentimes, when a generic drug first enters the market, the first generic drug company to successfully file an abbrevi-ated new drug application (ANDA) receives 180 days of market exclusivity before other generic drug man-ufacturers may bring their generic version to market. The initial generic price is often 80 to 90% of the branded drug until after the 180 day exclusivity peri-od, making the brand cheaper than the generic. Prenatal Vitamins Added to the PDL
Effective January 1, 2013, the Mississippi Division of Medicaid will begin including prenatal vitamins on the preferred drug list (PDL). As an ongoing effort to share information with Mississippi Medicaid providers, Medicaid wants to make sure you are aware of the Preferred Prenatal Vitamins found on the PDL. The list includes prenatal vitamins with and without DHA, as well as a chewable tablet option. All other prenatal vitamins not included on this list will be non-preferred and will require a prior authorization. Prenatal Vitamins
Preferred Agents
Non-Preferred Agents
Fe C Plus Tablet Prenatal AD Tablet Prenatal Plus Tablet SE-Natal 19 Chewable Tablet Tricare Prenatal Tablet All products not listed are assumed to be non-preferred Concept DHA Paire OB Plus DHA Combo Pack PreQue 10 Tablet Taron-C DHA Capsule IMPORTANT INFORMATION FROM THE MISSISSIPPI DIVISION OF MEDICAID New Miscellaneous Brand/Generic Category
Watch for the new miscellaneous brand/generic category on the PDL list effective January 1, 2013. THERAPEUTIC
PREFERRED AGENTS
NON-PREFERRED AGENTS
DRUG CLASS
MISCELLANEOUS BRAND/GENERIC
CLONIDINE
CATAPRESS-TTS (clonidine) clonidine patches clonidine tablets CATAPRESS (clonidine) MEGACE ES (megestrol) KALYDECO (ivacaftor) SUBOXONE (buprenorphine/naloxone) KORLYM (mifepristone) megestrol suspension 625mg/5ml SELECT ORAL CONTRACEPTIVES
ALL ORAL CONTRACEPTIVES ARE PREFERRED EXCEPT BEYAZ (ethinyl FOR THOSE SPECIFICALLY INDICATED AS NON- estradiol/drospirenone/levomefolate) Gianvi (ethinyl estradiol/drospirenone) norethindrone/ethinyl estradiol/fe chew tab Ocella (ethinyl estradiol/drospirenone) SUBLINGUAL NITROGLYCERIN
nitroglycerine lingual 12gm nitroglycerine lingual 4.9gm nitroglycerine sublingual NITROLINGUAL (nitroglycerine) 4.9gm NITROLINGUAL PUMPSPRAY (nitroglycerine) 12 gm NITROMIST (nitroglycerine) NITROSTAT SUBLINGUAL (nitroglycerine) PREFERRED BRAND NAME DRUGS
There are some cases when a brand name drug may be lest costly to Medicaid than its generic counterpart. The following is a partial list of common preferred brands with non-preferred generics (alphabetical).
PREFERRED BRANDED AGENTS WITH NON-PREFERRED GENERICS
ACTOS (pioglitazone) DURAGESIC (fentanyl) PAXIL CR (paroxetine) ANTARA (fenofibrate) EFFEXOR XR (venlafaxine) PAXIL SUSPENSION (paroxetine) ASTELIN (azelastine) FLOMAX (tamsulosin) PULMICORT (budesonide) FLEXHALER AUGMENTIN XR (amoxicillin/clavulanate) FLONASE (fluticasone) PULMICORT (budesonide) RESPULES AVALIDE (irbesartan/HCTZ) IMITREX NASAL (sumatriptan) RIBAPAK DOSPACK (ribavirin) AVAPRO (irbesartan) LEXAPRO (escitalopram) SINGULAIR (montelukast) COUMADIN (warfarin) LOTREL (benazepril/amlodipine) TARKA (trandolapril/verapamil) DIASTAT (diazepam rectal gel) METROGEL (metronidazole) UROXATRAL (alfuzosin) DUONEB (albuterol/ipratropium) NASAREL (flunisolide) WELLBUTRIN XL (bupropion HCl) IMPORTANT INFORMATION FROM THE MISSISSIPPI DIVISION OF MEDICAID Annual PDL Review Summary of Events
A comprehensive review of the entire PDL was performed during the meetings held during the fall of 2012. The following is a summary of the events:  72 drug classes were reviewed  76 drugs' status were recommended to be changed  34 agents recommended move from non-preferred to preferred  42 agents recommended move from preferred to non-preferred  12 generic drugs moved from preferred to non-preferred because branded agent is less costly than generic counterpart  3 new drugs classes added  17 drugs selected for preferred status  11 drugs selected for non-preferred status  9 products( this includes all categories listed above) have grandfathering language (if beneficiary is sta- ble on the non-preferred drug, then approval will be automatically be granted). Please see pages 5-8 of this newsletter for a comprehensive list of PDL changes. Please be mindful of these changes which may affect your patient population
Atypical antipsychotic: Abilify remains preferred with the following caveats--beneficiaries stable on
the drug are grandfathered; tablet splitting for new starts on 10, 20, 30 mg tablets.  Bronchodilators: Proventil HFA is the sole preferred albuterol inhaler. No grandfathering for Ventolin
HFA and/or ProAir HFA.
Proton Pump Inhibitors: Aciphex tablets, Nexium capsule/granules, and Protonix packets become the
sole preferred PPIs. No grandfathering for beneficiaries currently on Dexilant and/or omeprazole
which move to non-preferred.
Changes in this class offer multiple branded alternatives for adults and
children. There are preferred alternatives for children, beneficiaries with swallowing disorders, and/or
using a PEG tube. Please see pages 9-10 for a clinical guide for the use of PPIs in PEG tubes. For the most
recent update, please check the "Resources for Providers" at
These PDL changes, along with the changes in the summary of events above, could save the Mississippi
Medicaid program about $10 million per year.





 Mississippi Division Of Medicaid
Preferred Drug List Changes
RECOMMENDED for
THERAPEUTIC CLASS
PREFERRED STATUS
Acne Agents (Topical) DUAC (benzoyl peroxide/clindamycin) Acne Agents (Topical) EPIDUO (adapalene/benzoyl peroxide) Acne Agents (Topical) TAZORAC (tazarotene) Acne Agents (Topical Alzheimer's Agents ARICEPT 23 MG (donepezil) Alzheimer's Agents EXELON SOLUTION (rivastigmine) Analgesics, Narcotic –Long Acting OPANA ER (oxymorphone) Androgenic Agents TESTIM (testosterone gel) Antibiotics (GI) Antibiotics (Vaginal) METROGEL (metronidazole) Antidepressants, Other EFFEXOR XR (venlafaxine) Antidepressants, SSRIs LEXAPRO (escitalopram) Antidepressants, SSRIs PAXIL CR (paroxetine) Antimigraine Agents, Triptans IMITREX Nasal (sumatriptan) Antimigraine Agents, Triptans MAXALT (rizatriptan) Antimigraine Agents, Triptans MAXALT MLT (rizatriptan) Antimigraine Agents, Triptans ZOMIG BYSTOLIC (nebivolol) TOPROL XL (metoprolol) Bronchodilators & COPD Agents DUONEB (albuterol/ipratropium) Hepatitis C Treatments PEG-INTRON (peginterferon alfa-2b) Hepatitis C Treatments RIBAPAK DOSEPACK (ribavirin) Hepatitis C Treatments VICTRELIS (boceprevir) Intranasal Rhinitis Agents ASTELIN (azelastine) Intranasal Rhinitis Agents FLONASE (fluticasone) Intranasal Rhinitis Agents ZETONNA (ciclesonide) Lipotropics, Other (Non-Statins) ANTARA (fenofibrate) Lipotropics, Statins Macrolides/Ketolides clarithromycin Ophthalmics, Glaucoma Agents ALPHAGAN P 0.15% (brimonidine) Ophthalmics, Glaucoma Agents Otic Antibiotics CIPRO HC (ciprofloxacin/hydrocortisone) Pancreatic Enzymes PANCREAZE (pancrelipase) Proton Pump Inhibitors ACIPHEX (rabeprazole) Proton Pump Inhibitors NEXIUM (esomeprazole) Proton Pump Inhibitors PROTONIX PACKET (pantoprazole)




 Mississippi Division Of Medicaid
Provider Notice
Preferred Drug List Changes
RECOMMENDED for
THERAPEUTIC CLASS
NON-PREFERRED STATUS
Acne Agents (Topical) BENZACLIN GEL (benzoyl peroxide/clindamycin) Acne Agents (Topical) BP10 (benzoyl peroxide) Acne Agents (Topical) BPO (benzoyl peroxide) Acne Agents (Topical) ERY (erythromycin) Acne Agents (Topical) RETIN-A MICRO (tretinoin) Analgesics, Narcotics – Short Acting OXECTA (oxycodone) Analgesics, Narcotics – Short Acting SUBSYS (fentanyl) Analgesics, Narcotics – Long Acting KADIAN (morphine)* Analgesics/Anesthetics (Topical) FLECTOR (diclofenac epolamine) Analgesics/Anesthetics (Topical) LIDODERM Androgenic Agents ANDROGEL (testosterone gel) Antibiotics (Vaginal) metronidazole vaginal Anticoagulants warfarin* Angiotensin Modulators amlodipine/benzapril Angiotensin Modulators AZOR (olmesartan/amlodipine) Angiotensin Modulators TRIBENZOR (olmesartan/amlodipine/HCTZ) Anticonvulsants EQUETRO (carbamazepine)* Antidepressants, Other Antidepressants, Other Antidepressants, SSRIs LUVOX CR (fluvoxamine)* Antihistamines, Minimally Sedating and Combinations XYZAL Solution (levocetirizine) Antimigraine Agents, Triptans sumatriptan nasal Antiparasitics (Topical) SKLICE (ivermectin) Antiparkinson's Agents (Oral) NEUPRO (rotigotine) Atopic Dermatitis PROTOPIC (tacrolimus) Bladder Relaxant Preparations Bronchodilators & COPD Agents COMBIVENT RESPIMAT (albuterol/ipratropium) Bronchodilators, Beta Agonist PROAIR HFA (albuterol) Bronchodilators, Beta Agonist VENTOLIN HFA (albuterol) Cephalosporins SUPRAX Cytokine & CAM Antagonists KINERET (anakinra)* Erythropoiesis Stimulating Proteins OMONTYS (peginesatide) H. Pylori Combination Treatments OMECLAMOX clarithromycin, amoxicillin) Hepatitis C Treatments Hepatitis C Treatments REBETOL (ribavirin) Hepatitis C Treatments RIBASPHERE (ribavirin) Hypoglycemics, TZDs Intranasal Rhinitis Agents DYMISTA (azelastine/fluticasone) Intranasal Rhinitis Agents Intranasal Rhinitis Agents NASACORT AQ (triamcinolone) Intranasal Rhinitis Agents QNASL (beclomethasone)  Mississippi Division Of Medicaid
Provider Notice
Preferred Drug List Changes
Leukotriene Modifiers Lipotropics, Other (Non-Statins) Multiple Sclerosis Agents BETASERON (interferon beta-1b)* Ophthalmic Antibiotics IQUIX (levofloxacin) Ophthalmic for Allergic Conjunctivitis ELESTAT (epineastine) Ophthalmic for Allergic Conjunctivitis EMADINE (emedastine) Ophthalmic, Glaucoma Agents ALPHAGAN P 0.1% (brimonidine) Ophthalmic, Glaucoma Agents COSOPT PF (dorzolamide/timolol) Ophthalmic, Glaucoma Agents Ophthalmic, Glaucoma Agents XALATAN Ophthalmic, Glaucoma Agents ZIOPTAN Otic Antibiotics DERMOTIC (fluocinolone) Proton Pump Inhibitors DEXILANT (dexlansoprazole) Proton Pump Inhibitors Sedative Hypnotics INTERMEZZO (zolpidem) Stimulants and Related Agents ADDERALL XR (amphetamine salt combination)* Stimulants and Related Agents methylphenidate CD Stimulants and Related Agents INTUNIV (guanfacine ER)* Stimulants and Related Agents KAPVAY (clonidine ER)* RECOMMENDED for
NEW THERAPEUTIC CLASS
PREFERRED STATUS
Miscellaneous Brand/Generic Catapres TTS (clonidine) Miscellaneous Brand/Generic nitroglycerin lingual 12gm Miscellaneous Brand/Generic nitroglycerin sublingual Miscellaneous Brand/Generic NITROLINGUAL (nitroglycerin) 12 gm Miscellaneous Brand/Generic NITROSTAT (nitroglycerin) Miscellaneous Brand/Generic – Select Oral Contraceptives All preferred except those specified as non-preferred below Prenatal Vitamins CONCEPT DHA CAPSULE Prenatal Vitamins FE C PLUS TABLET Prenatal Vitamins PAIRE OB PLUS DHA COMBO PACK Prenatal Vitamins PRENATAL AD TABLET Prenatal Vitamins PRENATAL PLUS TABLET Prenatal Vitamins PREQUE 10 TABLET Prenatal Vitamins SE-NATAL CHEWABLE Tablets Prenatal Vitamins TARON-C DHA CAPSULE Prenatal Vitamins TRICARE PRENATAL TABLET Prenatal Vitamins  Mississippi Division Of Medicaid
Provider Notice
Preferred Drug List Changes
RECOMMENDED for
NEW THERAPEUTIC CLASS
Non-PREFERRED STATUS
Miscellaneous Brand/Generic clonidine patches Miscellaneous Brand/Generic KALYDECO (ivacaftor) Miscellaneous Brand/Generic KORLYM (mifepristone) Miscellaneous Brand/Generic nitroglycerin lingual 4.9gm Miscellaneous Brand/Generic NITROLINGUAL (nitroglycerin) 4.9gm Miscellaneous Brand/Generic NITROMIST (nitroglycerin) Miscellaneous Brand/Generic – Select Oral Contraceptives BEYAZ (ethinyl estradiol/drospirenone/levomefolate) Miscellaneous Brand/Generic – Select Oral Contraceptives GIANVI (ethinyl estradiol/drospirenone) Miscellaneous Brand/Generic – Select Oral Contraceptives norethindrone/ethinyl estradiol/fe chew tab Miscellaneous Brand/Generic – Select Oral Contraceptives OCELLA (ethinyl estradiol/drospirenone) Prenatal Vitamins All non-preferred except those specified as preferred Use of Proton Pump Inhibitors in PEG tubes
MS Medicaid Preferred Drug List Effective 01-01-2013
Medication
Instruction for use
PREFERRED
NG: Open capsule and place intact granules into a 60 mL catheter-tip syringe; mix with 50 mL of water. Replace plunger and shake vigorously for 15 seconds. Ensure no granules NEXIUM capsules‡ remain in syringe tip. Do not administer if pellets dissolve or disintegrate. Use immediately after preparation. After administration, flush NG tube with additional water. NG/G: If using a 2.5 mg or 5 mg packet, first add 5 mL of water to a catheter-tipped syringe, then add granules from packet. If using a 10 mg, 20 mg, or 40 mg packet, first add 15 mL of NEXIUM granules for Yes water to a catheter-tipped syringe, then add granules from packet. Shake the syringe, leave 2-3 minutes to thicken. Shake the syringe and administer through NG or G tube (size > 6 French) within 30 minutes. Refill the syringe with equal amount (5 mL or 15 mL) of water, shake and flush nasogastric/gastric tube. NG: Remove plunger from 60-mL catheter-tipped syringe; attach syringe to tube. Empty packet contents into syringe. Add 10 mL of apple juice. Gently shake syringe to empty PROTONIX granules Yes contents into tube. Flush syringe and tubing with 10 mL of apple juice. Repeat flush at least 2 for suspension‡ additional times or until no granules remain in syringe. Administer in a French size >16. Hold tubing upright during administration to prevent bending of tube. Yes NG: Open capsule, mix intact granules into 40 mL of apple juice (no other liquids). Inject through the NG tube into the stomach. Flush with additional apple juice to clear the tube NG (> 8 French): Place a 15 mg tablet in a syringe and draw up 4 mL of water, or place a 30 Lansoprazole ODT‡ mg tablet in a syringe and draw up 10 mL of water. Shake gently to allow for a quick Yes dispersal. After the tablet is dispersed, inject through the NG tube into the stomach within 15 minutes. Refill the syringe with approximately 5 mL of water, shake gently, and flush the NG tube. NG/OG: Open capsule and gently mix granules in acidic fruit juice. *Pour the mixture down the tube, flush tube with additional juice. Clamp tube for at least 1 hour. PREVACID delayed- release oral susp. Last updated: December 6, 2012 Use of Proton Pump Inhibitors in PEG tubes
MS Medicaid Preferred Drug List Effective 01-01-2013
Medication
Instruction for use
Pantoprazole tablet NG/OG: Add appropriate amount of water to a catheter-tipped syringe; add contents of PRILOSEC granules packet (2.5 mg = 5 mL; 10 mg = 15 mL). Immediately shake syringe; allow 2–3 minutes for Yes suspension to thicken. Shake syringe again; administer contents. Administer within 30 for oral solution‡ minutes of reconstitution. Use an NG tube or gastric tube that is a size 6 French or larger; flush the syringe and tube with water. NG/OG: Open capsule and gently mix granules in acidic fruit juice.*Pour the mixture down the tube, flush tube with additional juice. Clamp tube for at least 1 hour. ZEGERID powder for NG/OG: Mix well with 20 mL of water (do not use other liquids) and administer immediately. Yes Flush tube with an additional 20 mL of water. Suspend enteral feeding for 3 hours before oral suspension‡ and 1 hour after administering NG – nasogastric tube; OG – orogastric tube; G – gastric tube *acidic fruit juice: apple, orange, cranberry, grape, pineapple, prune, tomato, and V8 †Medically accepted indication ‡FDA labeled indication Compiled from package inserts from Dexilant; Prilosec; omeprazole (AvPAK, Lake Erie, Kaiser, McKesson, Watson, Altura, Apotex, Bryant Ranch, Cardinal, Dr. Reddy's, HJ Harkins, Kremers, Legacy, Lifeline, Mylan, NCS Healthcare, PD-RX, Physicians Total care, Preferred, Rebel, Sandoz, STAT Rx, Unit Dose, Dexcel, Ranbaxy); Aciphex; Prevacid; lansoprazole (Preferred, Sandoz, American Health, Mylan, UDL, Bryant Ranch, Dr. Reddy's, Physicians Total Care, Rebel, STAT Rx, TEVA, Takeda, Caremark, PD-Rx, Cardinal); Nexium; Zegerid; omeprazole and sodium bicarbonate (Par, Prasco, Santarus); and Protonix; pantoprazole (Macleods, AvKARE, REMEDYREPACK, STAT Rx, Cardinal, Contract Pharmacy, Wyeth, Actavis, American Health, Jubilant Cadista, Kremers, Mylan, NCS Healthcare, Physicians Total Care, Rebel, Sun Pharma, Teva, Torrent, UDL, Wockhardt, PD-Rx, Dr. Reddy's, Major, Lake Erie). Additional information: Wensel, TM. Administration of proton pump inhibitors in patients requiring enteral nutrition. P T. 2009 Mar;34(3):143-60. and Beckwith, MC, et al. A guide to drug therapy in patient with enteral feeding tubes: dosage form selection and administration methods. Hospital Pharmacy. 2004; 39(3):225-37. Products included in this reference do not guarantee coverage by the Division of Medicaid. Please refer to the package insert for official FDA-labeled uses and updates. See the Mississippi Division of Medicaid website for the offici Last updated: December 6, 2012

Source: http://pharmacy.olemiss.edu/cpmm/wp-content/uploads/sites/18/2014/03/MS-DUR_Newsletter_Winter_2012.pdf

tgdtheory.fi

Quantum Model of Memory anen1, February 1, 2006 1 Department of Physical Sciences, High Energy Physics Division, PL 64, FIN-00014, University of Helsinki, Finland. Recent address: Puutarhurinkatu 10,10960, Hanko, Finland. Geometric and subjective memories . . . . . . . . p-Adic physics as physics of intentionality . . . . . . Spin glass model of memories . . . . . . . . .

Pii: s0378-8741(99)00085-9

Journal of Ethnopharmacology 68 (1999) 3 – 37 Aloe vera leaf gel: a review update T. Reynolds a,*, A.C. Dweck b a Jodrell Laboratory, Royal Botanic Gardens, Kew, Richmond, Surrey, UK b Dweck Data, 8 Merrifield Road, Ford, Salisbury, Wiltshire, UK Received 20 April 1999; accepted 20 May 1999