Pharmacy corner and updates

Our Pharmacy and Therapeutics Committee performs ongoing reviews of products for effectiveness, safety and cost. The changes below are those most likely to affect your patients.

Brand epinephrine reminder

Brand epinenphrine products including EpiPen ($360) and Auvi-Q auto-injector ($2,700) are non-formulary. Prescriptions written for the “generic epinephrine auto-injector” will be dispensed without prior authorization

Pancreatic Enzymes

CareOregon is implementing prior authorization on pancreatic enzymes to combat growing off-label use. The average cost per prescription claim averages $1,000. Pancrelipase prior authorization requests will be reviewed for the following diagnoses: cystic fibrosis, pancreatectomy, exocrine pancreatic cancer, and chronic pancreatitis. Prior authorizations submitted for use of pancrelipase for malabsorption from a chronic condition will need to submit additional pancreatic insufficiency confirmatory test results to be considered.

Botulinum Toxin

The existing CareOregon prior authorization criteria were edited to reflect the OHP covered conditions. All other indications and use will be considered investigational. See table below for approved indications and unit frequency:

Condition

Botox

Dysport

Xeomin

Myobloc

Interval

Achalasia

100 units

6-24 months

Migraine

155 units

 

 

 

3 months

Torticollis

400 units

1000 units

120 units

5000 units

3 months

Torsion dystonia

140 units

3 months

Blepharospasm

5/eye

120 units/eye

35/eye

3 months

Overactive bladder

100 units

3 months

Neurogenic bladder

200 units

 

 

 

3 months

Strabismus

25 units

once

Upper limb spasticity

400 units

1000 units

400 units

3 months

Lower limb spasticity

400 units

3 months

Spasticity in CP

200 units (for peds)

 

 

3 months

 

 

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