Formulary Updates

  • Admelog: CareOregon Medicaid (Oregon Health Plan) has historically covered Novolog and Humalog. For the first time, we are now preferring Admelog, the same insulin type as Humalog. New starts are currently being asked to use Admelog, but existing users will not be required to switch products until July 1, 2018. New starts will be asked to use Admelog (see Admelog FAQ, below). The Admelog pen will require a prior authorization (PA).
    • Note: Medicare (CareOregon Advantage and Star) prefers Novolog products, and continues to be their preferred formulary agent. – No PA is needed for pens.
  • Shingrix: CareOregon has officially added Shingrix–a new, two-dose vaccine for preventing Shingles—in accordance with CDC recommendations. It will be covered for adults aged 50 and older without a PA (younger patients will require a PA).

 

Admelog FAQ 

Q: What is Admelog?

A: Admelog is essentially a “generic” form of Humalog.  It contains the exact same active ingredient (insulin lispro) in the same amounts as Humalog (100 units/ml).  Some may call it a “branded generic,” as it has its own trade-name. 

Q: How does it compare to Novolog?

A: Admelog (insulin lispro) is a different insulin than Novolog (insulin aspart), however, they are considered clinically interchangeable. CareOregon reached out to two diabetes specialists who agree Admelog and Novolog can be interchanged. In fact, it is common for hospitals to only use one of these products, regardless of what the patient has used at home.

Q: Does Admelog need a new prescription or can it be substituted like a generic?

A:  It needs a new Rx. Prescriptions written for “Humalog” or “Novolog” cannot be substituted for Admelog. The provider needs to be contacted and a new prescription sent to the pharmacy.

Q: Are there any differences in doses?

A: No, providers are encouraged to make a 1:1-unit conversion from Humalog/Novolog to Admelog.

Q: Do Admelog Pens require PA?
A:
Yes, the standard PA criteria will apply to Admelog pens, as it was with Novolog or Humalog Pens. 

Q: Are existing Humalog/Novolog Pen users being affected by this change?

A: No. If the member was approved for a Humalog/Novolog Pen, Admelog pens will be covered.  No new PA will need to be submitted. The same pen needles can be used with Admelog as with the Humalog/Novolog pens.
 

Q: Are existing Humalog/Novolog vial users being affected by this change?

A: The existing members using Humalog/Novolog vials are not being affected by this change currently. We will notify you and your member(s) at least 30 days in advance when a switch is needed. We encourage you to make the switch when you can to prevent future potential disruption in therapy.

Q: When is the formulary change happening?

A: Novolog (vial and pens) and Humalog (vial and pens) are being removed from the formulary on April 1, 2018, for all new start members. 

Q: Since Basaglar is only covered as a pen device, will CareOregon approve Admelog Pens for consistency?

A: Unfortunately, no. Pens are only approved in cases of medical necessity, as outlined by the PA criteria, due to their higher cost.  CareOregon will continue to monitor for the opportunity to expand coverage of pen devices.

 

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