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Pharmacy and Therapeutics Meeting Agenda

Q3 2020 – Medicaid
Tuesday, July 14, 2020
5:30-6:30 pm


I. Call to Order / Roll Call - Stewart Gordon, Chief Medical Officer and Amy Himel, Medical Director

II. Meeting Minutes Review (Vote Required)

III. Old Business - NONE

IV. New Business

    A. Therapeutic Class Review - NONE

    B. New Drugs (Public Comment, Discussion, Vote Required)

        i. Review Types 1, 2, 3 and 5

           (1) RT1 - CP.PHAR.495 Mitomycin for Pyelocalyceal Solution (Jelmyto)
           (2) RT3 - Jelmyto™ (mitomycin)
           (3) RT5 - Sarclisa® (isatuximab-irfc)
           (4) RT5 - Yervoy® (ilimimumab)

        ii. Review Type 4

           (1) amisulpride (Barhemsys®) intravenous infusion
           (2) daratumumab/hyaluronidase-fihj (Darzalex Faspro™) subcutaneous injection
           (3) ephedrine sulfate (Emerphed) intravenous injection
           (4) nicardipine hydrochloride intravenous infusion
           (5) remdesivir intravenous infusion
           (6) sacituzumab govitecan-hziy (Trodelvy™) intravenous infusion
           (7) technetium Tc 99m albumin aggregated (Pulmotech™ MAA) intravenous infusion
           (8) vedolizumab (Entyvio®) intravenous infusion

    C. Guidelines (Public Comment, Discussion, Vote Required)

        i. Clinically Significant Changes

           (1) CP.PHAR.11 Burosumab-twza (Crysvita)
           (2) CP.PHAR.93 Bevacizumab (Avastin, Mvasi, Zirabev)
           (3) CP.PHAR.94 Alpha1-Proteinase Inhibitors
           (4) CP.PHAR.103 Immune Globulins
           (5) CP.PHAR.121 Nivolumab (Opdivo)
           (6) CP.PHAR.146 Deferoxamine (Desferal)
           (7) CP.PHAR.150 Mecasermin (Increlex)
           (8) CP.PHAR.168 Corticotropin (H.P. Acthar)
           (9) CP.PHAR.179 Romiplostim (Nplate)
           (10) CP.PHAR.228 Trastuzumab Biosimilars Trastuzumab-Hyaluronidase
           (11) CP.PHAR.258 Mitoxantrone (Novantrone)
           (12) CP.PHAR.260 Rituximab (Rituxan, Ruxience, Truxima, Rituxan Hycela)
           (13) CP.PHAR.270 Paricalcitol Injection (Zemplar)
           (14) CP.PHAR.303 Brentuximab (Adcetris)
           (15) CP.PHAR.310 Daratumumab, Daratumumab-Hyaluronidase-fihj (Darzalex, Darzalex Faspro)
           (16) CP.PHAR.319 Ipilimumab (Yervoy)
           (17) CP.PHAR.322 Pembrolizumab (Keytruda)
           (18) CP.PHAR.379 Etelcalcetide (Parsabiv)
           (19) CP.PHAR.384 Lutetium Lu 177 dotatate (Lutathera)
           (20) CP.PHAR.405 Inotersen (Tegsedi)
           (21) CP.PHAR.433 Polatuzumab vedotin-piiq (Polivy)
           (22) CP.PHAR.465 Teprotumumab (Tepezza)
           (23) CP.PHAR.466 Valoctocogene Roxaparvovec
           (24) CP.PHAR.468 Aducanumab
           (25) CP.PHAR.475 Sacituzumab govitecan-hziy (Trodelvy)
           (26) CP.PMN.199 Esketamine (Spravato)

        ii. New Guidelines (Policies)

           (1) CP.PHAR.480 Ferric Derisomaltose (Monoferric)
           (2) CP.PHAR.481 Idecabtagene vicleucel (BB2121)
           (3) CP.PHAR.482 Isatuximab-irfc (Sarclisa)
           (4) CP.PHAR.483 Lisocabtagene maraleucel (JCAR017)
           (5) CP.PHAR.484 Viltolarsen
           (6) CP.PHAR.486 Bimatoprost Implant (Durysta)
           (7) CP.PHAR.491 Setmelanotide (RM-493)
           (8) CP.PHAR.492 Teplizumab
           (9) CP.PHAR.493 Infusion SOC Optimization
           (10) CP.PMN.234 EPSDT Benefit for Pediatric Members
           (11) CP.PMN.236 Amisulpride (Barhemsys)

       iii. No Clinically Significant Change(s)

           (1) CP.PHAR.28 Immunization coverage
           (2) CP.PHAR.82 Collagenase (Xiaflex)
           (3) CP.PHAR.88 Belimumab (Benlysta)
           (4) CP.PHAR.95 Thyrotropin alfa (Thyrogen)
           (5) CP.PHAR.169 Vigabatrin (Sabril)
           (6) CP.PHAR.277 Cytomegalovirus Immune Globulin (Cytogam)
           (7) CP.PHAR.312 Blinatumomab (Blincyto)
           (8) CP.PHAR.323 Plerixafor (Mozobil)
           (9) CP.PHAR.338 Cerliponase alfa (Brineura)
           (10) CP.PHAR.351 Daptomycin (Cubicin, Cubicin RF)
           (11) CP.PHAR.425 Metreleptin (Myalept)
           (12) CP.PHAR.429 Valproate (Depacon)
           (13) CP.PMN.155 lacosamide (Vimpat)

        iv. To Retire - NONE

    D. Medicaid (Public Comment, Discussion, Vote Required)

        i. Policy and Procedures

           (1) CC.PHAR.03 Drug Recall Notification
           (2) LA.PHAR.08 Pharmacy PA and MN Criteria
           (3) LA.PMN.01 Appropriate Use and Safety Edits

        ii. Louisiana State PDL link:

           LHCC website Provider link to the State PDL

           LDH static link (PDF)

    E. DUR Education Car-T (Public Comment, Discussion, Vote Required)

    F. FDA Updates (Informational only)

V. Other Business

    A. DUR

        i. Retrospective

    B. PMUR

VI. Confirm Roll Call for attendance

VII. Announcements

       The next Q4’2020, LHCC P&T Medicaid Meeting, is tentatively scheduled for Tuesday, October 13, 2020 at 5:30pm.

VIII. Verify Roll Call

IX. Adjournment (Vote Required)