Review of authorization criteria in PDL drug classes. Nicole N. Nguyen, PharmD Senior Clinical Pharmacist Health Care Services September 24, 2014. Newer Sedative Hypnotics. August 15, 2007 DUR board review
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Nicole N. Nguyen, PharmD
Senior Clinical Pharmacist
Health Care Services
September 24, 2014
Medicaid will cover the following hypnotic drugs without PA within the following limits:
Sleep consultation with a board certified sleep specialist at a HCA-approved sleep center for clients receiving more than 6 months of continuous nightly treatment with:
Continuous nightly use may be necessary in some clients, but may not be appropriate for others.
I move that Medicaid continue to limit ramelteon to 90 days continuous use at one tablet per day, and other products in the Newer Sedative Hypnotic class to an initial fill of 30 tablets for 30 days, and 10 tablets per 30 days thereafter. Exceptions may be made on a case by case basis, but clients requiring more than 6 months continuous nightly treatment are required to have a sleep consultation with a board certified sleep specialist at a HCA-approved sleep center.
Criteria originally developed and approved by DUEC in 1999.
February 12, 2003 PDL drug class review of NSAIDs and COX-2 inhibitors. At the time:
I move that Medicaid limit the use of proton pump inhibitors to 90 days continuous use unless the client has a diagnosis of Barrett’s esophagitis, hypersecretory condition, erosive esophagitis, duodenal ulcer, or other appropriate comorbid conditon. Continuous use may be approved when used concurrently with anticoagulants, NSAIDs, bisphosphonates, or prednisone. For a diagnosis of GERD, patients should be required to try a step down to ranitidine at least every two years. Patients whose symptoms are not adequately controlled on ranitidine may be approved for continuous use up to two years.
Step-wise (Steps 1 -6) approach for managing asthma, recommended steps to initiate treatment at:
Moderate persistent asthma
Step down if possible and asthma is well controlled at least 3 months.
Symptoms (CAT or CCQ questionnaires)
Nicole N. Nguyen PharmD, Senior Clinical Pharmacist
Health Care Services