OBJECTIVE The intent of the Antidepressant Agents Step Therapy program is to encourage the use of generic antidepressant agents - selective serotonin reuptake inhibiting agents (SSRIs), serotonin norepinephrine reuptake inhibiting agents (SNRIs), bupropion/bupropion extended-release, mirtazapine, or trazodone extended-release - prior to brand antidepressant agents and to accommodate for use of brand antidepressant agents when generic prerequisite agents cannot be used due to previous trial, documented intolerance, FDA labeled contraindication, or hypersensitivity. The criteria for Cymbalta also encourage its use for neuropathic pain after trial of amitriptyline, nortriptyline, imipramine, desipramine, or gabapentin, for fibromyalgia (FM) after a trial of amitriptyline, nortriptyline, imipramine, desipramine, cyclobenzaprine, tramadol, or gabapentin, and for chronic musculoskeletal pain (CMP; for example, osteoarthritis or chronic low back pain) after a trial of acetaminophen, oral NSAID, topical NSAID, or any other prerequisite for FM or neuropathic pain already listed. Requests for brand antidepressant agents will be reviewed when patient-specific documentation has been provided.
TARGET DRUGS Aplenzin™ (bupropion) Brintellix™ (vortioxetine) Celexa® (citalopram)a Cymbalta® (duloxetine)b Khedezla® (Desvenlafaxine ER tablets, brand product) Effexor® (venlafaxine)a Effexor XR® (venlafaxine extended-release)a Fetzima™ (levomilnacipran extended-release) Fluoxetine 60 mg (tablets, brand product) Forfivo XL® (bupropion extended–release) Lexapro® (escitalopram)a Luvox CR® (fluvoxamine extended-release)a Maprotiline (tablets, brand product) Oleptro™ (trazodone extended-release)b Paxil® (paroxetine hydrochloride)a Paxil CR® (paroxetine extended-release)a Pexeva® (paroxetine mesylate) Pristiq® (desvenlafaxine) Prozac® (fluoxetine)a Prozac® Weekly™ (fluoxetine delayed-release)a Remeron® (mirtazapine)a RemeronSolTab® (mirtazapine)a Venlafaxine ER (tablets, brand product)a Viibryd™ (vilazodone) Wellbutrin® (bupropion)a Wellbutrin SR® (bupropion extended-release)a Wellbutrin XL® (bupropion extended-release)a Zoloft® (sertraline)a a - available as a generic; generic included as a prerequisite in step therapy program
MT_PS_Antidepressant_ST_ AR0613_1113.doc
Copyright Prime Therapeutics LLC. 11/2013 All Rights Reserved
b – generic anticipated in 2013; generic will be included as a prerequisite in step therapy program
MT_PS_Antidepressant_ST_ AR0613_1113.doc
Copyright Prime Therapeutics LLC. 11/2013 All Rights Reserved
PRIOR AUTHORIZATION CRITERIA FOR APPROVAL Brand Antidepressant Agents (except Cymbalta, see below) will be approved when BOTH of the following are met:
The patient has not filled a prescription for a monoamine oxidase (MAO) inhibitor in the past 30 days AND
The patient’s medication history includes use of a generic SSRI, SNRI, bupropion, mirtazapine, or trazodone extended-release OR
There is documentation that the patient is currently using the requested brand antidepressant OR
The prescribing physician states the patient is using the requested brand antidepressant AND is at risk if therapy is changed OR
The patient has a history of a documented intolerance, FDA labeled contraindication, or hypersensitivity to a generic SSRI, SNRI, bupropion, mirtazapine, or trazodone extended-release
Cymbalta will be approved when BOTH of the following are met:
The patient has not filled a prescription for a monoamine oxidase (MAO) inhibitor in the past 30 days AND
The patient’s medication history includes use of a generic SSRI, SNRI, bupropion, mirtazapine, or trazodone extended-release OR
The patient has a diagnosis of neuropathic pain and the medication history includes use of amitriptyline, nortriptyline, desipramine, imipramine, or gabapentin OR
The patient has a diagnosis of fibromyalgia and the medication history includes use of amitriptyline, nortriptyline, desipramine, imipramine, cyclobenzaprine, gabapentin, or tramadol OR
The patient has a diagnosis of chronic musculoskeletal pain and the medication history includes use of acetaminophen, oral NSAID, topical NSAID, tramadol, amitriptyline, nortriptyline, desipramine, imipramine, cyclobenzaprine, or gabapentin OR
There is documentation that the patient is currently using Cymbalta (duloxetine) OR
The prescribing physician states the patient is using Cymbalta (duloxetine) AND is at risk if therapy is changed OR
The patient has a history of a documented intolerance, FDA labeled contraindication, or hypersensitivity to a prerequisite for the requested diagnosis
Length of approval: 12 months
MT_PS_Antidepressant_ST_ AR0613_1113.doc
Copyright Prime Therapeutics LLC. 11/2013 All Rights Reserved
Noise, Ears and Hearing Protection One in 10 Americans has a hearing loss that affects his ability to understand normal speech. Excessive noise exposure is the most common cause of hearing loss. Can Noise Really Hurt My Ears? Yes--noise can be dangerous. If it is loud enough and lasts long enough, it can damage your hearing. The damage caused by noise, called sensor neural hearing loss
How did you hear about Dermatology at Winslow Animal Hospital: _________________________1. Describe your pet’s skin problem (check al that apply):( ) Scratching, chewing, licking, rubbing skin( ) Other (describe) ________________________________2. Was itching the first sign of your pet’s skin disease that you noticed? ( ) Yes; ( ) No. 3. How long has your pet had this problem? ___________