Description: ATT2554636

 

Pharmacy Benefits Management-

Medical Advisory Panel-VISN Pharmacist Executives

Ez-Minutes

Volume 10, Issue 4   August 2012 – October 2012

Bookmark the New Portal for the PBM Intranet Web site:  https://vaww.cmopnational.va.gov/cmop/PBM

 

 

The purpose of the PBM-MAP Ez-Minutes Newsletter is to communicate with the field on items that will impact clinical practice in the VA……whether it is changes to the National Formulary, availability of new Criteria for Use, or recent medication safety issues. We want clinicians to be informed.

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Editor's Notes: After selecting the RSS Feeds, a link at the bottom of the page called Subscribe to an RSS feed will provide instructions on how to subscribe to an RSS feed depending on what software you want to use for the subscription. Some of you may be asking, “What does a RSS feed do? “ Answer: When new content is posted, in this case, the new issue of Ez-Minutes, it will alert the user BUT… it isn’t until the user clicks on the RSS feed notification will it download the content. We are testing it first with Ez-Minutes before adding the feature to other areas so we welcome any feedback and comments. Send comments directly to Janet.Dailey@va.gov with Ez-Minutes in the subject line.

 

This newsletter is in a HTML format. A printer-friendly document throughout the system is more likely to occur with a HTML format compared to a word document. Users should select print preview and review the document, then make any necessary changes to the document before printing to ensure the document will print fine for their hardware configuration. Feedback and comments are welcomed. Send comments to Janet.Dailey@va.gov with Ez-Minutes in the subject line.

This issue of the Ez-Minutes is dedicated to the VA employees, their families, and Veterans affected by Superstorm Sandy. No words can adequately express what the residents in the affected areas have experienced from the impact of this powerful storm. The PBM-MAP-VPE acknowledges the support and assistance from you in extending hope and support to our colleagues and friends in these devastated areas. Please continue! Thanks.

 

INSIDE THIS ISSUE

·       Posting of National PBM Documents Aug-Oct 2012

·       Posting of VAMedSAFE Documents Aug-Oct. 2012

·       New! Bookmark for PBM Intranet Web site

·       Combivent Respimat

·       Discontinuation of Buprenorphine/Naloxone (Suboxone) Sublingual Tablets

·         Pharmacy-Prosthetics-Logistics and Acquisitions (PPLA)* Workgroup Recommendations 

·         Educational Programs

Posting of National PBM Documents August-October 2012

Formulary Decisions

Added to the VA National Formulary (VANF)

Not added to the VA National Formulary (VANF)

Removed from the VA National Formulary (VANF)

·         Atorvastatin

·         Autoinjector devices for multiple sclerosis therapies

·         Calcium Polycarbophil (Fibercon)

·         Cefdinir

·         Hydrocortisone rectal suppository

Abbreviated Review

·         Ipratropium-albuterol (Combivent Respimat)

Criteria For Use

·         Abiraterone

·         Cabazitaxel

·         Dronedarone [Updated Oct. 2012]

·         Pegloticase

·         Statin (fluvastatin-prav-rosuva-pitava) [Updated Oct. 2012]

Drug Class Review

·         Anticholinergics for Overactive Bladder Syndrome

 

·         Brentuximab vedotin

·         Fentanyl transmucosal immediate-release products

·         Pegloticase

·         Pralatrexate

Drug Monographs

·         Brentuximab vedotin

·         Pegloticase

·         Pralatrexate

·         Ranibizumab Use in Diabetic Macular Edema and Macular Edema following Retinal Vein Occlusion [Addendum}

The following documents from the VHA Oncology Field Advisory Committee and High Cost Oncology Drug Workgroup are available:

·         Chemotherapy Review Committee Process

·         Determining Clinical Benefit of High Cost Oncology Drugs

·         Dose Rounding in Oncology

·         Oncology Drug Table-Recommended Dispensing Monitoring Sept. 2012

·         Oral Anticancer Drugs Dispensing and Monitoring

·         Benzalkonium chloride/Tyloxapol Oph Soln (no longer manufactured)

·         Hemorrhoidal Rectal ointment (no longer manufactured)

·         Hydrocortisone/pramoxine (Analpram HC)

·         Piroxicam

Therapeutic Interchange Guidance

·         Atorvastatin Conversion Guidance

Treatment Recommendations

·         Pharmacotherapy Recommendations in Parkinson's Disease

·         Recommendations for use of IV Iron Chronic Kidney Disease

VAMedSAFE Documents Posted: August 2012-October 2012

National PBM Communication

·         Compounded Epidural Steroid Injections and Meningitis Outbreak [10-5-12]

·         ADDENDUM: Fungal Meningitis Outbreak and Additional Patient Notification [10-18-12]

Bookmark the New Portal for the PBM Intranet Web site:  https://vaww.cmopnational.va.gov/cmop/PBM

Combivent Respimat

The current Combivent-CFC pressurized metered-dose inhaler (pMDI) will be replaced with a new formulation of Combivent using a novel drug delivery system known as the soft mist inhaler (SMI). The SMIs provide multi-dose medication using liquid formulations similar to that used in nebulizers and are propellant-free.  Presently, Respimat is the only SMI commercially available for clinical use. According to the manufacturer, the last shipment of Combivent-CFC pMDI will ship to wholesalers on April 30, 2013; therefore, it is anticipated that the wholesalers will be out of the MDI by June 2013. 

 

The soft mist is released at a slower velocity and has a more prolonged spray duration than the mist produced from pMDIs.  Pressurized MDIs require coordination of actuation with inhalation which may be difficult for some patients partly due to the rapid speed at which the drug is delivered and the short duration of the mist.  Because of the slower spray velocity and longer spray duration, use of Respimat is less dependent on inhalation technique.  A spacer is not needed with Respimat.  In addition, Respimat does not require generation of high inspiratory flow rates required for some dry-powder inhalers.

 

Dosing/Administration

The dose of Combivent Respimat is ONE inhalation 4 times daily not to exceed 6 inhalations in 24 hours.  The dosage for this product differs from the CFC formulation which is dosed as TWO inhalations 4 times daily not to exceed 12 inhalations in 24 hours.  Each Combivent Respimat inhaler delivers 120 metered actuations after preparation for use which provides 30 days of medication when used as once inhalation four times daily.  The discard date is 3 months from the date the cartridge is inserted into the inhaler. 

 

The device has a dose indicator that uses a color-coded scale marked in increments of 30 doses. The indicator provides an approximation of how many doses are left, but does not count individual doses. When the pointer enters the red area of the scale, there is enough medicine for 7 days. Once the dose indicator has reached the end of the scale, all 120 puffs have been used, the inhaler locks automatically. At this point, the base cannot be turned any further.

 

Assembly of the device, dosing, how one uses the inhaler, and the quality of the mist produced differ from the original Combivent.  Because of differences between the delivery devices, patients will require education on use when converting to the new product.

Submitted by  Debbie Khachikian, PharmD-VHA Pharmacy Benefits Management Services                                                                                                                                                      

Discontinuation of Buprenorphine/Naloxone (Suboxone) Sublingual Tablets

Click here to read message from Deputy Chief Consultant PBM-Formulary Management sent 10/1/2012.

Update Nov. 2012: The VISN Pharmacist Executives and Medical Advisory Panel recommend continuing “business-as-usual” until a definite date for the tablet discontinuation is announced. Clinical guidance for sublingual buprenorphine products will be forthcoming.

Pharmacy-Prosthetics-Logistics and Acquisitions (PPLA)* Workgroup Recommendations

The table below depicts the various products reviewed during August and September 2012 meetings. The X marks which service(s) is responsible for managing the respective products. Please Click HERE  for further details and decisions made from earlier meetings.

Products

Pharmacy

Prosthetics

Logistics and Acquisitions+

Cervical Caps for contraception (outpatients)

X

 

 

Endoscopic Spot Marker**

 

 

X

**INR POC testing machines and testing supplies

 

** For inpatient or in clinic use, it is recommended that Laboratory Service be responsible for purchasing the INR POC testing machines and testing supplies. However, since the PPL workgroup does not include representation from Laboratory Service, sites need to coordinate with their Laboratories locally to work out a process.

X

(test supplies for outpatients)

X

(test machines for outpatients)

 

Orthopedic fixation devices

 

 

X

Lissamine Green Ophthalmic Strips**

 

 

X

Other brands of amnio fluid products similar to AmnioSurgix, such as AmnioMatrix

 

X

 

OsteoGen and similar grafts for filling bone defects, tooth extractions and cyst defects

 

X

 

Paraffin Baths and Wax Blocks

X

(subsequent refills of the wax blocks used with paraffin baths for outpatients)

X

(Paraffin Baths and starter supply of wax refills  for outpatients)

X

(wax refills for paraffin baths for inpatients or

 for in-clinic use)

Rose Bengal Ophthalmic strips**

 

 

X

Solesta and other similar products used for bulking tissue (vocal cord, urethral, or rectal)

 

X

 

Suction machine supplies (disposable)

X (for outpatients)

 

X (for inpatients)

Surgical Mesh

 

 

X

The PPLA would like to remind the field that for compression hose, please inform your patients and providers that a prosthetics consult is required for dispensing.

 

Implementation of these recommendations should be coordinated between services at local sites to ensure a smooth transition if recommendations lead to a change in responsible service. For certain products, VISN or local Clinical Product Review Committee (CPRC) must review and approve prior to providing. If you have any questions related to this announcement, please contact the responsible local service (Pharmacy, Prosthetics, or Logistics) for more detailed information.

 

*The Pharmacy, Prosthetics, Logistics (PPL) workgroup was created to help clarify the responsibility for management (e.g. ordering, storing, purchasing, AND/OR dispensing) of those products in which it is not clear which service should provide. The workgroup is not responsible for determining formulary status, clinical merit, or appropriate use of the products reviewed.

** Logistics Service will provide stains or reagents used in the hospital or clinic.; + Contingent upon approval from VISN or local Clinical Products Review Committee (CPRC)

SAVE-The DATE PBM-MAP-VPE Webinar:

·       December 12, 2012 @ 3PM ET. Improving Veteran’s Pain Care: Opioid Trial & Exit Strategy “THE TALK”! Join the meeting 1-800-767-1750 Access Code: 49792# Accreditation. ACPE (pending)

·       January 15, 2013 @ 3 PM ET. Hepatitis C Update. Join the meeting  1-800-767-1750  Access Code: 49792#

Program Details will be posted to the National PBM Education SharePoint site. https://vaww.portal.va.gov/sites/ed/default.aspx

Other Programs of Interest via On-Demand viewing in TMS: https://www.tms.va.gov/learning/user/login.jsp)

September 2012: Antipsychotic Medication use in Residents with Dementia in Community Living Centers

September 2012: Revised VA Lipid Performance Measures (link to this taped program and previous ones are also available on PBM Education SharePoint site CLICK HERE )