2012 Medicaid StepTherapy Last Update: 12/12/2011
Brand Name: ACTOplus met Generic Name: Pioglitazone / Metformin ActoPlus Met (pioglitazone/metformin) Step Therapy Criteria:
Coverage is provided for a diagnosis of type 2 diabetic mellitus.
Coverage provided for the treatment if the member has tried and failed a minimum of a 4 week trial or had an intolerance to one of the following:
Brand Name: Actos Generic Name: Pioglitazone HCl Actos (pioglitazone) Step Therapy Criteria:
· Coverage is provided for a diagnosis of type 2 diabetic mellitus. · Coverage provided for the treatment if the member has tried and failed a minimum of a 4 week trial or had an intolerance to one of
o DiaBeta, Glynase, Micronase (glyburide)
Brand Name: Avandamet Generic Name: Rosiglitazone/Metformin HCl Avandamet (rosiglitazone/metformin) Step Therapy Criteria:
· Coverage is provided for a diagnosis of type 2 diabetic mellitus. · Coverage provided for the treatment if the member has tried and failed a minimum of a 4 week trial or had an intolerance to one of
o DiaBeta, Glynase, Micronase (glyburide)
2012 Medicaid StepTherapy Last Update: 12/12/2011
Brand Name: Avandaryl Generic Name: Rosiglitazone/Glimepiride Avandaryl (rosiglitazone/glimepiride) Step Therapy Criteria:
· Coverage is provided for a diagnosis of type 2 diabetic mellitus. · Coverage provided for the treatment if the member has tried and failed a minimum of a 4 week trial or had an intolerance to one of
o DiaBeta, Glynase, Micronase (glyburide)
Brand Name: Avandia Generic Name: Rosiglitazone Maleate Avandia (rosiglitazone) Step Therapy Criteria:
· Coverage is provided for a diagnosis of type 2 diabetic mellitus. · Coverage provided for the treatment if the member has tried and failed a minimum of a 4 week trial or had an intolerance to one of
o DiaBeta, Glynase, Micronase (glyburide)
Brand Name: Cymbalta Generic Name: Duloxetine HCl Cymbalta (duloxetine) Step Therapy Criteria:
· Coverage is provided for a diagnosis of diabetic peripheral neuropathy, fibromyalgia, chronic low back pain, and chronic
· Coverage provided for the treatment of major depressive disorder and generalized anxiety disorder if the member has tried and
failed a minimum of a 4 week trial or had an intolerance to one of the following generic antidepressants:
2012 Medicaid StepTherapy Last Update: 12/12/2011
Brand Name: Duetact Generic Name: Pioglitazone/Glimepiride Duetact (pioglitazone/glimepiride) Step Therapy Criteria:
· Coverage is provided for a diagnosis of type 2 diabetic mellitus. · Coverage provided for the treatment if the member has tried and failed a minimum of a 4 week trial or had an intolerance to one of
o DiaBeta, Glynase, Micronase (glyburide)
Brand Name: Janumet Generic Name: Sitagliptin phos / metformin Janumet (sitagliptin/metformin) Step Therapy Criteria
· Coverage is provided for a diagnosis of type 2 diabetes mellitus. · Coverage is provided for the treatment of type 2 diabetes mellitus if the member has tried and failed a minimum of a 4 week trial or had an intolerance to one of the
o Glucophage (Metformin)o Glucophage XR (Metformin ER)o Glucovance (metformin/glyburide)o Metaglip (metformin/glipizide)o Glumetza (metformin)o Riomet (metformin)o Fortamet (metformin)o Amaryl (glimepiride)o DiaBeta, Glynase, Micronase (glyburide)o Diabinese (chlorpropramide)o Glucotrol, Glucotrol XL (glipizide) o Orinase (tolbutamide)o Tolinase (tolazamide)
· When criteria are not met, the request will be forwarded to a Medical Director for review. The physician reviewer must override criteria when, in their professional
judgment, the requested medication is medically necessary. 2012 Medicaid StepTherapy Last Update: 12/12/2011
Brand Name: Januvia Generic Name: Sitagliptin Phosphate Januvia (sitagliptin) Step Therapy Criteria · Coverage is provided for a diagnosis of type 2 diabetes mellitus. · Coverage is provided for the treatment of type 2 diabetes mellitus if the member has tried and failed a minimum of a 4 week trial or
had an intolerance to one of the following:
o DiaBeta, Glynase, Micronase (glyburide)
· When criteria are not met, the request will be forwarded to a Medical Director for review. The physician reviewer must override
criteria when, in their professional judgment, the requested medication is medically necessary.
Brand Name: Lipitor Generic Name: Atorvastatin
· Benefit is approved in instances when the patient has tried and failed a generic formulary alternative or in instances when
the physician can provide documentation of an intolerance or adverse event to one of the alternatives and an explanation as to why they are trying another medication in the same class.
· Benefit is approved for 12 months. · When criteria are not met, the request will be forwarded to a Medical Director for review. The physician reviewer must
override criteria when, in their professional judgment, the requested medication is medically necessary.
Brand Name: Restasis Generic Name: Cyclosporine Restasis (cyclosporine ophthalmic emulsion) Step Therapy Criteria:
· Benefit is approved to increase tear production, when tear production is presumed to be suppressed due to ocular inflammation
associated with keratoconjunctivitis sicca.
· Benefit is approved after patient has tried and failed treatment with Tears Naturale, Artificial Tears, Refresh, Genteal, Lacrilube,
Celluvisc, or Bion Tears, or has required other treatments such as punctual plugs or goggles.
· Member must be 16 years of age or older · Benefit is approved for 12 months. · When criteria are not met, the request will be forwarded to a Medical Director for review. The physician reviewer must override
criteria when, in their professional judgment, the requested medication is medically necessary.
Deutsches Ärzteblatt: Diabetes-Therapie: Mit Kombinat. http://www.aerzteblatt.de/archiv/45974/Diabetes-Ther. VARIA: WIRTSCHAFT - AUS UNTERNEHMEN Diabetes-Therapie: Mit Kombinationen die Zielwerte erreichen Dtsch Arztebl 2005; 102(11): A-771 Unter einer Monotherapie mit oralen Antidiabetika erreicht nur ein Teil derPatienten die angestrebte Stoffwechseloptimierung mit HbA1c-Werten umsiebe
USING NIACIN AND AVOIDING SIDE EFFECTS The vitamin Niacin (B-3) given in pharmacologic amounts is a very effective medication to combat atherosclerosis and reduce the risk of heart attack and stroke. It has been used for decades but eclipsed in recent years by statin drugs (Lipitor, Zocor, etc.) which are more potent in lowering the LDL so called "bad" cholesterol. However, it i