Medicaid Common Formulary – Fluticasone propionate /Salmeterol Shortage

Key Points

  • Medicaid Common Formulary changes for Asthma/COPD management for LABA/ICS combination inhalers were scheduled to begin on October 1st, 2018. At that time, MDHHS removed Symbicort (for anyone > 12 years old) and Dulera from the formulary in favor of generic AirDuo (fluticasone propionate/salmeterol). Patients established on Symbicort of Dulera prior to this formulary change were “grandfathered” and allowed to remain on their current therapies until 1/1/19.
  • At this time, the fluticasone propionate/salmeterol product, in several strengths, appears to be backordered resulting in patients not being able to obtain their inhaler. Given the challenges experienced by patients, MDHHS has extended the “grandfathering” for patients who were established on LABA/ICS therapy prior to the Common Formulary change date of 10/1/18 to 4/30/19, but this does not apply to patients who are new to LABA/ICS therapy.
  • Consider alternative agents (i.e. anticholinergic agents such as Combivent, ICS only inhalers like QVAR, etc.) that might be clinically appropriate for the patient at the current time. Also consider reviewing the specific managed Medicaid plan formulary (i.e. Priority Health Medicaid, Molina Medicaid, etc.) as they can have more products on their formularies, just not less than the Common Formulary.

What is the Medicaid Common Formulary & Do all Medicaid Plans Use it?

In 2015, the Michigan Department of Health and Human Services (MDHHS) developed a formulary that is common to all health plans contracted with Medicaid as required by Section 1806 of Public Act 84 of 2015. The common formulary not only includes which medications are covered, but also prior authorization criteria and step therapies. This common formulary was designed with the intent to reduce interruptions in prescription drug therapy if the member was to change between Medicaid health plans.

The health plans contracted with Medicaid (i.e. Priority Health Medicaid, Molina, etc.) have the option of being less restrictive than the parameters set by the Common Formulary, allowing the health plans to optionally open their formulary to include medications that are not included in the Common Formulary in an effort to benefit the members of their health plan and tailor the formulary to fit their needs. While given the option to expand the formulary beyond the Common Formulary, health plans cannot remove any of the medications included in the Common Formulary.

Summary of Asthma/COPD Therapy LABA/ICS Medicaid Common Formulary Coverage Changes & Medication Shortage Concerns

Formulary changes for Asthma/COPD management were scheduled to begin on October 1st, 2018. At that time, MDHHS removed Symbicort (for anyone > 12 years old)and Dulera from the formulary in favor of generic AirDuo (fluticasone propionate/salmeterol).

Patients who were actively using a LABA/ICS combination prior to the 10/1/18 formulary change that was no longer covered were “grandfathered” and allowed a transition period to make necessary therapy modifications until December 31st, 2018.

Common Formulary Preferred Agents / Formulary Changes

 

At this time, some patients are experiencing challenges obtaining the fluticasone propionate/salmeterol products as the product, in several strengths, appears to be backordered. Given the challenges experienced by patients, MDHHS has extended the “grandfathering” for patients who were established on LABA/ICS therapy prior to the Common Formulary change date of 10/1/18, but this does not apply to patients who are new to LABA/ICS therapy.

Managing Patients during the Fluticasone propionate/Salmeterol Inhaler Shortage

  • The Medicaid Common Formulary is allowing the continuation of “grandfathered” coverage. When this formulary change was first announced Fall 2018, all patients who had been established on alternative products (i.e. Dulera, Symbicort) were allowed to remain on those therapies until 1/1/19. Given the fluticasone propionate/salmeterol shortage, this “grandfathering” has been extended through 4/30/19, but this only qualifies for patients who were on an alternative (i.e. Dulera or Symbicort) prior to the formulary change announced 10/1/18.
  • Patients under the age of 12 years do have the option of using Symbicort as an alternative to fluticasone propionate/salmeterol as this is a preferred agent on the Common Formulary.
  • Consider alternative agents (i.e. anticholinergic agents such as Combivent, ICS only inhalers like QVAR, etc.) that might be clinically appropriate for the patient at the current time. Also consider reviewing the specific managed Medicaid plan formularies (i.e. Priority Health Medicaid, Molina Medicaid, etc.) as they can have more products on their formularies, just not less than the Common Formulary. See the following links to common Medicaid plan formularies:

References:

  1. Michigan.gov. History of Formulary Changes.
  2. Michigan Department of Health and Human Services. Medicaid Health Plan Pharmacy Benefit. 
  3. Michigan Department of Health and Human Services. Medicaid Common Formulary.
  4. Blue Cross Complete. Medicaid Formulary.
  5. Meridian. Medicaid Formulary.
  6. Molina. Medicaid Formulary.
  7. United Health Care – Community Plan. Medicaid Formulary.
  8. Priority Health. Medicaid Formulary.
Tiffany Jenkins
About the author

PharmD

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