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Transcript
Modernized Reference Drug Program Dihydropyridine Calcium Channel Blockers (CCBs) Fully Covered (Reference Drugs) Partially Covered (Non-Reference Drugs) •• Amlodipine •• Felodipine •• Nifedipine extended release Information provided is not intended as a substitute for professional judgement. Step 1 – Does your patient need to switch medications to retain PharmaCare coverage? Is patient already taking the fully covered (reference) drug listed above? NO YES No medication change Is patient concerned about prescription costs and about getting the most PharmaCare coverage possible? YES NO No medication change Pharmacists Prescribers To confirm Special Authority coverage for the patient’s current medication, call 1-866-905-4912 To confirm Special Authority coverage for patient’s current medication, call the PharmaCare HelpDesk and select the Self-Service Option Does patient already have Special Authority coverage of their existing drug (i.e., is eligible for continued full coverage as explained in Section 4 of the Guide to the Modernized RDP)? Prescribers NO YES No medication change Does the patient meet the criteria (below) for full coverage of a drug that will be only partially covered as of December 1, 2016? Criteria for full coverage of a partially covered (non-reference) drug* Treatment failure on optimal doses or intolerance to amlodipine or Complex patient requiring medication(s) for co-existing chronic condition(s)* NO Submit a Special Authority Request Specialty Exemptions from submitting Special Authority Requests: cardiologists, cardiovascular and thoracic surgery, internists specializing in cardiology, nephrologists, paediatrics, paediatric cardiology. Pharmacists If the patient meets the criteria, refer to prescriber who can submit a Special Authority Request for coverage YES Step 2 – Making the switch Consider the following precautions: •• If nifedipine is used to treat hypertension in pregnancy, these patients should not be switched to another CCB. •• Obtain a baseline BP measurement prior to therapeutic substitution OR ensure that the patient has had a recent BP measurement. •• Patients can switch at the next fill of their prescription. Switch the patient to the fully covered CCB at a therapeutically appropriate dose as shown below. Pharmacists You may wish to contact the prescriber for complex or frail patients such as: •• pregnant, lactating or pediatric patients •• patients with an acute or unstable cardiac condition, e.g.: • hospitalization in the past 6 months for cardiac reasons • cardiac medication has changed in the past 6 months • currently being seen by a cardiac specialist Target Doses and Dose Adjustments 1-4 Hypertension •• Amlodipine •• Felodipine •• Nifedieine extended release Adjustments–Renal Adjustments–Hepatic •• Initial: 5 mg daily •• Usual: 5-10 mg daily •• Max: 10 mg daily •• None •• Initial dose: 2.5 mg daily •• Initial: 5 mg daily (2.5 mg daily for elderly) •• Usual: 2.5-10 mg daily •• Max: 10 mg daily •• Initial: 20-30 mg daily •• Usual: 30-60 mg daily •• Max: 90 mg daily •• None •• Initial dose: 2.5 mg daily •• None •• Caution: may need to reduce dose Drug Approximate Equivalent Dose 5 •• Amlodipine 2.5 mg 5 mg 10 mg •• Felodipine •• Nifedipine (extended release) 2.5 mg 20 mg 5 mg 30 mg 10 mg 60 mg-90 mg Monitor blood pressure. Inform the patient of the changes made, of any self-monitoring required, and of plans for follow-up. * If medical circumstances warrant, Special Authority may be granted for exceptional coverage on a case-by-case basis. Prescribers Pharmacists Check patient progress at next scheduled appointment. Communicate therapeutic substitution information to the appropriate prescriber according to the requirements of PPP-58. Check patient progress at next pharmacy visit. REFERENCES: 1. CPS [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2016 [updated 2011 Sep; cited 2016 Apr 25]. Calcium Channel Blockers [CPhA monograph] Available from www.e-therapeutics.ca. Also available in paper copy from the publisher. 2. CPS [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2016 [updated 2015 Jul; cited 2016 Apr 25]. Amlodipine [Sivem product monograph] Available from www.e-therapeutics.ca. Also available in paper copy from the publisher. 3. CPS [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2016 [updated 2015 Jan; cited 2016 Apr 25]. Adalat XL [product monograph] Available from www.e-therapeutics.ca. Also available in paper copy from the publisher. 4. CPS [Internet]. Ottawa (ON): Canadian Pharmacists Association; c2016 [updated 2015 Jan; cited 2016 Apr 25]. Plendil [product monograph] Available from www.e-therapeutics.ca. Also available in paper copy from the publisher. 5. Therapeutic Interchange Program and Prescription Interpretations at Vancouver Community of Care. Available at www.vhpharmsci.com/vhformulary/(2)%20VA%20Copy%20of%20BCHA%20Formulary%20THERAPEUTIC%20INTERCHANGE%20PROGRAM.pdf