Edluar and Zolpimist coverage

[participant1]

How are plans covering new zolpidem products, Edluar and Zolpimist, given that a generic is available? Please comment on your formulary positioning and any prior auth or quantity limits. Thanks!

[Pantablo]

I think we will exclude these dosage forms from coverage and reimburse only if a presciber can provide compelling and justifiable doumentation why these dosage forms are needed versus the oral tablets.

[chantell.reagan]

Minimal clinical benefit has been seen with two new zolpidem formulations: Edular (sublingual tablets), just approved in 3/2009, as well as Zolpimist (oral spray), approved in 12/2008. These products appear pharmacokinetically equivalent to oral zolpidem, so no apparent advantage could be seen in terms of shorter onset of action.

Though these new products have just been launched (Edluar) or soon to be launched (Zolpimist), it is likely that plans will consider these products to be non-formulary and/or institute prior authorization or quantity limits.

In an informal analysis of 10 plans, 2 plans have already placed quantity limits on Edluar (#30/30days), 1 plan with a limit on Zolpimist (1 container/30days), while 1 plan has PA on both products with quantity limits.

Sources:

Edluar prescribing information

Zolpimist prescribing information

Wellpoint/NextRx: Edluar (non-formulary/tier 3), Zolpimist not listed

UnitedHealthcare: Edluar/Zolpimist not listed

Aetna: Edluar (#30/30days); Zolpimist not listed

Cigna: Edluar not covered; Zolpimist not listed

Humana: Edluar/Zolpimist not listed

Highmark: Edluar/Zolpimist not listed

BCBS of Michigan: Edluar/Zolpimist not listed

Regence formulary search and Regence zolpidem policy: Edluar/Zolpimist not listed

BCBS Alabama Pharmacy Guidelines: PA required: Edluar (#30/30days) and Zolpimist (1 container/30days)

Independence Blue Cross: Edluar/Zolpimist not listed

[participant1]

Is Zolpimist out on the market yet?

[chantell.reagan]

As of 12/10/09, according to the Novadel website, the manufacturer is currently looking for a marketing partner.

[rxmm]

Now that Zolpimist is available we will be excluding these dosage forms from coverage. They can request a medical exception and we will reimburse only if a presciber can provide compelling and justifiable doumentation why these dosage forms are needed versus the oral tablets.