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LEDERLE’s ZEBETA ADDED TO MEDI-CAL LIST OF COVERED BETA BLOCKERS FOLLOWING CATEGORY REVIEW; MERCK ANTILIPIDEMIC ZOCOR ON PRIOR APPROVAL AS OF MARCH 1

Executive Summary

Lederle's beta-blocker Zebeta (bisoprolol fumarate) will be added to the list of drugs available to Medi-Cal patients without prior authorization as of March 1, 1994, following a therapeutic category review of beta blockers by the California Medicaid agency. Zebeta, which is currently not on Medi-Cal's list of contract drugs, will join nine other beta blocker products that the agency has decided to retain on its formulary -- Wyeth-Ayerst's Sectral (acebutolol HCl), generic atenolol, Searle's Kerlone (betaxolol), Glaxo's Trandate (labetolol), Ciba-Geigy's Lopressor (metoprolol tartrate), Reed & Carnrick's Levatol (penbutolol sulfate), Sandoz' Visken (pindolol), generic propranolol and generic timolol maleate. Zebeta is the only beta blocker that is being added to the Medi-Cal formulary after the category review, while five products that are currently on formulary will be placed on prior authorization: Schering-Plough's Normodyne (labetolol), Glaxo's Trandate HCT (labetolol/hydrochlorothiazide), Ciba's Lopressor HCT (metoprolol tartrate/HCTZ), and Bristol-Myers Squibb's Corgard (nadolol) and Corzide (nadolol/bendroflumethiazide). Six other beta blockers will remain on the prior approval list. Medi-Cal expects to realize one-year savings of $1.3 mil. as the result of its review of the beta blocker category. The state agency currently spends $15.9 mil. annually on beta blockers, and receives $4.1 mil. back in rebates. Medi-Cal's review of beta blockers is one in a series of therapeutic category reviews that the agency is conducting at the behest of the state legislature in an attempt to generate at least $18 mil. in savings by limiting the number of covered single- source outpatient drugs in selected categories. The agency bases its decisions on a combination of price and therapeutic considerations, soliciting revised price offers from manufacturers of potentially delisted products. Reviews of ulcer drugs, angiotensin-converting enzyme inhibitors and nonsteroidal anti- inflammatory drugs already have been completed ("The Pink Sheet" Jan. 11, p. 3 and April 12, p. 5). Effective March 1, Medi-Cal will also implement changes to its list of covered cholesterol-lowering agents following its review of antilipidemics. As a result of the review, Merck's Zocor (simvastatin) will be removed from the Medi-Cal formulary. Antilipidemics remaining on formulary are Bristol-Myers Squibb's Questran and Questran Light (cholestyramine), Upjohn's Colestid (colestipol), Parke-Davis' Lopid (gemfibrozil), Merck's Mevacor (lovastatin), generic nicotinic acid, Bristol-Myers Squibb's Pravachol (pravastatin) and Marion Merrell Dow's Lorelco (probucol). Continuing to be available only with prior authorization are generic clofibrate and Boots' Choloxine (dextrothyroxine). The result of the antilipidemic category review -- the prior authorization of Zocor and any revised price offers Medi-Cal may have received -- is expected to generate $2.3 mil. in savings off of the $28 mil. that the agency spends on cholesterol-lowering agents annually. Medi-Cal receives $5.1 mil. in rebates on its purchase of the products.
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