Epinephrine Auto-injectors

Drugs - Auvi-Q
             epinephrine auto-injector (Authorized Generic of Adrenaclick)
             epinephrine auto-injector (Authorized Generic of Epipen and Epipen Jr.)
             Epipen, Epipen Jr.

June 2017

Therapeutic area - Anaphylaxis

• Preferred Product: epinephrine auto-injector (Authorized Generic of Epipen and Epipen Jr.)
• Nonpreferred Products: Epipen, Epipen Jr., epinephrine auto-injector (Authorized Generic of Adrenaclick)
• Noncovered Product: Auvi-Q. Auvi-Q is excluded from coverage effective 4/1/2017. Kaleo, the manufacturer of Auvi-Q, terminates its participation in Medicaid Drug Rebate Program effective 4/1/2017

Authorization will be granted for nonpreferred products if the recipient has had a documented:

• Allergic reaction to a specific inactive ingredient in the preferred product
• Adverse reaction to a specific inactive ingredient in the preferred product
• Therapeutic success while taking the non-preferred product and therapeutic failure while taking the preferred product documented by patient diary or medical chart notes

Questions?

MHCP Provider Call Center 651-431-2700 or 800-366-5411