What information does the CCHI Formulary provide?

CCHI Formulary provides the following information:

• Indication
• Drug Class
• ICD Code
• Drug Sub-class
• Active Ingredient
• ATC Code
• Dosage Form
• ROA (Route of Administration)
• Strength
• G or B (Available: Yes / No)
• Prescribing edits
• Quantity Limit Adults
• Quantity Limit Pediatrics
• Notes

What is an ICD code?

International Classification of Diseases (ICD) code, based on WHO definition, is “the international standard for defining and reporting diseases and health conditions. It allows the world to compare and share health information using a common language. The ICD defines the universe of diseases, disorders, injuries and other related health conditions. These entities are listed in a comprehensive way as a list of codes with their corresponding descriptions.”

Example:

What is an ATC Code?

“The Anatomical Therapeutic Chemical (ATC) Classification is an internationally accepted classification system for medicines that is maintained by the World Health Organization (WHO). The WHO assigns ATC codes to all active substances contained in medicines based on the therapeutic indication for the medicine.”

Example:

• B01AC06 acetylsalicylic acid
• B01AC07 dipyridamole
• B01AC30 combinations (e.g. acetylsalicylic acid and dipyridamole)

What are prescribing edits?

Some covered drugs may have additional requirements, rules or limits on coverage. These requirements and limits may include:

Examples:

Age edit: Desmopressin in Nocturnal Enuresis should not be prescribed for children < 5 years.

Concurrent Use Edit: Flavoxate in Nocturnal Enuresis should be used as add on to desmopressin after desmopressin failure and cannot be used alone.

Gender Edit: Exemestane in Endometriosis should be used only by Females.

Physician Specialty Edit: Fentanyl in Endometriosis should be prescribed by a gynecologist or pain management specialist.

Prior Authorization: Desmopressin in Nocturnal Enuresis: The prescriber must check the following before prescribing:

• Failure of combination of behavioral and alarm therapy.
• Serum Na at the start of therapy, every 3-7 days and if stable every month then every 3 months thereafter.

Quantity Limit: Idarubicin in Acute Leukemia: Cumulative dose should not exceed 150 mg/m2. Please note that this Quantity Limit is different than the one based on maximum daily dose as this is not necessary based on Maximum Daily Dose.

Step Therapy: Aripiprazole in Social Anxiety: should be used as third line after:

• First-line: Escitalopram, fluvoxamine, fluvoxamine CR, paroxetine, paroxetine CR, pregabalin, sertraline, venlafaxine XR
• Second-line: Alprazolam, bromazepam, citalopram, clonazepam, gabapentin

Emergency use only: Furosemide IV form in Hypertension is used only in emergency setting.

Protocol edit: Bendamustine Hydrochloride, Cyclophosphamide, Ifosfamide, Dacarbazine should be used in Lymphoma as per the following protocol

What is a Brand?

Also known as an originator drug, a brand-name is one marketed by a manufacturer under a brand name ( rather than its generic name). Brand-name drugs are often single-source drugs following their initial SFDA approval because of patent protection and SFDA-granted regulatory exclusivity. Later, generic versions of some brand-name drugs enter the market and compete with the brand-name drug on price.

What is a Generic?

This is a drug approved by the SFDA by referencing an originator brand-name drug's initial application. Generic drugs can enter the market after the reference product's regulatory exclusivity has expired and after its patents have either expired or been successfully challenged in court.

What is a Quantity Limit?

This is either the adult or pediatric maximum amount of a drug that can be administered per day based on a maximum daily dose.

What information are available in the notes?

“Notes” section provides details of the prescribing edits, extra important drug information and special warning and precautions.

How to navigate the Formulary?

The CCHI Formulary is provided on an excel sheet platform that users can filter by disease, ICD code, Drug classes, Active ingredient, ATC code, and whether the drug is a Brand or Generic.

The Formulary provides Appendices with various tables and protocols that users should refer to whenever mentioned in the notes. Hyperlinked Appendices are provided on a separate column for each disease or indication.

General Role

Medication Prescribing must

1. Medications should be covered if it is mentioned as part of the Indication "ICD-10" coverage.
2. Prescribing must be done based on the Active ingredient, and automatic substation will be done Except: generics not therapeutically equivalents as per SFDA list", Prescriber Place do not substite note "Insurance covarage deductable will be based on the EBP criteria" https://www.sfda.gov.sa/sites/default/files/2021-08/SFDADDD.pdf
3. Generic dispensing and covarage for EBP should be based on least expensive avilable generic
4. Each Insurance company must provide beneficiaries with a list of covered Generics included in their package ' based on their contractual deal with suppliers"
5. dispensing and prescribing medications must comply with the IDF list and prescribing regulations

Adult acute lymphoblastic leukemia (ALL) ADULT ACUTE MYELOID LEUKAEMIA (AML) Asthma Bacterial Meningitis Bipolar disorder Breast Cancer Early Hormonal Breast cancer HER-2 +VE Breast Cancer Early HER-2 -VE Breast Cancer Metastatic HER-2 +VE Breast Cancer Metastatic HER-2 -VE Breast Cancer Metastatic HORMONAL Burkitt's lymphoma CHRONIC LYMPHOCYTIC LEUKEMIA (CLL) COLORECTAL CANCER-ADVANCED- METASTATIC Maintenance Dosage Recommendations for Digoxin Dental abscess DIFFUSE LARGE B-CELL LYMPHOMA (DLBCL) ESOPHAGEAL CANCER Fluids and Volume Expanders abbreviations Follicular lymphoma GASTRIC CANCER HODGKIN'S LYMPHOMA Hospital and Ventilater Acquired Pneumonia H-Pylori Eradication INTRA-ABDOMINAL INFECTIONS LEIOMYOSARCOMA & LIPOSARCOMA MANTLE CELL LYMPHOMA MARGINAL ZONE LYMPHOMA MULTIPLE MYELOMA NON-SMALL-CELL LUNG CARCINOMA (NSCLC) PAIN MANAGEMENT IN CANCER PATIENTS PEDIATRIC ACUTE LYMPHOBLASTIC LEUKAEMIA (ALL) PEDIATRIC B-CELL LYMPHOMA PROSTATE CANCER RHEUMATOID ARTHRITIS SMALL CELL LUNG CANCER (SCLC) SPONTANEOUS BACTERIAL PERITONITIS IN ADULTS T-CELL LYMPHOMA TRAVELER’S DIARRHEA TRAVEL IMMUNIZATION TRAVEL RELATED INFECTIONS-INFLUENZA PROPHYLAXIS TUBERCULOSIS VITAMIN D DEFICIENCY